Across the Lifespan (75 Harley Street)

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