Ascroft Medical

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the service on 15 November 2017 and asked the provider to make improvements regarding safe care and treatment; effective care and treatment; leadership and duty of candour.

We checked these areas as part of this comprehensive inspection 25 May 2018 and found these issues had been resolved.

This was a joint dental and medical inspection of an independent healthcare service.

Our inspector’s description of the service.

• Ascroft Medical is an independent dental and medical care and treatment service provided by Multimed Limited and is situated at Peter Street, 3 Ascroft Court, Oldham. OL11 1HP.

• The service is primarily focussed towards people who speak Polish as a first or second language although it is open to all who choose to seek care from the service.

• Patients self-refer by phoning the service and appointments are available at different times during the day and early evenings Monday to Sunday.

Our inspection team was led by a CQC lead Inspector and included one dental inspector, a CQC GP specialist advisor and a Polish language interpreter.

During the inspection we spoke with the registered manager, the business manager, one doctor, one dentist and two administrators.

We reviewed personnel files, practice policies and procedures and other records concerned with running the service. We reviewed the full medical records for a sample of patients.

At this inspection we asked the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that since the last inspection the service had improved and was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that since the last inspection the service had improved and was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that since the last inspection the service had improved and was providing well-led care in accordance with the relevant regulations.

Background Information

This was a planned announced comprehensive follow-up inspection carried out on 25 May 2018 to check whether the service was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Ascroft Medical is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services for children and adults and is in Oldham, Greater Manchester. Patients are primarily Polish people with English as a second language. Patients are self-referring and there are no geographical boundaries to using the service. The service is accessed through pre-booked appointments.

The service is registered with the CQC to provide the following regulated activities:

• Diagnostic and screening procedures;
• Surgical procedures
• Treatment of disease disorder and injury.

The service mostly employs doctors, dentists and dental nurses on a sessional basis. A full range of dental care and treatment including extractions, is provided at the service.

Medical services include: gynaecology; diagnosing and treating adult illnesses and diseases, dermatology and treatment of ear, nose and throat conditions.

The regular team consists of:

• Five dentists one of whom was responsible for having oversight of the dental care provided at the service.
• Two dental hygienists.
• Two dental nurses.
• Seven doctors one of whom was responsible for having oversight of the clinical care provided at the service.
• One registered nurse.
• One phlebotomist.

The doctors, dentists and other health care professionals are supported by the registered manager and a team of administration and reception staff.

The registered provider is the registered manager. 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.

11 people provided feedback about the service and this included completed CQC comment cards and all feedback was positive. Patients confirmed they felt listened to and were treated with compassion and kindness. They said they were happy because they were informed about test results quickly. Patients also told us that the facilities were clean and pleasant.

Our key findings were:

• Adult safeguarding and child protection training had been provided. Policies and procedures had improved and were in line with best practice guidance.
• The provider had systems in place to establish links with the appropriate child protection team when required.
• Protocols to ensure adults accompanying children had parental authority were in place.
• The quality of records had improved and now met best practice standards.
• Systems in keeping with best practice guidance had been introduced to confirm the identity of patients.
• Medicines management had improved to ensure prescribing was always in line with best practice guidance.
• Systems in keeping with best practice guidance to ensure communication with the patients GP and other health care practitioners had been introduced.
• Staff supervision and appraisal systems were in use.
• A duty of candour policy was in place and understood by staff.
• Management and governance of the service had improved as systems to monitor and assess the quality of all aspects of the service had been introduced.

There were areas where the provider could make improvements and should:

• Review the information provided on the website about accessing urgent or emergency treatment when the service is closed.
• Review where confirmation is recorded when information has been shared with the patient’s GP.

We carried out this announced inspection on 15 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

This was a joint inspection as part of an independent healthcare service. This report relates to the dental service only. A separate report has been written for the medical service provided by the clinic. You can read the medical report by selecting the 'all reports' link for Ascroft Medical on our website at www.cqc.org.uk.

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 form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Ascroft Medical Centre is located in Oldham, Manchester and provides private medical and dental treatment to adults and children, predominantly to patients with English as a second language (mainly Polish). They are known locally as Ascroft Medical.

There are steps to access the practice with a portable ramp for people who use wheelchairs and pushchairs. Car parking is available near the practice.

The dental team includes five dentists, three dental nurses (one of which is a trainee) and a dental hygienist. The clinical team is supported by two receptionists, a practice manager and a business development consultant. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Ascroft Medical was the practice manager.

On the day of inspection we collected 17 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, one dental nurse, two receptionists, the practice manager and the business development consultant. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 9:00am – 8.00pm, Saturday and Sunday 10.00am – 6.00pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance. Auditing of this process was not being carried out.
• Staff knew how to deal with emergencies. Appropriate medicines were available.
• Not all medical emergency equipment was in place.
• The practice had thorough staff recruitment procedures.
• The process in place to identify and respond to incidents or significant events could be improved.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had a safeguarding policy which required updating. Staff knew their responsibilities for safeguarding adults and children. A process to identify vulnerable adults was not in place.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Management processes could be improved.
• Staff felt involved and supported and worked well as a team.
• The processes in place to help them manage risk could be improved.
• The practice asked staff and patients for feedback about the services they provided.
• The process in place to identify and deal with complaints could be improved.

We identified regulations the provider was not meeting. The regulation breach is covered in the GP report and can be found by selecting the 'all reports' link for Ascroft Medical Centre on our website at www.cqc.org.uk.

There were areas where the provider could make improvements. They should:

• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s policies and procedures in relation to complaints handling, whistleblowing, duty of candour, closed circuit television and safeguarding.
• Review the use of quality assurance processes and risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities paying attention to infection prevention and control, COSHH, dental specific risk assessments and Hepatitis B vaccination.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.

We carried out an announced comprehensive inspection on 15 November 2017 to ask the service the following key questions; are services safe, effective, caring, responsive and well-led? We planned the inspection to check whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

This was a joint dental and medical inspection of an independent healthcare service. This report relates to the medical services only. A separate report has been written for the dental service provided by the clinic. You can read the report by selecting the ‘all reports’ link for the Ascroft Medical- HSCA.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices at the end of the report).

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices at the end of the report).

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices at the end of the report).

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Ascroft Medical is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services for children and adults and is located in Oldham, Greater Manchester. Patients are primarily Polish people with English as a second language who live in the United Kingdom and the service is accessed through pre-booked appointments.

The clinic is registered with the CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder and injury
• Maternity and midwifery services

Doctors and other health professionals such as nurses and dieticians are employed on a sessional basis. The service offers specialist care in the fields of gynaecology, internal medicine, defined as dealing with the prevention, diagnosis, and treatment of adult diseases, dermatology, orthopaedics and psychiatry. Medical consultations, diagnostic tests and minor surgery are provided by the clinic.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner. At Ascroft Medical HSCA the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulations.

The health care team consists of:

• Five dentists
• Three dental nurses
• One dental hygienists
• Six doctors (including an internal medical specialist, gynaecologists, a dermatologist, orthopaedist and psychiatrist).
• One speech and language therapist
• Three non-clinical staff including the registered manager and receptionists.
• One phlebotomist

All the doctors and dentists are registered with either the General Medical Council (GMC) or the General Dental Council (GDC).

The owner of the service is the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We received feedback about the service from 18 patients. All comments were positive and indicated that the service was accessible, patients had confidence in the doctors and felt involved in planning their care and treatment. They told us the staff were caring and the clinic was always clean.

Our key findings were:

• Child protection and paediatric services were not provided in line with best practice guidance.
• There was no clinical governance oversight of the medical services provided.
• The consulting rooms were clean and tidy. However the provider needs to take action to make sure the minor surgery room meets best practice infection control standards.
• Protocols relating to consent in minor surgery did not meet best practice guidance.
• Meetings to discuss patient outcomes did not take place and the doctors employed by the service did not attend team meetings.
• Patient’s records did not always contain sufficient detail to show what treatment had been provided and why.
• Processes for reporting incidents were not well established and systems for dealing with safety alerts were not reliable.
• Medicines for dealing with medical emergencies were incomplete, however all emergency medication was in date and systems were in place to monitor their use and expiry dates.
• Antibiotic prescribing and monitoring was not based on local or national guidance.
• Policies and procedures in place, for example the clinical significant event policy, were not always understood by staff. Policies and procedures were only available in English which was the second language for a significant number of staff.
• Information about making a complaint was available and detailed. However information about how to escalate a complaint to an independent body was incorrect.
• The whistleblowing policy did not support staff because they were not signposted to contact an independent organisation.
• The provider could not demonstrate a clear understanding of responsibilities under the Duty of Candour regulation.
• Information about the range of services and fees was available.
• Systems were in place to follow-up blood and other test results.

We identified regulations that were not being met and the provider must:

• Ensure medicines are managed according to best practice protocols and comply with national and local guidance about prescribing antibiotics.
• Ensure all doctors employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure children and young people are protected from abuse and improper treatment.
• Introduce effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure processes are in place to support compliance with the duty of candour regulation.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review consent processes for minor surgery.
• Review how staff summons assistance when they are lone-working.
• Review risk assessments that have been completed.
• Review the system for signposting patients to the most appropriate out of hours provision when the service is closed.
• Review the process for reflecting feedback from the main social media websites.
• Review the processes for dealing with safety alerts.