Carmenta Life

Updated 26 July 2019

Our inspection team

Our inspection team was led by a Care Quality Commission (CQC) lead inspector. The team included a GP specialist adviser.

Background to Carmenta Life

Carmenta Life is an independent healthcare service provided by Euro Health Service Limited from the ground floor of Chesham House, Church Lane, Berkhamsted, Hertfordshire, HP4 2AX.

Information regarding the service can be found on the following website: www.carmenta-life.co.uk

The service lead and registered manager is Joseph Iskaros, a consultant obstetrician and gynaecologist. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider employs the services of other self-employed medical practitioners to perform regulated activities from one consultation and treatment room. These practitioners have a third-party employment contract with Carmenta Life. They are a GP, an ultrasonographer, a tongue-tie practitioner and a consultant paediatrician.

The provider uses several other rooms for unregulated activities. These were not included in this inspection. A well-being service also operates from the same location and the reception staff from the well-being service welcome patients to Carmenta Life.

Services are provided by appointment only. There is no walk-in service provision. Appointments are available by arrangement on a flexible, fee-paying basis from 8am to 10pm Mondays to Fridays and from 8am to 5pm on Saturdays. Appointments are also available on Sundays if required. The services provided include, but are not limited to:

• General practice including general medical consultations.
• Paediatric consultations.
• Gynaecology services.
• Infertility services.
• Antenatal and post-natal care.
• Frenulotomy – new-born and neonatal tongue-tie division.
• A range of diagnostic procedures and ultrasound scans based on the services listed above.

How we inspected this service

Before our inspection we reviewed a range of information we held about the provider. During our inspection we:

• Spoke with the service lead.
• Looked at the premises and equipment used by the service.
• Reviewed Care Quality Commission comments cards left for us by patients to share their views and experiences of the service.
• Looked at a sample of patient records.
• Reviewed policies, procedures and other information the service used to deliver care and treatment.

Third party medical practitioners who worked from the service were not available to speak with us on the day of the inspection. We contacted all of them by email shortly after our inspection and some of them responded. From their responses we ascertained their understanding of some policies, processes and their responsibilities at the service, what support they received and the culture at the service.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 26 July 2019

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Carmenta Life on 1 November 2018. We found that the service was not providing safe and well-led care in accordance with the relevant regulations. A requirement notice was served in relation to the breaches identified under Regulation 12 - Safe care and treatment. We carried out an announced comprehensive inspection at Carmenta Life on 19 June 2019 to follow up on the breaches of regulation and as part of our inspection programme.

We found the service had taken the necessary action to make the required improvements in relation to the breaches of regulation we identified on 1 November 2018.

The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Carmenta Life on our website at www.cqc.org.uk.

Carmenta Life provides a range of general medical, gynaecology, paediatric, antenatal and post-natal services to private, fee-paying patients. Diagnostic and screening procedures are available using a range of high-quality equipment and laboratory tests. This includes performing ultrasound scans and taking blood and cytology samples for testing.

Carmenta Life is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some of the services provided at Carmenta Life are not within the CQC scope of registration and are exempt from CQC regulation. We did not inspect or report on these services.

The service is registered with the Care Quality Commission to provide the regulated activities: treatment of disease, disorder or injury; family planning; maternity and midwifery services; surgical procedures and diagnostic and screening procedures.

Seven patients contacted the Care Quality Commission directly to share their experiences of the service with us. We also reviewed five patient Care Quality Commission comments cards at the service during our inspection. All of the comments we received were positive about the practitioners and the service experienced. Patients said they felt staff were personable, caring and respectful. They told us they felt listened to and had confidence and trust in the practitioners to make the right decisions about their care and treatment. They said the service was accessible and it was easy to book appointments.

Our key findings were:

• Care and treatment was delivered in accordance with evidence-based guidelines. Quality improvement activity was used to review the effectiveness and appropriateness of the care provided.
• Patients were treated with kindness, respect and compassion. Their privacy and dignity was respected and they were involved in decisions about their care and treatment.
• Services were organised and delivered to meet patients’ needs. Patients could access care and treatment in a timely way.
• There was a culture of high-quality, sustainable care. The service encouraged feedback from patients.
• Structures, processes and systems to support good governance and management were clearly set out, understood and effective in most cases.

The areas where the provider should make improvements are:

• Introduce a formalised, service-wide process and policy to verify the identity of service users prior to consultation or treatment.
• Adhere to the intercollegiate guidance on safeguarding competencies so that staff complete the appropriate level of safeguarding adults training for their roles.
• Strengthen the system in place to monitor that medicines and medical equipment are fit for purpose, so that the expiry dates of the medical oxygen and body spillage kits are regularly checked.
• Take steps so that in all cases when a medicine is prescribed, the dose is accurately recorded in the patient’s notes.
• Introduce a written business continuity plan that details how a service would be maintained in the event of a major incident.
• Take steps to formalise and document the annual meeting of the medical practitioners at the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care