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Queens Urgent Treatment Centre

Reports


Inspection carried out on 5 to 13 Febraury 2020

During a routine inspection

We carried out an announced comprehensive inspection of Queens Urgent Treatment Centre, Rom Valley Way, Romford, Essex, RM7 0AG on 5, 12 and 13 February 2020.

We have taken the decision not to rate this service because Queens Urgent Treatment Centre’s date of registration with the CQC was 23 January 2020.

At this inspection we found:

  • The service was led by a chief executive who was supported by a senior leadership team that reported to the PELC council. Local clinical and performance meetings fed into the integrated clinical governance committee, management executive team, and finance, audit and remuneration meetings which in turn fed into the PELC council meetings (Board). We found the service held monthly integrated governance committee meetings.

  • The service mostly had clear systems to keep people safe and safeguarded from abuse.

  • The service learned and made improvements when things went wrong and responded to and learnt from complaints.

  • To improve the service, staff had completed 24 audits over a period of 18 months, two of the audits were two cycle audits.

  • The provider has increased the number of patients seen in the urgent treatment centre from 41% to over 70% since taking over the service, which resulted on less pressure in the A&E department at the hospital.

  • The service was open 24 hours a day, seven days a week, and adjusted their staff according to patient demand.

  • At the time of our inspection, the management team did not have effective oversight of staff recruitment and training. However, following the inspection, the provider employed a human resource compliance officer whose role was to ensure that all staff have completed the appropriate training for their role and to ensure the service's recruitment system is effective.

  • The system for the management of the emergency medicines and patient group directions used by non-prescribers was sometimes not fully effective or fully embedded. However, immediately following the inspection, the provider took immediate action to ensure an improved and effective system.

  • The protocols in place did not provide the streamers with a consistent approach to aid the safe direction of patients. In addition, staff were not always following the guidance provided and completing observations prior to streaming patients to all areas. However, immediately following the inspection, the provider submitted information to demonstrate that they had introduced new streaming guidance regarding children. They also, summitted an action plan that included to review all the streaming guidelines, to ensure adequate detail was provided by the patient and recorded. In addition, they had changed the patient record system to ensure staff always completed and documented the necessary observations.

  • The provider had introduced a streaming competencies framework in 2018, however the management team had failed to ensure this system was adhered to and completed by all required staff. In addition, we found a new process for clinical supervision for streaming staff had been commenced, but the process was not formalised or embedded. However, immediately following the inspection, the provider submitted an action plan that included to further develop a performance management process for streamers, improving training, and review the competency framework. The provider has also changed the patient record system to ensure streaming staff complete and record patient observations. In addition, the provider was planning to change the patients notes audit system so that it  included streamers record keeping.

  • The Trust, where the service was located managed the prevention of infectious diseases at the service, however, we found the service did not always have full oversight of these arrangement.

  • Although, the management team robustly monitored patient feedback and provided the information to the local clinical commissioning group, we were not provided with any evidence of how they had responded to lower patient survey results.

The areas where the provider 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.

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

The areas where the provider should make improvements are:

  • Follow the correct system for the review of non-medicine Central Alerting System (CAS) and Medicines and Healthcare products Regulatory alerts (MHRA).
  • Continue to improve the privacy and dignity of patients in the waiting room.
  • Improve the process in place to navigate patients to the major’s lite service so that it includes information regarding the streaming process, colour coding and is available in other languages.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care