We carried out an announced comprehensive Hightree Clinic on 25 September 2019. This was the provider’s first rated inspection, and to follow up on breaches of regulations
CQC inspected the service on 9 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was the provider’s first comprehensive inspection. We found the service was not providing safe, effective, responsive or well-led care in accordance with the relevant regulations. We issued two warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance), requiring the provider to achieve compliance with the regulations set out in those warning notices. We also issued two requirement notices for Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 19 (Fees) of the CQC (Registration) Regulations 2009.
We then undertook a focussed inspection on 23 January 2019. At this inspection, we found the requirements of the two warning notices had not all been met. We issued two further warning notices against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).
We then undertook a focussed inspection on 30 April 2019 to follow up on the actions taken in response to the warning notices. Although improvements had been made, not all issues were resolved and we issued two requirement notices for Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).
We followed up on the requirement notices issued following inspection on 9 October 2018 and 30 April 2019 at this inspection. We found the issues concerning Regulation 19 (Fees) of the CQC (Registration) Regulations 2009 had been resolved. We found that although significant improvement had been made, not all issues concerning Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) had been resolved.
This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of regulated activities and services and these are set out in and
of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Hightree Clinic is an independent doctor service. They provide consultation, treatment and prescribing services for conventional and complementary medicine, with an aim to improve and/or sustain patients’ overall quality of life. The clinic offers consultation and treatment only to patients over the age of 18.
Hightree Clinic provides a range of complementary therapies, for example medical acupuncture and osteopathy, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.
The lead GP 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.
We received 14 completed comment cards. Feedback from clients was consistently positive. We received comments that the staff were friendly, kind and knowledgeable. They commented that the service received from the lead GP was caring, professional and thorough.
Overall this service is rated as good.
We rated the service as requires improvement for providing safe services because:
- Systems and processes for infection prevention and control were not all effective, including processes to mitigate the risk of legionella and to maintain staff immunisation.
- Patient records we reviewed showed that information about care and treatment was not always available in an immediately accessible way.
- The clinic was not receiving all safety alerts.
Our key findings were
:
- The clinic organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- The provider was fully aware of the issues and challenges that affected the service. They had realistic action plans to make sure all necessary improvements were made.
- Feedback from clients who used the service was consistently positive.
- The service was proactive in seeking patient and staff feedback to identify and resolve concerns.
- There was a clear leadership structure and staff felt supported by management.
- The culture of the service encouraged candour, openness and honesty.
- Staff worked well together as a team. All staff demonstrated their determination and willingness to improve systems and processes at the clinic.
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.
We have told the provider to take action. You can see full details of the action and regulations not being met in the Requirement Notices section at the end of this report.
The areas where the provider should make improvements are:
- Review and improve the organisation and structure of personnel files.
- Continue to review and strengthen training received relating to child and adult safeguarding, and basic life support.
- Strengthen and continue clinical quality improvement activity.
- Strengthen staff training by determining and implementing mandatory requirements for the clinic.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care