The Cliffs Chiropractic Clinic

The Cliffs Chiropractic Clinic is operated by Mr Arif Omar Josef Soomro. The service has three clinic rooms. One clinic room also provides X-ray facilities. The diagnostic imaging part of the service operates on Monday, Wednesday and Friday mornings and Wednesday evenings.

The service provides chiropractic and diagnostic imaging services to patients on an outpatient basis. We inspected the diagnostic imaging part of the service only, because the Care Quality Commission does not regulate chiropractic medicine. We have made some reference to the chiropractic element of the service in this report to add context, although this has not affected our ratings. The service only provided x-rays to the chiropractic clinic in which it was based. Interpretations of the x-rays was performed by the chiropractic staff. The service x-rays both adults and children under the age of 18.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 26 September 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.

We have provided guidance for services that we rate and do not rate.

Services we rate

This was the first time we have inspected this service. We rated it as Good overall.

We found good practice in relation to diagnostic imaging:

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Patients consistently were risk assessed and had comprehensive records. Records included consent and sections detailing that patients had been informed about their care and investigations.
• Equipment was all safe, serviced, and repaired.
• A thorough audit programme ensured that radiology and x-ray equipment were under regular review, with learning rolled out from these audits to improve the service.
• Patients gave consistently positive feedback about the service and felt cared for, respected and well informed about all aspects of their care.
• The service was planned well to ensure that patients received care when they needed it, and that staffing was planned to meet this need too.
• Patients’ individual needs were considered which was evidence throughout the clinic such as provision for those with reduced mobility.
• The service had low complaint numbers and we saw complaints information in the clinic for patients.
• The leadership of the clinic was experienced and well qualified.
• The culture amongst staff was consistently positive.
• Staff were encouraged to input to the service and team meetings showed that all staff were involved in the learning from governance issues such as audit and complaints.

We found areas of practice that require improvement:

• The safeguarding lead for the service did not have an adequate level of training. This was a lack of robust oversight of the safeguarding requirements, although the safeguarding lead knew how to escalate concerns.
• Policies underpinning the functioning of the clinic, such as the infection control and clinical governance policies, were largely out of date. This meant that the guidance being followed may not have been current or best practice. We escalated this to the clinic lead on our inspection.
• The service did not train its staff in the Mental Capacity Act 2005. This meant that staff were not competent to assess patients’ capacity to consent to their treatment and investigations.
• The service did not have a formalised risk register. This meant that known risks to the service which the clinic lead told us about, such as the risk of equipment or electrical failure and inadequate staffing levels in the event of staff sickness, were not logged along with the controls, assurances and mitigating actions to manage those risks.
• The service did not have a forward strategy. This meant that service innovations and improvements were not part of a planned programme and were at risk of not receiving appropriate time and resource management.

Heidi Smoult

Deputy Chief Inspector on behalf of the Chief Inspector of Hospitals