Archived: Park View Medical Centre

Updated 17 May 2019

Park View Medical Centre is operated by Mrs Susan Elizabeth Appleton. The service opened in the 1990s and was registered with CQC in May 2011. It is a private facility in Middlesbrough, Cleveland, and primarily serves the communities of the North East of England. The service offers private rooms for hire for consultations, counselling sessions, and complementary therapies, along with support services to the doctors and other healthcare professionals who use those rooms. Amongst the support services offered is the provision of plain film X-rays on request; the service is therefore registered with CQC to provide diagnostic and screening procedures.

The service has had a registered manager in post since May 2011.

We have inspected this service once previously, in 2013, when it was found to be meeting each of the criteria then assessed.

Updated 17 May 2019

Park View Medical Centre is operated by Mrs Susan Elizabeth Appleton. The service has one standalone X-ray facility providing diagnostic imaging service for adult patients. The provider is also the registered manager for the service and the single radiographer operating the service.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 20 February 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Our rating of this service was Inadequate overall.

We found areas of practice that were inadequate:

• The service did not have agreed protocols of imaging for each anatomical area with the referring consultant, and the radiographer was not aware that she was responsible for justification of every incidence of patient exposure to radiation and for each decision whether, and how, to X-ray.
• There was no record of any provision by the referrer of relevant patient histories or clinical information on which to base a decision, and there was no record of any clinical question to be answered by the X-ray image.
• The radiographer did not carry out a ‘Three Points of ID’ check or use the Society of Radiographers (SoR) ‘Pause and Check’ protocol before the X-ray procedure.
• The radiographer did not record the Dose Area Product (DAP) following the X-ray procedure.
• The service did not provide mandatory training in key skills to staff.
• The service did not carry out any hand-hygiene or other infection prevention and control audits, and we observed poor practice in hand hygiene during the inspection.
• The provider did not understand what might constitute a serious or clinical incident. There was no information available for staff about their responsibilities to raise concerns, to record safety incidents, concerns or near misses, and to report these internally and externally. Nor was there any information about how to investigate or learn from any incident.
• Staff did not complete risk assessments for patients. The service did not have systems to identify risks and to plan to eliminate or reduce them or to cope with both the expected and unexpected. The service’s risk management policy lacked expected detail.
• There were no systems of accountability within the service; the radiographer did not keep any records of her work that could be audited or monitored to provide assurance in respect of safety or outcomes for patients.
• Staff employed by the service had not undergone any checks to ensure the employment of fit and proper persons.
• There was no programme of clinical or internal audit to monitor quality or operational processes, and there were no systems to identify where action should be taken. There was no monitoring or reporting of service performance measures.
• There was no provision to patients of any statement that included terms and conditions of the service being provided.
• There were no arrangements to ensure the availability, integrity or confidentiality of identifiable data or records; medical records kept were insufficient and were not held securely.
• The provider did not have any duty of candour policy or any other written processes to ensure that the service met this duty.
• The radiographer had not undertaken any ongoing training or professional development in the radiography field.
• There was no formal vision or strategy document for the service.
• There were no mechanisms for providing staff with opportunities for development.

We found areas of practice that required improvement:

• The radiographer did not introduce herself or others to patients, nor did she ask patients whether they were comfortable with others being in the room during X-ray procedures.
• Staff did not fully involve patients and those close to them in decisions about their care and treatment; the radiographer did not discuss alternative imaging modalities with patients or encourage them to be part of the decision-making process.
• Staff were not aware of the potential need to seek accessible ways to communicate with people.
• There was no evidence of promotion of equality and diversity within or beyond the service.
• The service did not fully plan and provide services in a way that met the needs of local people. Access to parts of the service was difficult for anyone whose mobility was restricted, and there were no adjustments to the service to allow people with a disability to access and use services. The service did not use any schemes to support those with dementia, learning disabilities, autism or other additional needs.
• There were no adjustments to the service to ensure that it took account of the needs of different people, including those with protected characteristics under the Equality Act 2010 and those in vulnerable circumstances.

However, we found good practice in relation to:

• Staff we spoke with enjoyed working for the service and had no concerns about culture. There was a friendly and welcoming atmosphere amongst staff, and they interacted with people in a pleasant manner.
• Feedback from patients confirmed that staff treated them well and with kindness. Patients were very complimentary about the service.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. We suspended regulated activity at the location following our inspection, and we gave the provider 35 days to address the breaches and concerns that we raised. This notice of urgent suspension of registration was given because we believed that a person would or might be exposed to risk of harm if we did not take this action. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Updated 17 May 2019

The service provided plain film X-rays for adult patients on referral from an independent orthopaedic consultant during his weekly clinics at the location.

We rated the service as inadequate, because there were failings in safety, responsiveness and leadership.