19 December 2019
During an inspection looking at part of the service
We carried out an announced comprehensive inspection at The Gingerbread Centre for Health on 30 May 2019. Overall the service was rated as good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure safe services were provided. Consequently, the provider was rated as requires improvement for providing safe services.
At the inspection on 30 May 2019, the provider was informed they must:
- Ensure care and treatment is provided in a safe way to patients.
Additionally, the provider was informed they should:
- Introduce a process so that all medical equipment is calibrated to ensure its accuracy.
- Use a pulse oximeter at the service.
- Take steps so that in all appropriate cases, a documented check is made with each patient’s NHS GP when prescribing them medicines, especially high-risk medicines and those with the potential for abuse.
- Strengthen awareness of the alternative communication provisions available for patients who may need additional support.
- Review and acknowledge the business continuity and major incident arrangements in place.
The Gingerbread Centre for Health is an independent, private GP service. Services are provided by Dr Heidi Rosenfeld (also known as Dr Heidi Miller).
The Gingerbread Centre for Health is registered with the 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 services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some of the services provided at The Gingerbread Centre for Health are not within the CQC scope of registration and are exempt from CQC regulation. These include: facial aesthetics using wrinkle-reducing injections, dermal fillers and face-lifting threads. We did not inspect or report on these services. Only the independent, private GP services were inspected and reported on. The Gingerbread Centre for Health is registered with CQC to provide the regulated activity: Treatment of disease, disorder or injury.
This inspection was an announced focused inspection carried out on 19 December 2019 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 30 May 2019. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
On this focused inspection we found that the provider had made some improvements since our previous inspection. We found the provider had not taken sufficient action on one part of the breaches of regulation identified on our previous inspection.
Consequently, the service remains rated as good overall and requires improvement for providing safe services.
We found that:
- The service had clear systems to keep people safe. A service specific infection prevention and control policy was in place. The GP was clear about the infection prevention and control processes in place they had responsibility for. The digital medical equipment in place at the service was all purchased in 2019 and did not yet require calibration or a check for accuracy. A pulse oximeter was available.
- The service had reliable systems for the appropriate and safe handling of medicines. Documented checks were completed on the medicines kept in the GP’s home visit bag to ensure they remained appropriate and safe to administer when needed. All the medicines we checked were legibly marked with and were within their expiry dates.
- In most cases, staff had the information they needed to deliver safe care and treatment to patients. A process was in place for the GP to prescribe medicines and consider the need to consult with other medical professionals involved in those patients’ care if necessary to ensure their safety. The GP was competent in identifying instances of concern and taking the appropriate precautionary measures in those circumstances. Hard copy records of past patients and paper copy correspondence relating to existing patients were securely stored and not accessible to individuals not involved in those patients’ care.
- At our last inspection we found the GP had not signed the host provider’s business continuity plan as reviewed and understood. During this inspection, the GP demonstrated they had acknowledged the plan and provided their emergency contact details for the plan. The GP demonstrated an understanding of how a service would be maintained in the event of a major incident and their responsibilities in relation to it.
- Since our last inspection, a new patient procedure had been introduced. We found the policy was not consistently adhered to and not every new patient had the documented check made on their photographic identification in accordance with the policy. Any checks completed were not done in accordance with the agreement reached between the GP and the host provider service. The GP took immediate action, and following our inspection told us they had developed a template to be completed for each patient visit. This required specific documented checks on the identity of new and existing patients. This was implemented in consultation with the host provider service.
- During our May 2019 inspection, we found that an interpretation service for patients who did not have English as a first language was available from the host provider service, but the GP did not necessarily have automatic access to this. The GP told us they would source an interpretation service as and when it was required and would provide information in a range of formats on request. No such requests had ever been made. At this inspection, we found there had been no change to this situation. The GP told us that as a fee-paying (private) service, they would provide patients with information in a format that best met their needs. This included providing access to alternative methods of communication and interpretation services on request. The GP said that in the 15 years of the service operating, no such requests had ever been made, but they were fully aware of how to source or provide such services if required.
The area where the provider must make improvements as they are in breach of regulation is:
- Ensure care and treatment is provided in a safe way to patients.
Please see the final section of this report for specific details of the action we require the provider to take.
Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care