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Inspection report

Date of Inspection: 10 February 2014
Date of Publication: 7 March 2014
Inspection Report published 07 March 2014 PDF

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 February 2014, observed how people were being cared for and talked with people who use the service. We talked with staff and reviewed information given to us by the provider.

Our judgement

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who use the service and others.

Reasons for our judgement

Patients who used the clinic were asked for their views about their care and treatment. We saw comment cards were given to patients at the end of their treatment. A small number had been completed. The feedback was all positive and demonstrated that people who used the clinic were very happy with the service they received. Staff told us a plan was in place to formalise a patient satisfaction survey to obtain more detailed patient feedback in the future to improve the service.

A complaints notice was on display in the waiting area. Patients told us they had no cause to complain about any aspect of the service. The provider had a system for recording and responding to complaints although no complaints had been received by the clinic.

We reviewed the clinic's accident book. It included very few minor incidents relating to staff. We were told there had been no patient incidents reported. This meant incidents were monitored in the interest of people's safety.

The surgeons and clinic manager conducted regular meetings and an annual clinic review meeting. We reviewed the notes of the last annual review meeting (5 February 2014). We found there had been discussion and agreed actions in relation to service improvement issues. This meant there was a process in place to develop the service.