The London Centre for Eating Disorders and Body Image Ltd

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

Clinic areas were clean, well furnished, and fit for purpose. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe and record medicines. The service managed patient safety incidents well. However, whilst patients and carers told us they were aware of their specific plans to manage their risks and condition, not all patients had documented risk management plans. The service’s clinic lead had not completed their yearly appraisal or safeguarding training. Following the inspection, the clinic lead had completed their appraisal and had completed their safeguarding training.

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.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety 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 clinical director and clinic lead. These were then documented in their service’s incident log.

There had been no serious incidents in the last 12 months. There had been 9 lower-level incidents reported, such as technical issues with their online platform, a GP refused to carry out routine physical health checks and a confidential email was sent to the incorrect clinician.

Managers reviewed and investigated all reported incidents. Incidents were discussed by the management team in their weekly meetings. Learning had been identified following incident investigations, for example, the service had found private physical health monitoring services to refer patients to when needed. They also created an escalation protocol, in line with Medical Emergencies in Eating disorder (MEED) guidance. This was following an incident where a higher risk patient was not escalated by a therapist for clinical director and psychiatric review. Lessons learnt were shared with the wider clinical team in all-staff emails and individual supervision sessions. We saw evidence that an email was sent to all staff explaining the high-risk patient escalation protocol.

Staff told us managers were responsive to any issues they raised. They said managers were quick to investigate concerns and make improvements where possible.

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 were aware of the need to be open and transparent, including after an incident. We saw examples of this in managers response to patient’s informal complaints.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems in place for processing information relating to new patients. Patients were able to be referred through a professional, such as a GP, or a self-referral. Patients were required to fill out a questionnaire as part of their referral. In consultation with clinicians, the service had recently begun a trial to accept new referrals without the need for pre-assessment questionnaires. This was following feedback from patients that there were too many questions to answer before meeting a clinician. Some clinicians had agreed to trial this new assessment process, however, at the time of inspection, patients had not yet used this pathway. Managers stated this pathway was only for patients requiring specific interventions and was not suitable for higher risk patients.

The referral process ensured that enough information was received to determine if the patient’s needs could safely be met by the service. The administration team initially reviewed and signposted new referrals to clinicians based on their initial requests. The clinical director, who was a clinical director, also reviewed all new referrals in a weekly team meeting. The clinical director provided training on the escalation protocol to administration staff, which was developed in line with MEED guidance. This included looking out for key indicators such as rapid weight loss, suicidal thoughts and chest pain. Where high risk indicators were identified, referrals were immediately escalated to the clinical director and psychiatrist for urgent review.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. For example, involving local NHS specialist services when needed.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately. The service made referrals to local authority safeguarding services where needed. The majority of staff had completed their safeguarding training. Following the inspection, the clinic lead had completed the necessary 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 they would follow 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. Staff told us they had discussed safeguarding concerns with the external professionals when they needed further advice.

Clinical staff received their safeguarding training externally. The service requested the training certificates from all clinical staff. At the time of inspection 94% of clinical staff had completed their safeguarding children and adults training.

The administrative staff had not completed safeguarding training. This included the clinic lead and a non-employed contracted personal assistant. Following the inspection, the clinic lead, who had no face to face clinical contact with patients, had completed the appropriate safeguarding training. The personal assistant was leaving the service and managers had a plan in place to recruit a permanent employed member of staff for this role. They had a plan to ensure future administrative staff complete safeguarding training on induction. The service had an internal escalation process in place for any concerns which came from administrative communication with patients.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed the care and treatment records of 5 patients. All records contained risk assessments, which included specific risks related to eating disorders.

Three records did not have recorded risk management plans. Two of those patients were deemed low risk from their risk assessment. Managers told us patients who were low risk did not need risk management plans. The service has since introduced a universal risk plan to be used for all patients, regardless of their level of risk.

Following the inspection, the service had carried out their own clinical record audit. They reviewed 20 records and found 95% had a risk plan documented. The service did however note information was not always easy to find in their record system. They noted improvements were needed on the clarity, consistency, and ease of navigation within the patient record.

Patients told us they felt involved in their care and treatment plans. Patients were aware of how to get additional support should their condition worsen. Clinic letters contained information and contact numbers for out of hours crisis support and charities. Should a patient email the service out of hours, an automatic out of office was sent with the contact details for crisis support.

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

For online appointments, staff verified patients’ identity by asking questions related to their care and treatment. They did not request or check photo identity documents before consultations, in line with NHS digital guidance for all online health services.

We scored the service as 3. The evidence showed a good standard. 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 ensured their clinic was clean and well maintained. The clinic was within a larger shared building. They had 3 meeting rooms, a shared waiting area and a toilet available to their patients. The meeting rooms for patients were on the third floor. Staff told us they were able to reserve a room on the ground floor, or have remote appointments, if there were any accessibility concerns.

Patients told us they felt the rooms were comfortable and appropriate. The service had received 1 informal complaint from a patient who had difficulty accessing the building outside of the building’s working hours. After hours, the reception area was unmanned. The service reported they have information on how to access appointments outside of regular working hours in their appointment reminder emails.

There was a business continuity plan in place which was monitored and reviewed. This included incidents such as power failures, loss of staff and criminal activity.

The service had completed a fire risk assessment, and there were fire evacuation plans for each floor of the building. There were fire extinguishers and a fire blanket in place. Fire alarm points were checked each week. The building had an external fire safety inspection every 6 months.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support and supervision. They worked together well to provide safe care that met people’s individual needs. At the time of the inspection, the clinic lead had not completed their appraisal. This has since been completed.

The service had 1 employed operational staff member, who worked as the clinic lead. They were also a co-director of the service. They were responsible for areas such as service development, recruitment, and managing complaints. The service also employed the service’s clinical director, who was responsible for all clinical areas of care, including providing support and supervision to clinicians. A personal assistant worked for the clinic, however they were not directly employed by the service. Clinical staff were associate team members and not directly employed by the service.

Most staff had completed an induction when they began working for the service. Two staff out of 35 had not completed an induction. These two staff members were long standing clinicians who had joined the service prior to the service’s CQC registration. An induction process was in place, and all new staff have completed this. Inductions were made up of an operational induction provided by the clinic lead, followed by a clinical induction provided by the clinical director.

The clinic lead received weekly check in meetings, although these meetings were not documented. They had not received a formal documented appraisal. The clinic lead told us they felt well supported in their role and had regular discussions about their role and objectives. Following the inspection, a formal documented appraisal had been carried out.

Clinical staff received regular supervision within the service. The timescale for supervision varied depending on a number of factors, such as, if a clinician was new, if they were a junior staff member, and how many patients they were seeing at the service. The consultant psychiatrist received external supervision, which included discussions on their work at this service. Clinicians received external appraisals with their primary employer or their professional bodies.

Staff had access to peer supervision within the service every 2 to 3 months, depending on demand. They also attended complex case discussions every 4 to 6 weeks.

At the time of inspection, the induction and safeguarding training was the service’s mandatory training. Training in other subjects was completed externally to the service. Staff were asked to provide their training certificates in a range of areas, however not all staff had sent these. The service did keep a record of which staff sent in their certificates and when these training courses expired. Following the inspection the service was reviewing what should be deemed as mandatory. They had also booked the clinic lead onto a number of training courses, such as autism awareness training and safeguarding training.

Safe recruitment practices were followed. When associate clinicians were onboarded they uploaded information, such as, professional certificates, DBS, and professional registrations. These documents were stored and reviewed by the clinic lead.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. Infection prevention and control training was not mandatory at the time of inspection.

The meeting rooms were clean, with well-maintained furnishings. There were cleaning schedules and cleaning logs in place. Around 50% of patients were seen remotely for their appointments. We observed appropriate infection prevention and control practice whilst on site.

The service completed an annual audit on infection prevention and control. The audit looked at how tidy the rooms were, if hand sanitiser was available, waste disposal and any infection related incidents. The most recent audit showed no concerns.

Infection prevention and control training was not deemed mandatory for this service. Thirteen out of 35 staff had provided certificates showing that they had completed this training.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs and preferences. They involved people in planning, including when changes happened.

Staff involved patients in the prescribing and reviewing of their medicines. They helped them understand how to manage their medicines safely. Patients told us the doctor explained their medicines to them before treatment started, including any side effects. We saw examples of this in patient’s records.

The service had policies related to medicines in place. For example, medicines management and prescribing.

The doctor only saw patients who had consented for their GP to be contacted and updated with the prescribing plans. The service often requested for the patient’s GP to carry out baseline health checks, such as blood tests and electrocardiograms (ECGs). The service had also recently created links with a private provider to assist with physical health checks when needed.

All medicines were prescribed electronically. The service did not have prescription stationary. The service used an external pharmaceutical company to dispense and deliver patient medicines. Most patients received their repeat prescriptions from their GP.

The service carried out an annual audit related to medicines. The audit showed medicines were prescribed within British National Formulary (BNF) guidance. It also showed that all medicine records had a reason for prescribing and consent to treatment documented and where medicines were prescribed off-licence the reason was documented. The audit also looked at whether a medicines review appointment had taken place.

The service did not prescribe controlled drugs.