Rosewood Clinic

We carried out an announced comprehensive inspection at Rosewood Clinic on 5 December 2019 as part of our inspection programme, under Section 60 of the Health and Social Care Act 2008. 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. This was the provider’s first rated inspection. The practice was previously inspected in July 2018 when the practice was not rated but was found to be meeting all regulations.

Rosewood Clinic is an independent provider of a range of GP services, including consultations, child and adult immunisations, travel health advice and vaccinations, well man and woman health checks and advice, cervical screening and Botox injections for the treatment of excessive sweating.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Rosewood Clinic provides a range of non-surgical cosmetic interventions, for example, Botox injections and facial fillers, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services. Services are also provided to patients under arrangements made by their employer or insurance provider with whom the servicer user holds an insurance policy (other than a standard health insurance policy). These types of arrangements are exempt by law from CQC regulation. Therefore, we were only able to inspect the services which are not arranged for patients by their employer or insurance provider.

The practice is registered with the Care Quality Commission to provide the following regulated activities: Diagnostic and screening procedures; Treatment of disease, disorder or injury. At the time of our inspection we identified that the provider had been providing services which included the insertion and removal of intrauterine contraceptive devices. This activity requires the provider to be registered for the regulated activity Family planning services, which the provider was not registered to provide. We asked the provider to submit an urgent application to register to provide the regulated activity or to discontinue carrying out that activity.

Services are provided by the medical director who is the founder of the service and one part-time GP. The medical director is male and the part-time GP is female. The medical director provides all travel advice and vaccination services.

The medical director is 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 received written feedback about the practice from 18 patients prior to and on the day of inspection. Feedback from patients was positive about the service and care provided. Patients described the service as being caring, respectful, reassuring and efficient. Several patients commented upon the high standards of clinical care afforded to them.

Our key findings were:

• The practice had good facilities and was equipped to treat patients and meet their needs.
• Services were offered on a private, fee paying basis only.
• Patients received care and treatment which met their needs and followed national guidance.
• Medical staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The service had systems in place to promote the reporting of incidents.
• The practice had some effective systems to manage safety risks within the premises. However, staff had not recently participated in a fire drill and there were no fire extinguishers or other fire-fighting equipment located within the premises.
• There were infection prevention and control policies and procedures in place to reduce the risk and spread of infection. However, the provider was unable to demonstrate that they held appropriate records relating to staff immunisations.
• Medicines were stored securely, however fridge temperature monitoring processes did not ensure the correct temperature range for their safe storage.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together.
• The service encouraged and valued feedback from patients and staff. Feedback from patients was positive.
• The culture of the service encouraged candour, openness and honesty.

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:

• Ensure written guidance for staff regarding red flag symptoms of sepsis is embedded within the practice.
• Ensure staff have access to safety information to support the control of substances hazardous to health (COSHH).
• Review processes and training to deal with medical emergencies following installation of an automatic external defibrillator within the practice.
• Ensure patients are made aware of the practice’s updated complaints policy and information to support them should their complaint remain unresolved.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care