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The London Travel Clinic at London Bridge Good

Reports


Inspection carried out on 17 Feb 2020

During an inspection looking at part of the service

We carried out an announced focused follow up inspection on 17 February 2020 at London Travel Clinic London Bridge to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 August 2019. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • There were systems in place to assess, address and mitigate the risks associated with fire and legionella.

  • The business continuity plan included contact details of all staff working in the service.

  • All staff knew who the safeguarding lead and fire mashals were in the service.

  • Staff understood their duty to raise concerns, report and record incidents and near misses.

  • There were systems in place to review and update Patient Group Directions (PGDs).

In addition the provider should:

  • Consider ways to better accommodate patients with accessibility needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 16 August 2019

During a routine inspection

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at The London Travel Clinic at London Bridge as part of our inspection programme. The London Travel Clinic at London Bridge is part of The London Travel Clinic which provides travel immunisations, treatment and advice to fee paying patients.

We had previously inspected this service as part of our unrated programme of independent health inspections. At our last inspection undertaken on 6 July 2018 we found that the service was in breach of regulation 12 (safe care and treatment) and regulation 17 (good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found that the provider had not adequately mitigated risks associated with infection control. The service was not monitoring ambient room temperatures to ensure that medicines were stored safely, the service had not risk assessed the need for all recommended emergency medicines and the accessibility of the nearest defibrillator and infection control risks and those associated with legionella and fire had not been adequately assessed or addressed. In addition we found that there was no ongoing quality improvement activity, there was no mechanism in place to review and act on patient feedback, there were no documented business continuity plans in place and there was insufficient oversight and management of patient group directions.

At this inspection we found that most of these concerns had been resolved; however, the provider still did not have adequate oversight of risk management activities undertaken by third parties, some risks had not been adequately assessed or mitigated including those associated with fire and legionella, there were two expired PGDs and some staff employed on a temporary basis had not signed a confidentiality agreement.

The clinical nurse lead for 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.

Two patients provided feedback to CQC about the service. Both patients said that the service was of a high standard and that staff members were kind and helpful.

Our key findings were:

  • The provider had systems in place in relation to safeguarding although one staff member was not clear on who acted as the lead for safeguarding.
  • Some risks were not adequately assessed, addressed or mitigated. For example the risks associated with fire and legionella had not been assessed and staff were not clear who acted as the fire marshal.
  • Appropriate emergency equipment was available on site and staff knew what to do If a patient presented with the symptoms of sepsis
  • There were systems in place to report and discuss significant events. However staff were not clear on the reporting mechanisms.
  • Medicines were appropriately managed in most respects and there were systems in place to respond to safety alerts. However we found that two patient group directions (PGDs) had expired.
  • Care and treatment provided was effective and met patient needs.
  • There were systems to review consultations, feedback to staff and implement improvements where needed.
  • Feedback from patients was positive about access to treatment and the care provided and there was a system for managing complaints.
  • Services were designed to respond to the needs of patients.
  • Leadership was visible and staff said that they felt happy to raise concerns or issues that arose.
  • Governance systems were present in most areas although there were some instances where the provider did not have effective systems in place to oversee risk.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

  • Consider ways to better accommodate patients with accessibility needs.
  • Include details of all staff working at the site in the business continuity plan.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 6 July 2018

During a routine inspection

We carried out an announced comprehensive inspection on 6 July 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 not providing safe care 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 not 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.

Dr Stephen Alex Bobak is the registered manager at The London Travel Clinic at London Bridge. 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.

The London Travel Clinic at London Bridge is an independent travel clinic in London and provides travel health services including vaccinations, medicines and advice on travel related issues to both adults and children. Prior to our inspection patients completed CQC comment cards telling us about their experiences of using the service. There were six responses, all providing wholly positive feedback about the service.

Our key findings were:

  • There were limited systems in place to keep patients safeguarded from abuse. Information about who to contact with a concern was not accessible to staff. Staff had received safeguarding training.
  • Not all risks were assessed or well-managed.
  • The premises were clean; however, no infection control audits had been completed and infection control risks were present which had not been addressed.
  • Procedures for managing medical emergencies were lacking.
  • Policies and procedures were generic and did not reflect day to day practice at the service.
  • There was no information available to tell patients how to make a complaint and the service did not have an effective system to gather or act on patient feedback.
  • The service had systems in place to respond to incidents. When incidents did happen, the service learned from them and improved.
  • The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. However, there was no evidence of activity which aimed to improve the quality of clinical care provided.
  • The appointment system reflected patients’ needs. Patients could book appointments when they needed them.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Staff felt involved and supported and worked well as a team.
  • There was a lack of effective managerial oversight and some areas of governance were not sufficient to ensure safe care and that quality of services improved.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

You can see full details of the regulations not being met at the end of this report.

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

  • Advertise the service’s complaints procedure and keep appropriate records of complaints received.
  • Review staff training needs.

Establish processes for sharing information with a patient’s GP in absence of patient consent.  

Inspection carried out on 28 February 2013

During a routine inspection

We spoke with the member of staff providing the service and with two of the providers` directors.

We spoke with the people using the service that day who all praised the efficiency and delivery of the treatment and advice given. Patient records were up to date and people were provided with information leaflets on different diseases.

The people said that they were not pressured to have any particular treatment and advice was given on precautions to take whilst travelling. One of the people using the service said �I am scared of needles, and he made it very relaxing and it was fine�

another person said "it`s a very good all round service".

We inspected the medicines and these were all found to be in date and stored correctly.

The provider had an adequate process to manage risks and measure the quality of the service provided.