Queens Clinic

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found that the service was not providing safe care, because: The clinical records system at the service could only be interrogated by patient name, date of birth or address. On this basis, if a patient was treated on site with a medicine about which there was a subsequent alert, there would be no way to identify them on the database. The service had not implemented processes to ensure that it was following its own safeguarding of adults policy and protocol.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider told us that he was aware of when concerns should be raised and investigated. The service lead told us that they would discuss issues of this kind with colleagues outside of the service. There were no recorded details of these discussions, nor consent of patients such that discussions could take place outside of the service.

There was a system for recording and acting on significant events. However, the service had not raised any clinical incidents in the last year, so we were unable to see how this worked in practice. The provider was only able to demonstrate that searches could be made on the database under patient post code and date of birth as well as patients’ names. They indicated that a “label” search for specific conditions or medicines was possible, but on the day of the inspection the service was not able to demonstrate that this worked. The database could still not be searched in relation to a safety alert, or to assist in outcome-based audits. The provider reported that they had spoken to the company who provides their database to look at improving it in the future, although no specific details were provided to corroborate this. If a patient was treated on site with a medicine about which there was a subsequent alert, there would be no way to identify them on the database.

We asked the provider if they had a protocol for sharing information with patients’ GPs, and more specifically where there were potentially red flag symptoms which required follow up, even where the patient had not consented. This is required so that potentially serious issues may be followed up in the best interests of the patient. The provider was not able to provide a protocol detailing this. We asked why details of what had been shared with patients' GPs either with or without patient consent did not appear in the clinical record. The provider did not provide a response to this.

The service had no formalised protocol for information sharing with a patient’s GP. There was no formalised recording of information sharing where patients’ health is potentially at risk.

Leaders were not able to demonstrate that safeguarding was being managed safely. They reported that it was their practice to have detailed discussions with patients where the possible need for safeguarding referral was suspected, and that they would record this on the patient record. We asked if the provider was able to demonstrate this in any of the patient records, and they were unable to provide an example of where they had done so. We asked the provider if they could provide any real time examples of where a safeguarding referral had been considered. They were not able to do so. There was a continued lack of formalised review of patients who may require referral to a safeguarding team.

The provider reported that they had made no changes to their safeguarding policy following breaches in regulation identified at the previous inspection, but added they had looked at introducing a template to assist with safeguarding referrals. However, this was not provided to the CQC team at the time of the inspection. The safeguarding process as detailed was in line with national guidelines, but was not being followed.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Leaders were not able to demonstrate safe and effective staffing procedures. CQC asked whether or not the service had undertaken a risk assessment of having a healthcare assistant (HCA) assist with operating procedures rather than a regulated clinician such as another doctor or nurse, as detailed as an area that needed to be addressed in two previous CQC reports. The provider was not able to provide this. We asked how in the absence of care certificate accreditation, the provider had oversight of the work of the HCA. They told us that the HCA was accredited to undertake cannulation, but was unable to detail formal mechanisms of how the work of the HCA was monitored and reviewed. The provider told CQC that they wished to have a further HCA, receptionist and service manager at the clinic. The provider provided details of ongoing recruitment for a service manager, but not the other two roles.

There were no formalised work force plans in place at the service for the number of staff. The service was not able to provide protocols for how staff were being utilised at the service.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.