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Inspection carried out on 6 June 2019

During a routine inspection

We carried out an announced comprehensive inspection at Luxmedica Ealing as part of our inspection programme, to follow up on breaches of regulations.

Our previous inspection in June 2018 found breaches of regulations relating to the safe, effective and well-led services. We found:

  • There was a lack of good governance and limited evidence of quality improvement activity.
  • Prescribing was not audited or reviewed to identify areas for quality improvement.
  • There was insufficient quality monitoring of clinicians’ performance.
  • Risks to patients were assessed and well managed in some areas, with the exception of those relating to gaps in recruitment checks, no electronic system to flag safeguarding concerns on vulnerable patients and the management of legionella risk were not always managed appropriately.

Previous reports on this service can be found on our website at: https://www.cqc.org.uk/location/1-2220453542

At this inspection, we found that the service had demonstrated improvements in most areas, however, they were required to make further improvements in some areas and are rated as requires improvement for providing safe services.

Luxmedica Ealing is an independent clinic in the London Borough of Ealing and provides private primary medical and dental healthcare services. The service offers services for adults and children. Most of the patients seen at the service are Polish patients. Medical consultations and diagnostic tests are provided by the clinic however no surgical procedures are carried out.

The clinic also provides dental services which were not included inspection.

The practice manager is going to be the new registered manager. They have submitted an application in May 2019 which is going through the registration process. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received 23 patient Care Quality Commission comment cards. All of the comment cards we received were positive about the service. Patients said they were satisfied with the standard of care received and said the staff was approachable, committed and caring.

Our key findings were:

  • The service had reviewed and improved their clinical governance systems.
  • The service was involved in quality improvement activity.
  • The service had implemented systems to undertake quality monitoring of clinicians’ performance.
  • Risks to patients were assessed and well managed in most areas, with the exception of those relating to appropriate recruitment checks, child safeguarding training and fire evacuation plan.
  • Care and treatment records were complete, legible and accurate, and securely kept.
  • Consent procedures were in place and these were in line with legal requirements.
  • Systems were in place to protect personal information about patients.
  • Appointments were available seven days a week on a pre-bookable basis. The service provided only face to face consultations.
  • The premises was not accessible for patients with mobility issues.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The service had gathered feedback from the patients.
  • Information about services and how to complain was available.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • There was a clear leadership structure and staff felt supported by management.
  • We noted that the previous Care Quality Commission inspection report had not been shared on the service’s website. However, the service informed us that it was shared on the service’s website two weeks after the inspection and we noted it was shared on the website.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Consider arranging a translation service and displaying information in the reception area informing patients this service is available.
  • Consider a response to complaints includes information of the complainant’s right to escalate the complaint if dissatisfied with the response.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 28 June 2018

During a routine inspection

We carried out this announced inspection on 28 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Luxmedica Ealing is an independent clinic in the London Borough of Ealing and provides private primary medical and dental healthcare services. Services are available to any feepaying patient. The dental care services are provided only to adult patients. The service-users at Luxmedica Ealing are predominantly Polish patients.

The dental team includes four dentists, two dental nurses and four receptionists. There were also two owners, a registered manager and an operation manager that oversee the running of the medical and dental services.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Luxmedica Ealing is the practice manager.

On the day of inspection, we collected 13 CQC comment cards filled in by patients. All of the comment cards we received were positive about the service. Patients said they were satisfied with the standard of care received and said the staff was approachable, committed and caring.

During the inspection we spoke with the two owners, the registered manager, one dentist, one dental nurse and one of the receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

  • Monday to Saturday 9am to 9pm

  • Sundays 10am to 5pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The practice staff were aware of infection control procedures which reflected published guidance.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • The appointment system generally met patients’ needs.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The practice asked patients for feedback about the services they provided.
  • The practice’s systems to help them manage risk required improvements.
  • The practice was providing preventive care and supporting patients to ensure better oral health.
  • Staff felt involved and supported and worked well as a team.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. All staff except one of the dentists had completed medical emergencies training.
  • The practice had a suitable safeguarding policy. All staff except one of the dentists had received up to date safeguarding training.
  • The practice had staff recruitment procedures in place, though improvements were required to ensure recruitment records were maintained suitably.
  • Risks associated with recruitment of staff, Legionella infection, and medical emergencies and safeguarding training had not been suitably identified and mitigated.

We identified regulations the provider was not meeting. They must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

  • Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
  • Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

Inspection carried out on 28 June 2018

During a routine inspection

We carried out an announced comprehensive inspection on 28 June 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Luxmedica Ealing is an independent clinic in the London Borough of Ealing and provides private primary medical and dental healthcare services. The service offers services for adults and children. Most of the patients seen at the service are predominantly Polish patients. Medical consultations and diagnostic tests are provided by the clinic however no surgical procedures are carried out.

The clinic also provides dental services. A copy of the full report of the dental service is available on our website: www.cqc.org.uk.

The premises is not accessible for patients with mobility issues.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the services it provides. They provider employs the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We spoke with three patients and received 13 patient Care Quality Commission comment cards. All of the comment cards we received were positive about the service. Patients said they were satisfied with the standard of care received and said the staff was approachable, committed and caring.

Our key findings were:

  • Some systems and processes were in place to keep patients safe. However, we identified some shortfalls in relation to safeguarding children and adults training, staff recruitment checks and the management of legionella.
  • The system for the reporting of significant events was not fully implemented in the service and staff we spoke with were not sure which template or form to use.
  • Staff we spoke with informed us the patient record system did not electronically alert clinical and reception staff to vulnerable patients.

  • There was a lack of clinical governance and limited evidence of quality improvement activity to review the effectiveness and appropriateness of the care provided.
  • There was no evidence of formal clinical supervision, mentorship or support. Individual prescribing decisions were not monitored or reviewed by the medical advisor.
  • Consent procedures were in place and these were in line with legal requirements. However, there was inconsistency in communication with NHS GPs.
  • The service was unable to provide documentary evidence to demonstrate that all staff had completed training relevant to their role and received a formal internal appraisal within the last 12 months.
  • Appointments were available seven days a week on a pre-bookable basis. The service provided only face to face consultations.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Information about services and how to complain was available.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.

We identified regulations that were not being met and the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider should make improvements:

  • Review the provider's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
  • Review systems to verify a patient’s identity on registering with the service.
  • Ensure consistency in communication with NHS GPs and assure all the doctors are sharing consultation notes if the appropriate patient consent is given.
  • Review the policy for offering the baby scans when consent to share information with the woman’s NHS GP is not given.
  • Develop a system to flag safeguarding concerns on patient record to alert clinical and reception staff to vulnerable patients.
  • Ensure information about a translation service is available and displayed in the waiting area.
  • Improve access to patients with hearing difficulties.
  • Ensure a response to complaints includes information of the complainant’s right to escalate the complaint if dissatisfied with the response.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice