Archived: CuRx Operational Base

This service is rated as Requires improvement overall. (Previous inspection 18 September 2018 – Not Rated)

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? – Requires improvement

We carried out an announced comprehensive inspection at CuRx Operational Base to follow up on the breaches identified during the service inspection carried out on 18 September 2018 and as part of our inspection programme.

At our last inspection we identified regulations that were not being met and the provider was told they must:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure all premises and equipment used by the service provider is fit for use.

There were also areas identified during the last inspection where the provider was recommended to make the following improvements.

• Review the service infection control policy, to ensure that information includes the requirements necessary to undertake scans for patients with suspected or confirmed contagious and communicable diseases and/or suppressed immune systems. The policy should also refer to the procedure for the decontamination of equipment and environment following use by patients with suspected or confirmed contagious or communicable diseases.

• Review the practice’s protocols to ensure recommendations made following audit is actioned and the issues identified re audited to improve the quality.

• Review the records kept demonstrating competency training for each staff member.

At the last inspection we asked the provider to make improvements regarding the above breaches and recommendations. We checked these areas as part of this comprehensive inspection and found that there had been some areas of improvement, but these had not been sustained.

We received feedback from 41 patients via completed CQC comments cards as part of this inspection. All the comments made were positive about the patient experience and only one comment was negative about not being able to find the location. Positive feedback included comments about how quick the service was, kind and friendly staff, good confidential support given, staff were helpful a kept patient fully informed.

Our key findings were:

• The service was not providing safe services for all areas related to safe systems and processes, in accordance with the relevant regulations. This included not having suitable equipment to deal with medical emergencies.
• There were arrangements for planning and monitoring the number and mix of staff needed.
• Clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance.
• There were systems for reviewing and investigating when things went wrong and when patient complaints were made. However, there was no formal system for recording and acting on significant events.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The provider had systems to keep clinicians up to date with current evidence-based practice. The service obtained consent to care and treatment in line with legislation and guidance.
• Up to date records of skills, qualifications and training were maintained. Staff were encouraged and given opportunities to develop, however, annual appraisals for relevant staff had not been completed.
• Feedback from patients was positive about how caring staff were and the positive experience they had encountered. Staff recognised the importance of people’s dignity and respect.
• The service took account of patient’s preferences in terms of choice of locations for having the scans. Patients had good access to appointments and timescales were monitored and discussed widely.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them. However, several patient safety risks required improvements.
• Staff told us they felt respected and supported. They described an open and honest culture and said they felt comfortable to raise concerns without fear of reprisals.
• Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to change services to improve quality.
• All patients were invited to give feedback about their experiences after each scan was performed. We noted positive feedback from patients.

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

• Ensure patients are protected from abuse and improper treatment
• 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK).

• Review the storage of cleaning materials and cleaning equipment.
• Review the audit arrangements for all sonographers including locums, to ensure an accurate sample of complex and uncomplex scan results are monitored regularly.
• An overall training matrix should be introduced to monitor staff training.
• Review the ways in which significant events are reviewed, investigated and reported.
• Review the information available to inform them that interpretation services are available for patients who did not have English as a first language.

We carried out an announced comprehensive inspection on 25 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 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 care 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 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.

Our key findings were:

• The service had systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The service had systems to safeguard children and vulnerable adults from abuse.
• The service had some arrangements to ensure that facilities were safe. However, some of the information required for this was not in place at the time of inspection. For example, some service contracts and maintenance schedules were observed however, this did not cover all the equipment currently in use.
• The provider carried out recruitment checks, including checks of professional registration where relevant, on recruitment and on an ongoing basis. Policies were in place to support this. However, we found that Disclosure and Barring Service (DBS) checks were not undertaken as required for all staff members prior to employment and there was no risk assessment in place to support this.
• The service had some systems for ongoing review and improvements. This included data collection and regular monitoring of key performance indicators.
• Staff treated patients with compassion, kindness, dignity and respect.
• 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 provider was aware of the requirements of the duty of candour.
• The service sought feedback from patients.

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure all premises and equipment used by the service provider is fit for use.

Full details of the regulations not being met are at the end of this report.

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

• Review the service infection control policy, in particular to ensure that information includes the requirements necessary to undertake scans for patients with suspected or confirmed contagious and communicable diseases and/or suppressed immune systems. The policy should also refer to the procedure for the decontamination of equipment and environment following use by patients with suspected or confirmed contagious or communicable diseases.

• Review the service protocols to ensure recommendations made following audit is actioned and the issues identified re audited to improve the quality.

• Review the records kept to demonstrate competency training for each staff member.