LivingCare Imaging Limited

Updated 16 April 2019

LivingCare Imaging Limited is part of LivingCare Imaging Limited. The service was established in was established in June 2017 and operates from a private clinic is based in Thorpe Park Clinic Leeds. The magnetic resonance imaging scanning, X-ray and Ultrasound services were available by referral to both private and NHS patients.

The clinic has had a registered manager in post since June 2017. The service is registered for the following regulated activities:

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury.

We conducted an unannounced an inspection of the magnetic resonance imaging service on 28 November 2018 and unannounced inspection of the X-ray and Ultrasound services on 5 February 2019

The service had not been subject to a previous CQC inspection.

Updated 16 April 2019

LivingCare imaging was based within a separate department of the Thorpe Park Clinic Leeds. The service offered controlled access to one 3T magnetic resonance imaging scanner, static digital X-ray equipment and a GE Logiq E9 version ultrasound machine.

The building is a two-storey modern purpose-built facility situated on a business park on the outskirts of Leeds. There is a large car park to the side of the building for patient parking including disabled parking bays nearest to the entrance and drop kerbs from the car park to the path leading to the clinic entrance. The building was alarmed and had external and internal CCTV.

The main clinic doors opened and closed automatically and were wide enough to allow wheel chair access. In the entrance lobby there was an electronic touch screen patient booking in system which alerted reception staff the patient had arrived. The was a reception desk where patients booked in after registering their arrival. There was a general patient waiting area which had enough seating for patients and space for wheel chair users. There was male and female toilet facilities and a disabled toilet in the ground floor diagnostic imaging waiting area. A water dispenser was available for patients to use.

The magnetic diagnostic imaging facility was on the ground floor. There was a separate entrance door which lead to a lobby area leading to the magnetic resonance imaging facility, X-ray room and Ultrasound room. There was a waiting area for patients. There was a shared male and female disabled toilet accessible by wheel chair. There were two patient changing cubicles for patients who were required to change into gowns. There were lockers for patients to leave their valuables in while being scanned or X-rayed. The was a portable automated external defibrillator in the lobby area. There was a consultation room with computers and seating where issues could be discussed privately with patients. There was a key pad coded entry door for magnetic resonance imaging staff to use to access the magnetic resonance imaging scanning facility. there was a bell for staff and patients to use next to the key pad to alert magnetic resonance imaging staff someone was outside. This system prevented someone who had not completed a safety questionnaire accidentally entering when a scan was ongoing. If there were back to back appointments there was a separate magnetic resonance imaging patient waiting area on the first floor.

The magnetic diagnostic imaging scan room contained the scanner. There was an office adjacent to the scan room with an observation window for magnetic resonance imaging staff to view patients while they were being scanned.

The X-ray room door had safety warning information displayed and a warning light which illuminated when the X-ray equipment was being used. The room was lead lined. There was a partitioned section and screen which the staff stood behind when X-raying patients. There were two computers with display screens which staff used to view the digital images generated by the X-ray.

The Ultrasound room had an external sign to indicate if the room was in use. Inside there was curtain which could be pulled around the examination bed if the patient needed to remove clothing and wear a gown. The ultrasound scanner was portable.

The service was not accredited by a national body.

LivingCare Imaging had a full staff establishment of 1.8 whole time equivalent (WTE) radiographers for magnetic resonance imaging. The service had recently recognised the need to increase the radiographer establishment in February 2018 by 0.8WTE because of an increase in demand. Both the radiographers had post graduate certificates in magnetic resonance imaging. The radiography staff undertook both magnetic resonance imaging scans and X-rays.

The staff in the ultrasound department consisted of two bank sonographers who worked on a Monday and Friday the working hours were dependent on demand. Both were health and care professional council registered (HCPC). One of the sonographers did muscular skeletal (MSK) and upper abdominal scans, and the other one only did MSK only. The service carried out ultrasound guided injections which were mainly steroid injections to settle pain and inflammation prior to a scan. No controlled drugs were used. The service carried out Arthrograms which are done for patients with small cartilage tears around joints. Arthrograms included use of dilute contrast dyes used during magnetic resonance imaging scans.

The magnetic resonance imaging service was available 9am to 5pm Monday to Friday. Staff could start at 8am and stay later if required dependent upon appointments. There was occasional weekend working for sports team referrals. There was no lone working as part of staff contractual arrangements and if the clinic was open on a Saturday one of the referrers medical team always attended with the patient, for example the team physiotherapist or doctor.

There was capacity for X-Rays from 9am to 5pm Monday to Friday with evening appointments offered if required. To maximise staff efficiency working across both X-ray and magnetic resonance imaging 30 min X-ray appointments were offered. There were currently 80 free appointments per week. The referrals for magnetic resonance imaging scans and X-rays came from professional football, rugby and sports clubs, private sources including Consultant Surgeons, Physiotherapists, Osteopaths, Chiropractors and internally from LivingCare ear, nose and throat NHS referrals. Referrals could be made for pre-magnetic resonance imaging safety X-Rays for private and NHS patients carrying out intra-orbital foreign body X-Rays (IOFBs) from a radiographer or an original magnetic resonance imaging referrer.

Referrals for ultrasound came from the following sources; professional sports clubs, private doctors, physiotherapists, other healthcare professionals, a private medical insurer, choose and book system for general PR actioners(GPs), internal NHS referrers from other services provided by LivingCare which were Urology for pre-cystoscopy renal and diagnostic scans and from the any qualified practitioner (AQP) contract with a local NHS hospital trust.

The service used seven radiologists on a consultation basis to review the magnetic resonance imaging scan results, X-rays and ultrasound scans and prepare reports. Four specialised in musculoskeletal images and three specialised in neurological images.

Administrative staff provide support for all the services located in Thorpe Park Clinic.

The service was registered to provide the following regulated activities:

• Diagnostic and screening procedures.

• Treatment of disease, disorder or injury.

Activity In the reporting period November 2017 to November 2018

• The magnetic resonance imaging section of the service saw 1526 patients, 383 were private non-sports, 960 were from professional sports clubs and 183 were NHS Living Care ear, nose and throat referrals.

• In the reporting period February 2018 and February 2019, the X- ray section saw 121 patients

• In the reporting period January 2017 and January 2018, the ultrasound section had carried out 511 ultrasound scans.

• Track record on safety

• No Never events

• No clinical incidents, no incidents with harm, one with low harm, none with moderate harm, none with severe harm and no deaths.

• There were no reports of serious injuries

• No IRMER/IRR reportable incidents

- No complaints were recorded.

Updated 16 April 2019

We rated it as Good overall because;

• All staff mandatory and safeguarding training was up to date.

• There were records of regular cleaning and hand hygiene audits being conducted.

• All relevant magnetic resonance imaging equipment was labelled in line with Medicines and Healthcare Products Regulatory Agency (MHRA) recommendations.

• All the staff files contained relevant proof of qualifications including practicing privileges, skills and experience, training record, photographic identification and current Disclosure and Barring Service (DBS) checks.

• Staff had current up to date appraisals and there were copies of current up to date appraisals from the primary employers of the seven sub-contracted radiographers.

• There was positive patient feedback and staff demonstrated an understanding of the patients.

• The availability of the service was designed around managing the demand and patient profile of those using the magnetic resonance imaging scan, X-ray and Ultrasound services.

• Patients were given choices around their appointment times which were discussed at the point of booking.

• There were regular governance meetings.

• There was a risk register and risk was discussed at the clinical governance committee meeting.