1 Kingdom Street

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular support to maintain high-quality care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated these events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them. Staff reported incidents to the operational manager and the registered manager. These would then be logged onto the service’s events log.

Managers reviewed and investigated all reported incidents. Incidents were discussed in monthly governance meetings, weekly business team meetings and clinical staff meetings every 2 months.

There had been no serious incidents in the past 12 months. The service’s event log had incidents such as, an email from a carer being missed, a referral was sent without a patient’s name and they logged when a safeguarding concern was raised with the local authority.

Learning had been identified following incidents, for example, creating a duty rota for their generic email inbox, to ensure one person had oversight for receiving and responding to all emails received on that day.

Lessons learnt were shared with the wider staff team in their team meetings. For example, we saw discussions around a recent safeguarding incident, reminding staff of the escalation protocols.

Duty of candour is a legal requirement, which means providers must be open and transparent with patients about their care and treatment. This includes a duty to be honest with patients if something goes wrong. Staff and managers were aware of the need to be open and transparent, including after an incident.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

There were systems in place for processing information relating to new patients.

Self-funding patients were able to self-refer themselves to the service. For patients who were referred by their NHS trusts, the NHS trust directly uploaded their referral documents to the clinic’s secure records site. The service had agreements in place with each trust regarding how many assessments they would carry out on their behalf.

The referral process ensured that enough information was received to determine if the patient was appropriate for an assessment. For self-funding patients, there was an initial video call with a doctor, the patient and the carer to determine if a full assessment was appropriate. For NHS trust patients, the NHS ensured the service had all of the necessary documentation to proceed with the assessment. The service requested additional documents from the NHS where needed prior to accepting the patient referral.

The administrative team screened the original referral to ensure all parts of the referral had been completed. The registered manager would then clinically review all new referrals to the service within 5 days.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately. All staff had completed the required level of safeguarding training.

In the past 12 months, there had been 1 referral made to the local authority. The local authority safeguarding team found this case did not meet the threshold for their external investigation.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. They understood the procedures to raise a safeguarding concern. The clinical director was the safeguarding lead for the service. The staff we spoke with were aware of this and would raise any concerns with them as needed.

The service had links with external safeguarding professionals. The service’s safeguarding lead discussed any concerns they had with local authorities, for their support and guidance.

Clinical staff received their safeguarding training externally. The service requested the training certificates from all clinical staff. At the time of inspection 100% of clinical staff had completed their level 3 safeguarding children and adults training.

The administrative staff had all completed level 2 safeguarding training.

The service had not notified CQC when their patient was referred to the local authority safeguarding team. However, the service ensured this was completed retrospectively whilst we were in the process of inspecting the locations.

The service worked with people to understand and manage risks by thinking holistically.

We reviewed the care and treatment records of 10 patients. Where patients were self-funding, the service completed a full risk assessment. Where patients were referred from the NHS, the NHS provided an up to date risk assessment. Risk assessments for NHS patients were updated by the service if they found areas of concern that had not been recorded by the NHS.

Prior to accepting a patient, the registered manager ensured the patient was clinically stable and suitable to receive a community assessment. All of the patients we reviewed were deemed low risk. Therefore, none of these patients required risk management plans.

Medical emergency equipment was available and maintained by the building management team. Staff told us they could recognise a deteriorating patient and knew what action to take.

There were appropriate indemnity arrangements in place to cover potential liabilities.

For online appointments, staff requested to view the patient or carers photo identity documents. For in person appointments, identity documents were checked by reception staff before allowing patients into the building.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service rented clinic rooms within shared, managed buildings. The service had access to one room for their London Autism Clinic location, and 3 rooms for their 1 Kingdom Street location. Both locations had shared waiting areas and toilets available for the patients. All rooms were large accessible rooms, with lift access.

All rooms had physical examination beds and sinks available. The rooms at 1 Kingdom Street were only used by this clinic. They were able to display their own branding and had designed these rooms to be child friendly. They had child sized tables and chairs in these rooms.

The service ensured the rooms were clean and well maintained. The service completed their own environmental risk audits, as well as daily room checks.

Patients told us they felt the rooms were comfortable and appropriate.

There was a business continuity plan in place which was monitored and reviewed. This included incidents such as cyber-attacks, loss of staff and travel disruptions.

Fire safety of the locations was managed by the building managers. The service was able to provide and review fire risk assessments and documentation as needed.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service directly employed administrative staff, an operational manager and service directors. Clinical staff were associate team members and not directly employed by the service.

The service worked with a range of clinicians, such as paediatricians, speech and language therapists, psychologists and occupational therapists.

Staff received an induction pack when they started working at the service. This included Information on the service, including their policies and mandatory training. They also included step by step guides for using their electronic systems.

Administrative staff received formal supervision every three months, as well as ad-hoc sessions as needed. The formal meetings had an agenda to ensure key areas such as performance, wellbeing and actions were discussed at each session. Administrative staff also attended the weekly business meetings which discussed areas such as incidents, complaints, wait times and service risks. Appraisals were held yearly for administrative staff.

Clinical staff received their appraisals and most of their supervision external to the service. This service did have a weekly case discussion meeting, where clinicians brought an assessment to discuss with the wider team to receive guidance and support. The service requested and recorded the date of their clinicians most recent appraisal.

The service ensures staff were up to date with mandatory training. Administrative staff received training from the service. Clinical staff completed their training externally, and provided the certificates to this clinic. At the time of inspection, mandatory training such as safeguarding, equality and diversity and data protection had been completed by all staff. All clinical staff had completed basic life support training. Mandatory training compliance was reviewed regularly by the administrative team and operations manager. Reminders were sent to staff when their training was due to expire.

Safe recruitment practices were followed. When staff were onboarded they uploaded information, such as, professional certificates, their DBS, and professional registrations. These documents were stored and audited by the administrative team and operations manager.

The service assessed and managed the risk of infection.

The building managers were responsible for ensuring the clinics were clean. If this service had any concerns about the cleanliness of the room, staff were able to contact the building managers to report their concerns.

The service completed an audit on infection prevention and control every 6 months. The audit looked at the cleanliness of the rooms, hand hygiene, and the availability of personal protective equipment. The most recent audit showed no concerns.

The service also carried out a cleaning checklist each day there was a clinic on. This checklist included ensuring the toys used during assessment were clean, the examination bed was cleaned between patients, and the room was visibly tidy.

Clinical staff completed infection, prevention and control training. At the time of inspection, 93% of clinicians had completed this training.

The service had their own spillage kits available at each site.

This service did not prescribe medicines.

The service did not prescribe medicines to patients or store any medicines on site.

The service had a policy in place around the prescribing of medicines to support a child’s sleep, following a full assessment. However, at the time of inspection, they had not yet prescribed this medicine.