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Review carried out on 8 July 2021

During a monthly review of our data

We carried out a review of the data available to us about Tollgate Clinic on 8 July 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Tollgate Clinic, you can give feedback on this service.

Inspection carried out on 29/08/2019

During a routine inspection

This service is rated as Outstanding overall. (Previous inspection September 2018 was an initial un-rated inspection.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Tollgate Clinic 29 August 2019 as part of our inspection programme, to follow up and rate the service. Tollgate Clinic Limited provides NHS referred surgery for carpal tunnel syndrome, and non-scalpel vasectomies. They also provide private patient paid surgery for minor skin lumps and bumps, joint injections, carpal tunnel syndrome, and non-scalpel vasectomies.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the services it provides.

A senior manager at the service is the 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.

We obtained feedback from 19 people through completed comment cards. These had been provided by the Care Quality Commission prior to the inspection at the service. Feedback was very positive in regard to the care, treatment, cleanliness, clinicians, administrative staff, and receptionists. We were unable to speak to patients on the day of inspection because it was a non-clinic day.

Our key findings were:

  • The service provider conducted regular well-documented safety and environmental risk assessments.
  • There was a designated lead and systems to safeguard children and vulnerable adults from abuse.
  • The service was well equipped to treat patients and the facilities met standards and patient needs. Emergency equipment and medicines were available, well monitored to guarantee they were safe for use, and signposted to ensure ease of access should an emergency occur.
  • Appropriate standards of cleanliness and hygiene were seen.
  • Patients’ care needs were assessed and delivered according to individual patient needs.
  • Treatment and care was delivered in line with current evidence based guidance.
  • Staff had the skills, capacity, knowledge and experience to deliver effective care and treatment.
  • Information about how to complain was available and easy to understand.
  • The service staff worked proactively with the GP practices that referred patients into their service, to improve patient experience.
  • Patients told us they were treated with genuine compassion, dignity and respect. Patient feedback was clear, they were active partners and fully involved in decisions about their care and treatment.
  • Patient feedback that we received on comment cards was extremely and consistently positive. Many of them told us the care and treatment provided by the staff exceeded their expectations and that they went the extra mile to ensure patients received excellent care.
  • There was a clear leadership structure and staff felt supported by clinicians and management.
  • The service proactively sought feedback from staff and patients, which it acted on.
  • The service used audits to monitor and study every aspect of their service. This ranged from administration, safety incidents, and best practice clinical decisions.
  • The service was aware and complied with the requirements of the duty of candour.
  • Staff told us they felt respected, supported that their work was valued, and proud to work for the service.
  • Leaders were knowledgeable about concerns and priorities relating to the quality and the future of the service. They understood the challenges and knew how to address them. There was a whole team approach to providing high levels of care.

We saw the following outstanding practice:

We saw evidence of a culture that tailored their services to meet the needs of people on an individual basis. They ensured flexibility, and patient centred involved choices in their care and treatment. To enable the service to do this they had developed an audit driven philosophy to monitor and investigate every aspect of the service they delivered. This ranged from service administration, through to patient satisfaction, compliments, comments, and best practice clinical guidance. Audits were run weekly and monthly and discussed with management and clinicians to monitor trends or themes. Actions, improvements and changes were seen as a continual work ethos to improve and develop the service. Staff we spoke with understood this vision and could describe how they were proud to be involved.

Dr Rosie Benneyworth BM BS BMedSci MRCGP Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 26 September 2018

During a routine inspection

We carried out an announced comprehensive inspection on 26 September 2018 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 providing safe services 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.

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.

Tollgate Clinic Limited is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of surgery for carpel tunnel syndrome, and non-scalpel vasectomy services.

A senior manager is the 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.

Nine people provided feedback about the service provided at the clinic. Feedback was very positive regarding the treatment and care provided.

Our key findings were:

  • We found an open and transparent approach to safety at the service.
  • There was an effective system to record and report significant events.
  • Risks to patients were assessed and well managed.
  • Information relating to patients was accurate and enabled staff to make appropriate treatment choices.
  • Patients’ care needs were assessed and delivered according to their need.
  • Treatment and care was delivered in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The service maintained appropriate standards of cleanliness and hygiene.
  • Information about how to complain was available and easy to understand.
  • The clinic worked proactively with those services that referred patients into the service, to improve their experience.
  • The service was well equipped to treat patients and the facilities met their needs. However emergency items of equipment and medicines were in separate rooms and not signposted to ensure easy access when an emergency occurred.
  • Patient feedback was consistently positive.
  • Patients said they were treated with compassion, dignity and respect and were fully involved in the decisions about their care and treatment.
  • There was a clear leadership structure and staff felt supported by management.
  • The service proactively sought feedback from staff and patients, which it acted on.
  • The service was aware and complied with the requirements of the duty of candour.

There were areas where the provider could make improvements and should:

  • Review where emergency equipment and medicine is stored, and the signposting to ensure easy access should a medical emergency occur.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 31 January 2014

During a routine inspection

We did not speak with people who use the service because on the day of our visit there were no surgical procedures being undertaken and therefore no people we could speak with. The general manager informed us that people using the service were routinely surveyed following their visit to determine their views on the quality of the service provided. We looked at the records of six people who used the service and found that the person was always contacted following their procedure. The records viewed showed that people provided positive feedback about the service. One person was quoted as saying, �Very happy with the results.� Another person was quoted as saying, �Excellent I could not be happier.�

We found that detailed medical assessments were undertaken to ensure people�s welfare before the procedure. People were also provided with plentiful information about post surgical care. The service had effective procedures in place to monitor infection prevention systems at the service. We found that on the day of our inspection the service was clean and well maintained.

We found that staff were supported through training, professional development, accreditation and appraisals. This ensured that people were suitably skilled to provide an effective service to people. We found that the records were accurate and fit for purpose.

Inspection carried out on 5 October 2012

During a routine inspection

We did not speak with people who use the service because on the day of our visit the people who were at the clinic were undergoing surgical procedures. The general manager informed us that people using the service were routinely surveyed following their visit to determine their views on the quality of the service provided. We looked at the results for the surveys for August/September 2012 and these showed overall a very high rate of satisfaction with regard to receiving information, convenience of appointment, service received and staff. We saw compliment cards with positive comments such as "Thank you for making it such a positive experience."