The Care Quality Commission (CQC) has rated Regency Clinic – City of London inadequate following a recent inspection. CQC also took urgent enforcement action to prevent the service from carrying out regulated activity until sufficient improvements had been made.
Regency Clinic – City of London is a private hospital operated by Regency International Clinic Ltd. The service is regulated to provide surgical and outpatient services, gynaecology surgery and diagnostic imaging, care and treatment.
CQC inspected the service in August to look at how safe, effective and well-run the service was. Caring and responsive were not inspected on this occasion.
Following the inspection, the overall rating for the service went down from good to inadequate. The ratings for effective and well-led also dropped from good to inadequate and safe dropped from requires improvement to inadequate. The overall rating for surgery also went down from good to inadequate.
Nicola Wise, CQC’s head of hospital inspection, said:
“Our recent inspection of the Regency Clinic – City of London, identified real concerns about the leadership of the service. Staff were not properly trained and they were unclear about their roles and responsibilities, policies were out of date, audits were not carried out to identify risks and issues, and the service did not undertake regular governance meetings to review performance and share learnings with the team.
“In 2018 we found that the service was performing procedures on women who were trying to get pregnant, which, if they were already in the early stages of pregnancy, could put their unborn baby at risk of harm. We told the provider that it must ensure that patients who may be pregnant are protected from harm. Yet during the latest inspection, we found inconsistent policies relating to when diagnostic (X-ray) imaging procedures can be carried out on women who may be pregnant.
“We also had concerns regarding the radiation protection advisor role, in terms of their understanding and training. The service did not have enough suitable equipment to monitor the levels of radiation that staff were being exposed to when carrying out diagnostic imaging procedures, which meant they could be exposed to harmful levels of radiation.
“As a result, we had to take urgent action to prevent the service from carrying out surgical, diagnostic and screening procedures, as well as the treatment of disease or injury, in order to keep people safe. The suspension was lifted on 15 October as we were satisfied that the provider had made sufficient improvements, however, we will continue to monitor the service closely to ensure that staff and patients are protected from harm.”
Inspectors found the following during this inspection:
- Leaders did not run the service well and did not have reliable information systems or support for staff to develop their skills. Staff were not clear about their roles and accountabilities. Inspectors found evidence of poor governance which included the service not having oversight of policies.Leaders did not have a robust audit schedule to monitor performance within the service
- Managers did not make sure staff were competent. The service did not have adequate oversight that training requirements were being met, this included safeguarding training and radiation protection training
- The service did not have any permanent nursing staff and relied on bank and agency nurses to deliver services. However, managers did not provide permanent, agency or bank staff with a robust formal induction process
- The service had a high turnover rate for medical staff. The permanent radiologist, obstetrician and GP had stopped working for the service in 2018 and had not been replaced. Managers could access locums when they needed additional medical staff, but they were not given a full induction before they started work
- Staff lacked training in key skills, and they did not manage safety well. Staff did not always accurately assess risks to patients and act on them and not all staff understood how to protect people from abuse
- During the inspection, the manager said that the locum radiographer was the named radiation protection supervisor for the service, but they had not completed radiation protection supervisor training. Inspectors subsequently saw correspondence between the manager and the radiation protection adviser which evidenced that the manager was in fact the radiation protection supervisor, but the manager had not completed the relevant training
- Staff did not have access to radiation monitoring badges. This meant they were unable to monitor the levels of radiation they were being exposed to, in order to prevent harmful levels being reached
- Inspectors reviewed policies which were inconsistent regarding the pregnancy rule, as some were using a 10-day rule* and others using a 28-day rule. The pregnancy rule is in place to protect a foetus from risk of exposure to radiation during imaging procedures. This was a concern as the service was performing procedures on people who were trying to get pregnant. The service did not have oversight of these inconsistencies, despite being issued with a requirement notice in August 2018 following a previous CQC inspection, which stated that it must ensure that patients who may be pregnant are safe from risk of harm
- The World Health Organisation safer surgery checklist was not in use at the service. This meant that people could be exposed to risk of preventable harm, such as surgery being carried out on the wrong person, or the wrong part of the body
- Staff did not have access to in date policies that were aligned with national standards and guidance for care and treatment published by recognised organisations (28 out of 33 policies had been out of date for more than two years)
- Clinical staff did not have regular meetings with management so were unable to discuss and learn from the performance of the service
- Appointments for cosmetic surgery were offered to people without the obligatory 14-day cooling off period.
Full details of the inspection are given in the report published on our website.
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