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Inspection Summary


Overall summary & rating

Good

Updated 29 November 2019

Lucerne Clinic is operated by International Ultrasound Services Limited. The service provides diagnostic ultrasound for musculoskeletal (MSK) issues, gynaecological and fertility issues, abdominal and thyroid problems, and limited vascular, urinary tract and pregnancy scans (excluding screening scans). The service took referrals from self-paying patients from a wide geographical area, although they were mainly located in London.

The service provides diagnostic imaging for patients aged 18 years and over. It is registered with the Care Quality Commission (CQC) to provide the regulated activity of diagnostic and screening procedures. It has one ultrasound machine in one clinic room.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 October 2019. We gave staff 48 hours’ notice that we were coming to inspect to ensure the availability of the registered manager and clinics.

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.

Services we rate

This is the first inspection of this service. We rated it as Good overall because:

  • The service had enough staff to care for patients and keep them safe. The service-controlled infection risk. Staff assessed risks to patients, acted on them and kept good care records. The service had processes in place to manage safety incidents well and learn lessons from them.

  • Staff provided gave patients enough to drink and checked if they were comfortable during scans. Managers made sure staff were competent. Staff worked well together for the benefit of patients. Consent processes were followed and patients were advised on how to prepare for scans. The service was available six days a week.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their scans. They provided emotional support to patients where necessary.

  • The service planned care to meet the needs of their patient population and took account of most patients’ individual needs. People could access the service when they needed it and did not have to wait too long for treatment.

  • Leaders were approachable and visible. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

However:

  • Although staff understood how to protect patients from abuse and the service worked well with other agencies to do so, the sonographer did not have in-depth knowledge of female genital mutilation (FGM). Therefore, not all staff had training on how to recognise and report all types of abuse, and how to apply it.

  • Leaders did not operate an effective governance process throughout the service. Staff at all levels were clear about their roles and accountabilities but had no regular opportunities to meet, discuss and learn from the performance of the service. There were no systems in place to monitor mandatory staff training compliance, review and update policies, or monitor the responsibilities of other providers the service worked with.

  • Staff did not regularly monitor the effectiveness of care and treatment, or regularly use the findings to make improvements and achieve good outcomes for patients.

  • At the time of inspection, the service did not provide information to people on how to give feedback and raise concerns about care they received. The service’s policy stated it treated concerns and complaints seriously, but did not state a target timeframe for full response to complaints.

  • Leaders and teams did not use systems to manage performance effectively. They identified some risks and issues and identified some actions to reduce their impact, but there was no formalised risk management framework. At the time of inspection, there were no plans to cope with unexpected events.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South) 

Inspection areas

Safe

Good

Updated 29 November 2019

This is the first time we inspected this service. We rated it as Good because:

  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. Clinic staff kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients 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, stored securely and easily available to all staff providing care.
  • The service knew how to manage patient safety incidents, but none had been reported in the 12 months prior to inspection. Staff recognised incidents and near misses and described how to report them appropriately. Managers told us they would investigate incidents and share lessons learned with the whole team. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • The service required staff to have mandatory training in key skills but did not have an effective system in place to make sure everyone completed it.
  • Although staff understood how to protect patients from abuse and the service worked well with other agencies to do so, the sonographer did not have in-depth knowledge of female genital mutilation (FGM). Therefore, not all staff had training on how to recognise and report all types of abuse, and how to apply it.
  • When we asked for records from the premises provider to demonstrate wider environmental cleaning had been completed, there were no recent checklists in place to evidence this.

Effective

Updated 29 November 2019

Caring

Good

Updated 29 November 2019

This is the first time we inspected this service. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their scan results.

Responsive

Good

Updated 29 November 2019

This is the first time we inspected this service. We rated it as Good because:

  • The service planned and provided care in a way that met the needs of the patient population.
  • The service was inclusive and took account of most patients’ individual needs and preferences. Staff made some reasonable adjustments to help patients access services.
  • People could access the service when they needed it and received the right care promptly.

However:

  • At the time of inspection, the service did not provide information to people on how to give feedback and raise concerns about care they received. The service’s policy stated it treated concerns and complaints seriously, but did not state a target timeframe for full response to complaints.

Well-led

Requires improvement

Updated 29 November 2019

This is the first time we inspected this service. We rated it as Requires improvement because:

  • The service did not have a formal vision for what it wanted to achieve, or a formal strategy to turn it into action.
  • Leaders did not operate an effective governance process throughout the service. Staff at all levels were clear about their roles and accountabilities but had no regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams did not use systems to manage performance effectively. They identified some risks and issues and identified some actions to reduce their impact, but there was no formalised risk management framework. At the time of inspection, there were no plans to cope with unexpected events.
  • At the time of inspection, there was no system to allow data or notifications to be submitted to external organisations as required.
  • The clinic lacked a robust approach to quality improvement.

However:

  • Leaders had the integrity, skills and abilities to run the service. They were visible and approachable in the service for patients and staff.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where staff could raise concerns without fear.
  • The information systems were secure.
  • The service engaged with patients and staff but there were limited opportunities for them to plan and manage services.
Checks on specific services

Diagnostic imaging

Good

Updated 29 November 2019

Diagnostic imaging is the sole core service provided at this location. We rated this service as good because although it required improvements in the well-led domain, it was safe, caring and responsive. We do not rate effective for this type of service.