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Inspection carried out on 1 May 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Berkshire Health limited on 18 October 2017. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Berkshire Health Limited on our website at www.cqc.org.uk.

Berkshire Health Limited operates under the name of The Forbury Clinic.

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.

This inspection was an announced focused inspection carried out on 1 May 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

CQC inspected the service on 17 October 2017 and asked the provider to make improvements regarding the lack of a system for monitoring medicine and safety alerts and a lack of risk assessments relating to the accessability of the emergency medicines and equipment. We checked these areas as part of this focus inspection and found these had been resolved.

The service has a 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.

Our key findings were:

  • Arrangements for actioning medicine and safety alerts kept patients safe.
  • The contents and accessibility of the emergency medicines and equipment had been assessed and actions undertaken to improve this.

Inspection carried out on 18 October 2017

During a routine inspection

We carried out an announced comprehensive inspection of Berkshire Health Limited based in Reading on 18 October 2017 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 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 providing well-led care in accordance with the relevant regulations.

Background to Berkshire Health Limited

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 Berkshire Health Limited was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Berkshire Health Limited is the parent company of The Forbury Clinic which was founded in 2011 and has two sites, 'The Forbury Clinic - Kendrick Road' & 'The Forbury Clinic - Craven Road' both situated close to the centre of Reading, Berkshire. This inspection was of The Forbury Clinic – Kendrick Road. As The Forbury Clinic has grown, its specialties’ covered have expanded to include Urology, Spinal Surgery, Plastic Surgery, Gynaecology, Physiotherapy, Ear, nose and throat Surgery, Eye Surgery, Oncology, Medical Imaging, Antenatal Scanning, Hand Surgery, Bariatric Surgery, General Surgery, Speech Therapy and Ophthalmology.

The Forbury Clinic is a group of surgeons and medical professionals who aim to provide the highest standard of care and treatment within comfortable and spacious surroundings. They operate from two buildings; 11 Kendrick Road and 23 Craven Road, both purposefully refurbished to provide consulting, diagnostic and treatment over a variety of specialty areas of medicine and surgery.

The consultants hold substantive posts at NHS hospitals and appear on the General Medical Council (GMC) Specialist Register. The service is also supported by a team of specialist nurses, healthcare professionals and a team of administrators.

All registered services for this inspection are provided from:

  • Berkshire Health Limited, 11 Kendrick Road, Reading , RG1 5DU

This service is registered with Care Quality Commission (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 service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The premises at Berkshire Health Limited consisted of a three storey building. The ground floor consisted of a reception area, one consulting room, a treatment room, a further room used for imaging, a sluice and a patient changing area. There were three further consulting rooms on the second floor alongside the practice manager’s office. The third floor was for administration staff.

The quality assurance manager was the registered manager. (A registered manager is someone who has been selected by a provider to be legally responsible for managing regulated activity from a provider location).

The service was open between 9am and 5pm Monday to Friday. Out of regular clinic hours patients were advised to contact their GP or the local hospital if required.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. All of the 46 patient comment cards we received were positive about the service experienced. Patients said they felt the Berkshire Health Limited offered an excellent service and staff were efficient, helpful and caring. They said staff treated them with dignity and respect and the care they received exceeded their expectations. Patients stated they felt all the staff took an interest in them as a person and overall impression was one of wanting to help patients.

Our key findings were:

  • There was an effective system in place for reporting and recording significant events. 
  • Procedures were in place for monitoring and managing risks to patient and staff safety. For example, there were arrangements to prevent the spread of infection and compliance with these was monitored. However, the provider did not receive patient safety and medicine alerts.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about their care.
  • Staff were supported to receive training appropriate to their role and to keep up to date with developments and best practice.
  • All written and verbal feedback from patients told us they had very positive experiences of the service and felt they were treated with respect, compassion and dignity.
  • Treatment plans were tailored to individual needs and according to the best options for treatment at that time.
  • Patients told us they had flexibility and choice to arrange appointments in line with other commitments. Patients also commented that they were offered cancellation appointments if these were available.
  • Information about services and how to complain was available and easy to understand.
  • There was a clear staffing structure and staff were aware of their own roles and responsibilities.

Inspection carried out on We have not revisited Berkshire Health Limited as part of this review because they were able to demonstrate that they were meeting the standards without the need for a visit

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

In September 2014 we found concerns related to the recruitment of staff during a comprehensive inspection of Berkshire Health Limited. Following the inspection the provider sent us an action plan detailing how they would improve recruitment and undertake necessary staff checks. We carried out a desktop review of Berkshire Health Limited on 8 July 2015 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in September 2014 had found breaches of regulations relating to the safe delivery of services.

We found the practice had made improvements since our last inspection on 16 September 2014 and they were meeting the regulation relating to the recruitment of staff that had previously been breached.

Specifically the practice was:

  • Operating safe systems in relation to the recruitment of staff.

We found the service was providing safe, effective, caring, responsive and well-led care in accordance with relevant regulations.  

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 16 September 2014

During an inspection looking at part of the service

When we visited Berkshire Health Limited in August 2013 we found there were inadequate systems in place to support staff in identifying, recording, and reporting safeguarding incidents. We also found that although nurses and consultants were vetted prior to employment, there were some gaps in nurses' recruitment records.

We carried out an inspection in September 2014 to check the provider had addressed the issues we previously identified. We saw the provider had taken appropriate action to meet the requirements of safeguarding vulnerable adults. We found the recruitment process had been reviewed and improvements had been made. However, all the required information in respect of staff employed in the service was not in place.

Inspection carried out on 13 August 2013

During a routine inspection

We spoke with three people who received consultations and treatment from Berkshire Health Limited. They praised the consultants and nurses for their clear communication, sensitivity, and professionalism. One person described the consultant with whom they had treatment as "a real expert" and the nurses as "wonderfully courteous." Another person said he would recommend the service to others and would use it again.

There were significant improvements since our last inspection. Improvements to infection control arrangements included access to external infection control expertise and support. There were audits of patient records and the administration of medicines. In our check of medical records, we found that some of the consultation notes remained illegible at times but staff were able to read and understand these records. There were documented records of people's care from the point of their referral to the service until they finished treatment.

Our check of safeguarding arrangements found there were inadequate systems in place to support staff in identifying, recording, and reporting safeguarding incidents. We also found that although nurses and consultants were vetted prior to employment, there were some gaps in nurses' recruitment records.

Inspection carried out on 12 February 2013

During a routine inspection

People spoke very highly of the services and staff at Berkshire Health Limited. They told us consultants discussed various treatment options with them and made them feel involved in their treatment. One person commented "the staff are so caring and they treat me like an individual." Another person said "the nurses and consultants here treat me with great sensitivity and concern. I value the time I have with my consultant."

We found people were involved in making decisions about their care and these decisions were documented. Care and treatment were provided by trained and competent staff. Arrangements were in place for clinical supervision and there were good opportunities for professional development. Although the facilities were clean, there were inadequate arrangements for preventing and controlling the spread of infection as required by Code of Practice on the prevention and control of infections and related guidance, under the Health and Social Care Act 2008. There were also inadequate systems in place for monitoring the quality of services.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.