Background to this inspection
Updated
31 July 2019
InHealth Endoscopy Ealing Diagnostic Centre is operated by InHealth Endoscopy Limited. The service opened in 2015 and is part of an independent sector provider delivering primarily NHS commissioned services in London. It provides endoscopy services for adults and serves a diverse community from across south-east England.
The service is registered to provide one regulated activity:
- Diagnostic and screening procedures.
The service has had a registered manager in post since March 2018. This individual was also the provider’s head of endoscopy operations and would rescind registration when a new unit manager achieved registration with CQC. This was on-going at the time of our inspection.
The service is co-located with the InHealth Integrated Diagnostics Centre and shares a reception team and some non-clinical space. Although this is operated by the same provider, they are registered separately with CQC. This means we did not inspect services not part of the endoscopy clinic.
We have not previously inspected this service.
Updated
31 July 2019
InHealth Endoscopy Ealing Diagnostic Centre is operated by InHealth Endoscopy Limited as part of a network of locations within a specialist services directorate. The service is a community clinic and provides care and treatment to patients who are medically fit and stable.
The clinic has two preparation (admission) rooms, two procedure rooms, two recovery bays and a seated discharge area with two reclining chairs. The service is commissioned by five clinical commissioning groups (CCGs) to provide direct access to colonoscopy, flexible sigmoidoscopy and gastroscopy for routine referrals from GPs. The service is co-located with the InHealth Integrated Diagnostics Centre and shares a reception team and some non-clinical space. Although all these services are operated by the same provider, they are registered separately with CQC. This means we did not inspect services not part of the endoscopy clinic. The clinic has in-house endoscope decontamination facilities and trained staff.
The service provides care and treatment to patients referred by the NHS to reduce waiting times.
We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 28 February 2019.
The service had typically operated five days per week from 8am to 6pm and at the time of our inspection had started to work towards seven-day working. The service had clinical space to accommodate this and the senior team were building staff numbers to ensure expansion was carried out safely.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
We have not previously rated this service. We rated it as Good overall.
We found good practice:
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Processes for safe water management were robust and ensured patient’s safety. Staff had taken immediate action where routine testing indicated a risk.
• The service team acted on audits and quality evaluations to continually identify opportunities for benchmarking and improvement.
• Safety and risk management processes were clearly embedded in practice and a strict referral system meant staff saw patients only when they had enough information to provide a safe level of care.
• Staff managed all areas relating to health and safety, such as medicines management and staffing, in line with established processes and protocols. The registered manager and the unit manager ensured protocols were reviewed and updated in a timely fashion to reflect the latest national standards.
• The provider facilitated a ‘just culture’ that encouraged open discussion of mistakes and reporting of incidents. This included use of the duty of candour, which staff used to ensure patients were kept informed when things went wrong.
• The service had a waiting list and managed this well. In the previous 12 months the service had met the standard six-week referral to treatment time (RTT) in five months.
• Governance processes included all staff and helped the team to assess the quality of the service and to drive development and improvement. The governance structure was being expanded and improved as part of a five-year development plan.
We found areas of outstanding practice:
• The provider was an early adopter of transnasal gastroscopy services, which provided a more comfortable experience for patients and reduced the need for sedation.
However, we also found the following issues that the service provider needs to improve:
•Storage arrangements for controlled drugs did not meet required standards in line with the Misuse of Drugs Act 1971.
•Although overall standards of infection control were good, there were risks in relation to how staff used the decontamination area and discrepancies between service standards and audit criteria.
We found a breach of Regulation 12, part 2 (g), of the HSCA 2008 (Regulated Activities) Regulations 2014 in relation to the safe and proper management of medicines. We told the provider that it must:
• Ensure controlled drugs are stored and managed in line with the requirements of the Misuse of Drugs Act 1971, including separate, secure storage. This must include effective audit processes.
We also told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve:
• Provide staff with the tools to monitor patients for deterioration and to respond to urgent clinical needs.
• Minimise infection control risks through effective, consistent audits and practice.
• Review safety monitoring and training to manage risks associated with major haemorrhages and sepsis.
• Store resuscitation equipment securely and provide tamper-proof storage.
• Check resuscitation equipment every day the clinic is open for service.
Professor Sir Mike Richards
Chief Inspector of Hospitals