Queens Clinic

This service is rated as inadequate overall. The service had previously been inspected on 13 February 2020, 9 February 2021, 2 September 2021 and 30 November 2021, and in each case, there were breaches of CQC regulations. Following the inspection on 30 November 2021 the service was rated as requires improvement overall, and in the safe, effective and well led key questions. The responsive and caring key questions were rated as good. The service was found to be in breach of regulations 12, 17 and of HSCA (RA) 2014 and requirement notices were put in place. The specific issues found at this inspection were:

• The oxygen bottle in place at the surgery was noted to be empty at the time of the inspection.
• The service did not own its own defibrillator but shared one with another organisation in the building. Staff at the service were unaware of where this was located, and by the time it was found and staff returned to the clinic, five minutes had passed.
• Learning from incidents was not routinely shared within the team.
• Learning from audits was unclear. Audits completed were not recorded in cycles, and as such it was not possible to determine whether or not performance had improved.
• The practitioner did not routinely send out letters to patients in a password protected format.
• On the day of the inspection, neither the lead clinician or service manager were able to show completed fire safety or information governance training.
• We spoke to several staff who either worked at the clinic or had worked there in the past. They told us that there was a non-supportive culture at the service. Several reported being publicly criticised by the provider, and they stated that they had no autonomy. They reported being afraid to raise issues of concern with the provider.
• The service did not have either a risk register or other formal way of showing that risks were being identified, recorded, monitored and mitigated.

We carried out an announced comprehensive inspection of Queens Clinic on 30 September 2022. We found that some of the breaches of regulation from the previous inspection had been addressed, but others had not. Following this inspection, the key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

Our key findings were:

• The service had good systems to manage risk in most areas so that safety incidents were less likely to happen. The service had limited quality improvement mechanisms in place, so it was unclear how the service was determining if the care was of sufficient standard, and incidents were not being missed.
• The service undertook procedures under local anaesthetic, but in the event of an adverse reaction to local anaesthetic, the lead clinician was the only person available to manage this. The lack of a second clinician had not been adequately risk assessed.
• The service had not reviewed the effectiveness and appropriateness of the care it provided. Records reviewed were also unclear regarding the exact nature of procedures, and what had been discussed with the patient.
• Staff at the service had not received appraisals.
• Staff treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service. An adequate complaints system was in place.
• The organisation had appropriate leadership structures in place. However, governance systems, particularly those whereby learning could be demonstrated, were unclear.
• The service had not addressed issues identified as requiring improvement in previous CQC inspections, and continuing breaches of CQC regulations were evident.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.
• Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of good staffing.

The service should:

• Review the notes tracker on the patient records database, which was incomplete.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services