Archived: Immunisation and Medical Centre - Birmingham

During our inspection we found that the provider had ensured that patients were protected from inappropriate or unsafe treatment because staff could respond properly to a medical emergency. We also found that the parents of children who were patients were provided with enough information about waiting for a short time after their child had been vaccinated to enable the staff to check for an adverse reaction. The timings of appointments had been modified to ensure that staff could spend enough time monitoring patients.

There was a lack of proper information about people using the service because records of some patients were incomplete and inaccurate. However, we found that the vaccination history of patients was explored with them and verified by the doctor before vaccines were administered.

We found that there were appropriate arrangements in place for managing medicines. Temperature sensitive vaccines were stored and rotated properly and the stocks were accurately accounted for.

There were sufficient staff on duty to ensure that the clinic ran effectively and that patients could be monitored after their vaccination. Staff were appropriately skilled for their role.

The provider had responded to the findings of our previous inspection and had put monitoring arrangements in place for staffing and medicines management. There was information available to help people make a complaint.

A pharmacist inspector from the Care Quality Commission visited the service. This was in order to look at medicine management. We looked at how the service stored, recorded and managed vaccines.

During the inspection the vast majority of patients being treated were children accompanied by a parent(s). There were a few adult patients also using the service on the day of the inspection. This inspection was undertaken to follow up on warning notices that had been issued in respect of concerns we found about medication management and staffing when we last visited this location. In addition we also checked compliance in respect of care and welfare, safeguarding, assessing and monitoring of the service, and records management.

We found that patients were not protected from unsafe care and treatment because the provider failed to have systems in place to protect them. Planning of treatment was difficult because records of previous vaccines were not available for all patients receiving treatment at the clinic, which could have placed patients at risk. The only staff member who was on duty in the clinic, besides the Doctor who administered the vaccines, did not have the skills or qualifications to assist and recognise possible medical emergencies if they occurred after treatment. However, one parent commented positively and told us: 'The Doctor always asks how my child has been generally.' .

Improved arrangements were in place with regard to child and adult safeguarding. All staff had received training in both in the last 12 months. Child protection local policy documents were available to staff within the clinic.

The provider had not ensured that safety audits had been completed effectively. Within local policy documents there were guidelines available for staff detailing safety tasks to be undertaken before and after each clinic session. These were not always followed which resulted in the clinic being run in an unsafe manner. Medicines that were stored for use in an emergency were past their expiry date and could have placed people at risk if they were needed or used in an urgent situation.

We found that although the provider told us that they did hold patient records these were not available at the clinic for all patients receiving treatment on the day of the inspection. This meant that treatment was provided to some people without full details or knowledge of previous treatment that had been administered.

This clinic was run from premises which belonged to a dentist surgery and operated on Saturdays only but not on every Saturday of the month. We spoke to 11 parents / guardians of children receiving the service and the staff in attendance.

The treating doctor verbally checked the general health of people prior to delivering the treatments. Parents / guardians were aware of the treatment being given to their children and records were maintained regarding treatment delivered. Parents / guardians knew what to do if their child developed any side effects they were concerned about.

People's care and welfare needs were not met by the service because the assessments of their needs completed prior to treatments were not detailed enough. Arrangements in place for foreseeable emergencies were not robust enough.

Insufficient arrangements were in place to protect vulnerable children. The policy in place contained inadequate information for staff to make a referral if they were concerned. Staff had not received up-to-date safeguarding training.

People were protected from the risks of infection as the premises and the clinical staff followed good infection control practices. The service was run from premises that were suitable for its operation. They were well maintained and offered people privacy for their treatments.

We found that arrangements were not in place to ensure that medicines were managed safely. This was because the service could not be fully assured that medications were maintained within the manufactures recommendations. We found that when the vaccines arrived at the Birmingham clinic no time and temperature checks were recorded prior to putting them in the fridge. Also the fridge security was not maintained.

Recruitment practices were followed and ensured that suitably skilled and qualified staff were appointed.

The number of trained staff used in the clinic was not enough to meet the needs of people in the event of a medical emergency. Having only one trained person on site put people at increased risk.

The auditing and monitoring practices were not robust enough or effective. We saw that documents supplied to us contained inaccurate analysis of the results and the auditing practices for the safe handling of medications were not followed. We noted that complaints were not handled in line with the services own policy.

Documents such as policies were not readily available to staff at the clinic, we also saw that some contained inaccurate information and omissions.