Old Orchard Consulting Rooms

This service is rated as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out this announced comprehensive inspection of Old Orchard Consulting Rooms on 20 February 2023, under Section 60 of the Health and Social Care Act 2008. 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. This was the provider’s first inspection of the service since it registered with the Care Quality Commission (CQC).

How we carried out the inspection:

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Speaking with staff in person, on the telephone and using video conferencing.
• Requesting documentary evidence from the provider.
• A site visit.

We carried out an announced site visit to the service on 20 February 2023. Prior to our visit we requested documentary evidence electronically from the provider. We spoke to staff on the telephone and using video conferencing prior to and following our site visit.

Old Orchard Consulting Rooms is an independent service providing consultation and examination with consultant surgeons, specialising in urology, colorectal and general surgery. Treatment for haemorrhoids, using haemorrhoid banding is provided by one colorectal surgeon. (Banding is an outpatient treatment wherebya special rubber band is placed round the base of the haemorrhoid which constricts and cuts off the blood supply.)

Old Orchard Consulting Rooms is registered with the Care Quality Commission to provide the following regulated activities: Treatment of disease, disorder or injury; Diagnostic and screening procedures.

The medical director of the service, although no longer involved in the delivery of clinical care, 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.

Our key findings were:

• There were safeguarding systems and processes to keep people safe. However, some staff had not completed training in the safeguarding of children and vulnerable adults at an appropriate level to support their role, in line with current guidance.
• There were processes in place for the induction and monitoring of training of administration staff. There was a lack of evidence of completed training for consultants.
• There were records to demonstrate that recruitment checks had been carried out in accordance with regulations for administration staff. However, there was a lack of checks undertaken of clinical consultants.
• Arrangements for chaperoning were displayed. However, the offer or attendance of a chaperone was not recorded within the patient’s clinical record.
• There were some processes to assess the risk of, and prevent, detect and control the spread of infection. However, there was no formal assessment of the risks associated with legionella bacteria.
• Staff immunisation status was not monitored in line with current guidance.
• There were governance and monitoring processes to ensure the safety of premises, including fire safety. However, there was a lack of a documented fire risk assessment for the premises.
• There were effective administrative processes in place to ensure patients had timely access to consultation and treatment.
• Patient consent to treatment and risks and complications of treatment were not recorded in clinical records.
• There was a lack of monitoring and audit of clinical record keeping.
• The service was not registered to receive safety alerts.
• There was effective and open communication and information sharing amongst the small staff team. There were regular team meetings and staff felt motivated to contribute to driving improvement within the service.
• Staff were subject to regular review of their performance and felt well supported by managers.
• Written policies did not always provide accurate and clear information to staff in line with current guidance.
• Service users were asked to provide feedback on the service they had received and there were high levels of patient satisfaction across the service.
• Complaints were managed appropriately.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons 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.

(Please see the specific details on actions required at the end of this report).

The areas where the provider should make improvements are:

• Further review COSHH risk assessment and take action to ensure the safe use of chemicals used to decontaminate suction device.
• Secure external clinical waste storage to prevent improper use or access.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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