Parkway

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.

At our last inspection we rated this key question as good. At this inspection the rating has changed to requires improvement.

We found a breach of regulations in relation to safe care and treatment. Staff had not completed training in medicines management and oxygen cylinders were not stored correctly. Records and observations were not always completed in accordance with service policy.

This service scored 63 (out of 100) for this area.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

This section was assessed using findings that are applicable to the whole Parkway site, which are included in the appropriate section of the surgery report.

This section was partly assessed using findings that apply to the whole Parkway site, which are included in the appropriate section of the surgery report.

The service’s referral and admission processes ensured that all essential information about the service user was received in advance to determine if their needs could safely be met. Consultants carried out an initial triage of referrals before prioritising them accordingly for appointments.

This section was assessed using findings that apply to the whole Parkway site, which are included in the appropriate section of the surgery report.

Staff in the service were assigned training in safeguarding to an appropriate level and when asked, they could identify their own responsibilities relating to this, as well as name the safeguarding lead.

This section was partly assessed using findings that apply to the whole Parkway site, which are included in the appropriate section of the surgery report.

Staff completed care plans and recorded details of any risks, where these were known. Pre-assessment risk assessments included questions about whether service users had any medical history of diabetes, hypertension, epilepsy, breathing difficulties, or bleeding abnormalities. The provider was not contracted to accept people with insulin-dependent diabetes, but did accept people with other types of diabetes, and provided information leaflets for endoscopy procedures that included information for these service users.

The service had a specific inclusion criteria and this was additionally detailed in the service specification document for community gastroenterology services. Any referrals for the diagnostic endoscopy service were for people over 18 years old and did not include any people with suspected cancer.

The service had a safe sedation for endoscopy policy. However, we saw in four records that service users had not received oxygen for the duration of their procedure, in accordance with this policy. Records we reviewed showed some inaccurate documentation and that some entries were not written contemporaneously.

The service had a decontamination policy for endoscopy scopes, which contained consideration of the risks of Creutzfeldt-Jakob Disease (CJD). Risk assessments for single room decontamination had also been completed in line with the Institute of Healthcare Engineering and Estate Management (IHEEM) requirements.

Staff followed a modified World Health Organisation (WHO) surgical safety checklist when carrying out endoscopy procedures. Latest audit results of the WHO Safety Checklist for Endoscopy in January 2025 showed 100% compliance for completion. The service followed established referral pathways for any service users where histology results following their procedure indicated a potential cancer diagnosis.

Service users were appropriately informed of precautions to take up to 48 hours after their procedure, including those such as driving or operating machinery.

This section was partly assessed using findings that apply to the whole Parkway site, which are included in the appropriate section of the surgery report.

The endoscopy suite was located on the first floor of the service premises, with a separate entrance. This area was bright, orderly and appeared visibly clean. The service had achieved Joint Advisory Committee for Gastroenterology (JAG) accreditation and at the time of inspection was preparing their submission for annual review. Following the inspection, the service sent a copy of the renewal approval letter to confirm the ongoing accreditation for meeting JAG standards.

In the procedure room we observed that there was a metal controlled drugs (CD) cabinet inside a large wooden storage cupboard. However, the CD cabinet was not secured to the wall. We raised this to the provider at the time who took follow-up action to resolve the issue.

There was no oxygen signage in areas where oxygen cylinders were stored. When we raised this during the inspection, the provider took steps to resolve this. Also, oxygen cylinders were not always safely stored in a cage or chained to the wall. We saw that there were portable oxygen cylinders stored in a cupboard in the recovery area.

There was one emergency trolley in the recovery area on the first floor and a second trolley on the corridor of the ground floor intended for anaphylaxis emergencies only. There was a stocklist of what should be contained in the trolley and staff undertook checks of the trolleys every day and signed to confirm it was complete and correct.

There were 6 consultant gastroenterologists in total working in the service, with 1 being substantively employed at Parkway for the endoscopy service. The other consultant staff worked under practicing privileges in the service, having their main employment in this specialty in other NHS organisations.

At the time of inspection, medicine management training was not included in the provider’s mandatory training matrix and none of the required nursing staff had completed this.

Mandatory training had been completed by 86% of nursing staff in the service. The JAG Training programme was in place for qualified nursing staff, which included Direct Observation in Practice assessments, competency assessments and endoscopy ‘Endo 1 and 2’ assessments. This ensured that all staff had the appropriate qualifications, experience, skills and competencies to perform their duties and were appropriately supervised.

Nurse staffing included the flexible use of regular bank nurses, according to the needs of the service. The bank nurses also currently worked in NHS organisations in the relevant speciality.

The Director of Quality and Performance also had previous experience of managing endoscopy services in NHS organisations.

The service had an infection prevention and control policy which staff adhered to. Records confirmed that regular cleaning procedures were followed and checklists were accurately completed. Personal Protective Equipment (PPE) was available in all areas in the endoscopy suite and we observed that staff were bare below the elbows in the clinical environment. The service completed regular infection control audits, which demonstrated a high level of compliance. Results from the most recent infection control audit for January 2025 showed the overall compliance with infection control standards was 99.1%.

The endoscopy suite had a decontamination room where used scopes were processed in a decontamination unit and placed in a drying cabinet following each endoscopy procedure. Scopes were tagged with barcodes throughout this procedure to ensure traceability and ensure there was maintenance of strict infection prevention and control measures.

Medicines were not stored safely.

The service did not adhere to The Misuse of Drugs (Safe Custody) Regulations 1973, posing risks to service users and the public. The service also failed to adhere to The Controlled Drugs (Supervisions of Management and Use) Regulations 2013 by not notifying CQC of their Controlled Drugs Accountable Officer (CDAO), who did not fulfil their regulatory duties or follow the service's policy. We found the service did not have the required exemption certificate in place to safely and appropriately dispose of unused medicines. When we raised this, the provider responded by applying for the certificate on the day of the inspection.

When people were having sedation for an endoscopy procedure, staff were not always administering oxygen to people throughout the procedure, as stipulated in the service’s policy. Whilst we saw no evidence people had been harmed during their procedures, people were being placed at risk of harm. We found the information provided prior to people having an endoscopic procedure lacked sufficient advice for people with certain health conditions or people taking certain medicines. Whilst we saw no evidence people had been harmed during their procedures, people were being placed at risk of harm.

The service was not following best practice when prescribing medicines for people to take prior to attending for an endoscopy procedure. Whilst we saw no evidence people had been harmed during their procedures, people were being placed at risk of harm.