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Inspection Summary


Overall summary & rating

Good

Updated 4 December 2019

134 Harley Street is operated by Harley Street Fertility Clinic. The service has no overnight beds. Facilities include one operating theatre, outpatient and diagnostic facilities. The service provides surgical procedures.

We inspected surgery.

We inspected this service using our comprehensive inspection methodology.

We carried out an unannounced inspection on 2 October 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Our rating of this hospital/service stayed the same. We rated it as Good overall because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and gave them access to good information. Key services were available six days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to continuously improving services.

However, we also found the following issues that the service provider needs to improve:

  • The safeguarding policy did not reflect most recent national best practice guidance. This was action we had previously told the provider to take on our last inspection.
  • The service could not be assured that staff always controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection, but these were not always consistently used or reliable. Not all staff at the service were bare below the elbow, and leaders had not completed the action plan from the most recent infection prevention and control audit.
  • We found one instance where the disposal of a controlled drug was not recorded correctly.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South & London)

Inspection areas

Safe

Good

Updated 4 December 2019

Our rating of safe stayed the same. We rated it as Good because:

  • The service delegated the provision mandatory training in key skills to all staff to an external company and made sure everyone completed it.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • The service had mostly reliable systems and processes to safely prescribe, administer and store medicines, although we found one instance where controlled drugs were not recorded correctly.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff were trained to recognise and report incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

However:

  • The safeguarding policy did not reflect most recent national best practice guidance. This was action we had previously told the provider to take on our last inspection.
  • The service could not be assured that staff always controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection, but these were not always consistently used or reliable. Not all staff at the service were bare below the elbow, and leaders had not completed the action plan from the most recent infection prevention and control audit.
  • We found one instance where the disposal of a controlled drug was not recorded correctly.

Effective

Not sufficient evidence to rate

Updated 4 December 2019

We did not have sufficient evidence to rate effective. However, we found the following:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff assessed patients’ food and drink requirements to meet their needs during their time at the clinic for a day case procedure. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available six days a week, with extended hours, to support timely patient care.
  • Staff gave patients practical support and advice to enhance their health and wellbeing, before, during and after surgical procedures.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

Caring

Not sufficient evidence to rate

Updated 4 December 2019

We did not have sufficient evidence to rate caring. However, we found the following:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 4 December 2019

Our rating of responsive stayed the same.We rated it as Good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
  • People could access the service when they needed it and received the right care promptly.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

Well-led

Good

Updated 4 December 2019

Our rating of well-led stayed the same.We rated it as Good because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
  • Leaders operated mostly effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had opportunities to meet, discuss and learn from the performance of the service.

However:

  • Governance meetings were infrequent.
  • Leaders did not always take timely action to address areas for improvement. For example, the safeguarding policy did not reflect most recent national best practice guidance. This was action we had previously told the provider to take on our last inspection.
Checks on specific services

Surgery

Good

Updated 4 December 2019

We found good practice in the safe, responsive and well led domains. We did not rate effective or caring due to the small size of the service, which meant there was insufficient information to make a judgment.