Hampshire Travel and Vaccination Clinic

We carried out an announced comprehensive inspection at Hampshire Travel and Vaccination Clinic on 13 January 2020 as part of our inspection programme and to follow up on breaches of regulations.

The Care Quality Commission (CQC) inspected this service on 21 May 2019 and rated the service Inadequate overall. We issued two Requirements Notices, for breaches to Regulations 12 Safe care and treatment, and Regulation 17 Good Governance, to the service to make improvements regarding:

• The service’s systems and processes relating to overall governance to assess, monitor and improve the quality and safety of the services being provided. For example, in relation to learning from significant events and complaints.
• The service’s management of cold chain protocols in line with national guidance.
• The service’s documentation of injection sites in line with national guidance.

We also issued the service a Warning Notice regarding Regulation 18 Staffing:

• Staff training in relation to basic life support including anaphylaxis, safeguarding children and adults, infection control, the Mental Capacity Act 2005 and information governance.
• Evidence of appraisals and demonstration of clinical supervision.

We followed up the Warning Notice with an inspection on 9 July 2019 where we found the service was compliant with all but one element of the Warning Notice.

As part of this inspection in January 2020 we reviewed the actions taken by the service in response to our previous inspections and found the some of these issues had been resolved, while others still required to be addressed and new issues were identified.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service has one employee who is also the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered services, 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.

As part of our inspection we asked for CQC comment cards to be completed by clients prior to our inspection visit. We received 28 comment cards, all of which were positive about the standard of care received.

Our key findings were:

• The service had made some improvements following our previous inspection. For example, the service was able to demonstrate that its registered manager had completed relevant online training modules, had received an appraisal and completed a clinical observation session.
• We saw examples of quality improvement activity taking place since our last inspection, including an infection prevention and control audit and an audit relating to the service’s consent seeking process.
• Since our last inspection, the registered manager had sought its own individual medical indemnity insurance.
• The service had risk assessed its need for chaperones and it now had a formal risk assessment in place to ensure only clinically trained professionals were used.
• Policies were in place to review and monitor risk, and new policies had been created in response to our last inspection. However, some policies, such as the peer review policy, did not appear relevant to the service, had no creation date, nor a review date to ensure regular reviews were undertaken to maintain the relevance of them.
• There continued to be a lack of evidence in relation to the recording of and learning from significant events or complaints at the service, despite examples of learning being provided. However, since the inspection, the service provided a learning log with examples of learning and actions taken as a result being documented.
• The registered manager had not yet completed basic life support training despite previous efforts to do so. We saw evidence to demonstrate a face-to-face course, which included formal defibrillator training, had been booked for 25 February 2020.
• There were systems in place to ensure that staff received the most up to date evidence-based guidance in relation to travel vaccinations and travel advice.
• The service had revised its travel risk assessment form, used as a patient record, to include confirmation of patient consent, confirmation that patient identification had been checked, and documentation of the site of injection used.
• Patient feedback about the service continued to be positive.
• The service had a clear vision and values in place. However, its governance arrangements and systems and processes continued not to support the service effectively.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

The areas where the service should make improvements are:

• Invite patient feedback using formal evaluation forms to help drive improvement to the service.
• Retain formal documentation of the actions taken following learning from events or incidents at the service.
• Revise website to reflect accurate information regarding appointment availability and availability of the service’s complaints procedure.
• Revise policies and procedures used by the service to clearly state the date when those were written. It should also be clear when a review date is due or the date when a review was completed.

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

Previously we carried out an announced comprehensive inspection at Hampshire Travel and Vaccination Clinic on 21 May 2019 to follow up on breaches of regulations identified at a previous inspection in March 2018.

As a result of our inspection in May 2019, we served a warning notice to the provider following a breach of Regulation 18: Staffing, of the Health and Social Care Act 2008 (Regulated Activities) 2014. We also issued requirement notices in relation to Regulation 12: Safe care and treatment, and Regulation 17: Good governance. Following our inspection in May 2019, the practice was rated as inadequate overall.

We carried out an announced focused follow-up inspection at Hampshire Travel and Vaccination Clinic on 9 July 2019 to confirm if the practice had met the legal requirements in relation to the warning notice served after our previous inspection in May 2019. We found that the service had met the majority of the requirements of the warning notice and were actively seeking appropriate arrangements to be fully compliant with the warning notice. This report covers our findings in relation to that warning notice only.

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected.
• Information from the service.

At this inspection we found that improvements had been made to the service’s staff training, clinical supervision and appraisal processes. We were satisfied that sufficient progress against the warning notice had been made.

Our key findings were:

• The sole employee of the service had completed appropriate safeguarding training for both adults and children. They were also able to demonstrate appropriate knowledge about safeguarding concerns and what their response would be when faced with a safeguarding concern.
• The sole employee of the service had completed appropriate online training modules covering infection prevention and control, fire safety, and information governance.
• The sole employee of the service was actively seeking arrangements to complete basic life support and anaphylaxis training.
• The sole employee of the service had undertaken a formal clinical supervision of one of their patient consultations and received written feedback. This was now in line with the service’s own policy.
• The sole employee of the service had received a formal appraisal. This was now in line with the service’s own policy.

The areas where the service should make improvements are:

• Confirm arrangements to provide appropriate basic life support and anaphylaxis training to the sole employee of the service.
• Review the service’s training policy to include information on appropriate training modules to be completed by staff which is relevant to their role.

The full report of the service’s previous inspection, published on 5 July 2019, should be read in conjunction with this report. The service was not rated at this inspection and remains rated as Inadequate until a full comprehensive inspection is carried out by the Care Quality Commission. Therefore, the overall rating remains Inadequate.

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

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

• 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 persons employed by the service receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

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

The areas where the service should make improvements are:

• Consider provision for alternative business arrangements so they are formalised and documented.
• Consider the provision of service information in alternative formats for patients with additional communication needs, for example, larger print for those with a visual impairment.
• Consider patient feedback when making improvements to the service.