Across the Lifespan (75 Harley Street)

Updated 3 February 2023

The service is provided by Across the Lifespan Limited. The service provides clinical and therapeutic services to clients with neurodevelopmental needs. The service specialises in the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) and Autism from childhood to adulthood. Most of their work is with individuals with ADHD with around 85% of their clients being children.

The service is based is at 75 Harley street, W1G 8QL with an additional room at 70 Harley street, W1G 7HF which is registered with the CQC as a separate service. These sites are opposite each other and owned by the same management company.

The provider contracts with 8 consultant psychiatrists, a consultant in paediatric neurodisability and sleep medicine, a counselling psychologist, an occupational therapist and a prescribing nurse.

The service is led by three directors; a medical director and a deputy medical director both of whom are consultant psychiatrists within the service, and a strategy director. The service also has a referrals manager, and six administrative staff. The service is open 9am to 5:30pm Monday to Friday and sees patients face to face and remotely via online appointments and sessions.

Referrals are received from several sources including GPs, schools and educational organisations, other consultant psychiatrists and psychologists, and patients and carers can self-refer. Patients and carers are responsible for funding their treatment either directly or through health insurance.

https://www.dr-giaroli.org/

How we inspected this service

During the inspection visit to the service, the inspection team:

• checked the safety, maintenance and cleanliness of the premises
• spoke with one patient and 10 parents and carers of patients who were using the service
• spoke with the medical director, the strategy director, the deputy medical director, the registered manager, 4 consultant psychiatrists, one consultant in paediatric neurodisability and sleep medicine, 2 personal assistants and the referrals manager
• reviewed 11 patient care and treatment records
• reviewed medicines processes and prescription pad storage and management
• reviewed 3staff records
• reviewed information and documents relating to the operation and management of the service.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 3 February 2023

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Across the Lifespan (75 Harley Street) on the 31 August 2022 as part of our inspection programme. This was the first inspection of this service.

Across the Lifespan (75 Harley Street) which operates under the name of the Giaroli Centre, provides a consultant led outpatient service to assess and treat children and adults with neurodevelopmental needs. This includes private consultations, physical examinations, health assessments and prescribing of medicines for mental health needs.

The provider is registered with the Care Quality Commission to provide the following regulated activities; treatment of disease, disorder or injury, and diagnostic and screening procedures

The practice manager at the service is also 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 spoke to one patient and 10 parents and carers of patients. All the comments were positive, describing caring, kind and professional staff who were instrumental in bringing about positive change. People said their children received effective treatment and support in an efficient, non-judgemental and tailored way. They felt fully involved in their care and said the service was friendly and accommodating and staff always respected their privacy and dignity.

Our key findings were:

• The service provided safe care. The premises where clients were seen were safe and clean. The service had clear systems to keep people safe and safeguarded from abuse. Staff assessed and managed risk well and followed good practice with respect to patient safety.
• Staff developed holistic care and treatment plans informed by a comprehensive assessment in collaboration with patients and carers. Care and treatment were planned and delivered in line with current legislation and best practice guidance produced by the National Institute for Health and Care Excellence (NICE) and suitable to the needs of the patients. The service evaluated and reflected on the quality of care provided to ensure it was delivered to a high standard.
• The service had a range of specialists required to meet the needs of the patients under their care. Leaders ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
• Staff treated patients with compassion and kindness, and understood the individual needs of patients. They actively involved patients and carers in decisions and care planning.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs. Staff had alternative pathways for people whose needs it could not meet.
• The service took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• The service was well led, and the governance processes ensured that its procedures ran smoothly. The provider had a clear vision for improving the service and promoting good patient outcomes.

However,

• Staff found the systems the service used for recording patient records and information complex and not easy to use.
• Physical health observation records were not always updated promptly.
• In cases where the service had not verified patients’ medical histories with their GPs the prescribing of controlled drugs did not follow national guidance.

We saw the following outstanding practice:

• The service provided a specific referral and assessment pathway to support Jewish orthodox communities. This enabled easy and supportive access to clinical and therapeutic services to community members particularly children with neurodevelopmental needs. The service also provided outreach work with these communities through training exploring cultural awareness and reducing stigma surrounding neurodevelopmental conditions such as ADHD and Autism.

The areas where the provider should make improvements are:

• The service should ensure that all patients’ medical information is verified with their GPs before the prescribing of controlled drugs.
• The service should ensure that work continues to improve systems the service uses for recording patient records and information.
• The service should ensure that work continues to improve the recording of patients’ physical health observations.

Jemima Burnage

Interim Director of Mental Health