Signature Clinic - Central London Also known as Signature Medical Ltd

On this page

• 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

At our previous inspection in August 2023, it was concluded that this service was not always safe. At this inspection, we were unable to rate safe, as we reviewed compliance with the warning notice that we served the provider following the previous inspection. We assessed four quality statements. There was a positive learning safety culture where events were investigated, and learning was embedded to promote good practice. Staff were open and honest when things went wrong. Staff provided safe care and treatment. The environment was safe, well maintained and met people’s needs. Leaders had increased staffing levels when needed to keep the department and people safe. Staff were trained and competent and had the right skills to meet people’s needs. They had the opportunity to learn and gain experience.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients were confident about raising concerns and these were taken seriously. Patients and their families were involved in investigations if they wanted to be, and reports of the event were shared with them. Patients or those who represented them were given an apology and an explanation of the event, and a timely written response. Patients were advised to raise any queries at consultation with the consultant or other suitably qualified clinical staff.

Staff knew what incidents they should report and when and were confident to do so. The provider’s formal reporting system was easy to use and staff were supported when things went wrong. Staff saw incidents as an opportunity to learn and improve.

A health based online information system had been introduced across the whole company in March 2024. It had been in use at the London location since April 2024 and was used to record all incidents. Since April 2024, we saw that 8 incidents had been recorded. The service investigated all reported incidents, had an action plan in place where a member of staff was assigned to the action and was responsible for implementing learning, within set timescales. Learning was disseminated to staff in all-staff monthly meetings.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

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 assess this quality statement on this inspection, and as such the score for it remains the same as at the previous inspection.

Patients told us staff were well trained and competent with the care and treatment they were providing. Patients were listened to and given good advice and information.

In response to our previous feedback that Healthcare Assistants (HCAs) were being signed off as competent for particular clinical skills by staff who did not have the appropriate knowledge and skills to do so, the service was now employing agency nurses to fulfil the roles the previously undertaken by HCAs. The scrub nurses at the service carried out duties which included dispensing and handling medication, and ensured that World Health Organization (WHO) checklists were completed. It was therefore clear who had prescribed medicines for each patient and this was documented.

The service had increased its staffing levels and now employed 2 additional full-time nurses. We noted 2 HCAs had been scrub-trained and their competencies for these additional tasks was overseen by the operating department practitioner responsible for assisting service development.

At the previous inspection, we found the bed used for post-operative patients was not suitable and could not be effectively cleaned after use. At our recent inspection, we observed that the bed in the post-operative room had been replaced with a fully adjustable and wipeable clean bed which staff cleaned between each patient. There were sufficient waterproof wipe down pillows in the post-operative room, which were cleaned in between patients. At the previous inspection, we found there were no paper hand towels for staff to dry their hands after washing, in multiple areas, including the kitchen and decontamination room. We observed paper hand towels and sufficient washing facilities in the decontamination room and toilet, including cleanser and hand wash were now in place. The provider had implemented effective surgical decontamination processes, including a magnifying glass with sufficient lighting and a stand. This was a core component of surgical decontamination standards, which were in use in the decontamination room.

Staff were trained and assessed to safely administer medicines. Staff we spoke with were aware of the provider’s medication management policy and procedures that needed to be followed when administering medicines for patients. The provider’s group pharmacist was responsible for ordering medicines, and once received some staff, including HCAs, were competency trained to bring prescription only medicines to the pharmacy room and who checked and labelled the medicines under the direct supervision of the pharmacist.

Staff stored medicines safely in locked fridges and cupboards. Records were kept of ambient and fridge temperatures in clinical areas where medicines were stored. However, we noted that the fridge temperature had no reset button, and the maximum temperature was above the manufacture’s recommendation. We informed the provider of this during the inspection, who confirmed that they were in the process of ordering a new refrigerator. We noted patient records included the patients’ medical history taken on admission and records of prescribed medicines. Patients were given specific written instructions for discharge medicines.

There were processes in place to ensure that patients received medicines safely and all medicines administered were recorded on the medicines administration record. Discharge medicines were prepared by the pharmacist, and at discharge given to the patient by a registered nurse or the duty doctor who ensured they were aware of how to use the medicines. The provider did not currently stock controlled drugs. There were storage facilities available to safely store controlled drugs if needed.