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Prime Endoscopy (Bristol) Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 2 April 2019

Prime Endoscopy (Bristol) Limited is part of the InHealth Group. The service has no inpatient beds and facilities consist of a reception and waiting area, two admission rooms, two pre-procedure rooms with ensuite facilities, two procedure rooms and a decontamination unit. In addition, a recovery area consists of four separate rooms and toilet facilities and a private non-clinical room used for consultation after the procedure. The service provides endoscopic procedures for patients who are over the age of 18 years.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 25 October 2018.

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.

The main service provided by this service was endoscopy procedures.

Services we rate

We rated it as Good overall.

  • The service ensured there were enough staff who had the appropriate training, skills and experience to maintain patient safety.
  • Staff mostly managed infection prevention and control risks well. They monitored equipment and staff complied with policies and best practice guidelines. Decontamination processes of endoscopic equipment were in line with national standards.
  • Staff had access to information they needed to care for patients including policies and procedures and information about patients’ current health needs.
  • Staff were caring and kind to patients involving and explaining their care and protecting their privacy and dignity.
  • The service used agreed pathways of care with NHS providers for patients who had a diagnosis of cancer.
  • Patients could access the service at times that suited them, between Monday to Friday of each week and waiting times rarely exceeded six weeks.
  • Staff felt respected and valued and were proud of working for this service.
  • Suitably experienced and competent managers led the service.
  • Staff used systems to report and manage risk. All concerns were investigated, reported and learning shared with staff.
  • Comments from patients were taken seriously and used to improve the service. Staff actively encouraged feedback from patients to shape the service.
  • Staff were sensitive to patients’ needs and ensured they were supported appropriately.

However, we also found the following issues that the service provider needs to improve:

  • Staff were trained in basic life support and use of electronic defibrillator but not in the Resuscitation Council (UK) immediate life support.
  • There was no formalised agreement between the service and the local NHS trust, for transferring an unwell patient.
  • Not all staff followed infection control and prevention guidance in being bare below the elbow in clinical areas and wore jewellery beneath surgical gloves.
  • Although staff had access to emergency equipment there was limited written guidance available for staff to use in the case of a major gastrointestinal haemorrhage.
  • Policies were not always detailed enough to provide guidance for staff.
  • There was a risk that in certain circumstances controlled medicines may not be in the custody of an appropriate professional.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South West)

Inspection areas

Safe

Requires improvement

Updated 2 April 2019

We rated safe as Requires Improvement because:

  • Although risks were identified and managed, there was limited written guidance for staff to follow in the event of a major haemorrhage during an endoscopic procedure.

  • There was no formalised agreement between the service and the local NHS trust, for transferring an unwell patient.

  • Staff were trained in basic life support and use of electronic defibrillator but not in the Resuscitation Council (UK) immediate life support.

  • Not all staff followed policy to be bare below the elbow during clinical procedures. A staff member wore jewellery beneath surgical gloves.

  • There was a potential risk that management of controlled medicines would not be in safe custody of appropriate professionals in certain circumstances.

However, we also found the followingareas of good practice:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff knew how to manage patient conditions in urgent situations which included calling the emergency services.

  • Staff understood how to protect patients from most types of abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service mostly controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

  • The service had suitable premises and equipment and looked after them well. Any breakdowns were dealt with promptly.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • The service followed best practice when prescribing, giving and recording medicines. Patients received the right medication at the right dose at the right time.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Updated 2 April 2019

Caring

Good

Updated 2 April 2019

We rated caring as Good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • The design of the environment and the way staff cared for patients protected patient privacy and dignity.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff made sure they involved patients and those close to them in decisions about their care and treatment.

Responsive

Good

Updated 2 April 2019

We rated responsive as Good because:

  • The service planned and provided services in a way that met the needs of local people. The service worked with commissioners and GPs to ensure patients were referred to the service when appropriate.

  • The service took account of patients’ individual needs.

  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

However, we also found the following issues the provider needs to improve:

  • Where patient information is provided it should include detail of specific risks for patients undergoing procedures based on how often they occur.

Well-led

Good

Updated 2 April 2019

We rated well-led as Good because:

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.

  • The service had a vision for what it wanted to achieve and workable plans to turn it into action.

  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service systematically improved service quality and safeguarded high standards of care.

  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

  • The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation.

Checks on specific services

Endoscopy

Good

Updated 2 April 2019

The service provides diagnostic endoscopy for adults. We rated this service as good for caring, responsive and well-led, and requires improvement for safe. We do not rate the effective domain for this service