Tooting Medical Centre

We carried out an announced comprehensive inspection at Tooting Medical Centre on 27 and 28 March 2018. We found that this service was not providing well-led care in accordance with the relevant regulations. The full comprehensive report for the comprehensive inspection can be found by selecting the ‘all reports’ link for Tooting Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 July 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 27 and 28 March 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Tooting Med Centre Ltd provides private medical, dental and aesthetic services at Tooting Medical Centre in the London Borough of Merton. Services are provided to both adults and children.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by a medical or dental practitioner, including the prescribing of medicines. At Tooting Med Centre Ltd the aesthetic treatments that are provided by therapists are exempt from CQC regulation.

Our findings were:

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Our key findings were:

• There was evidence that incidents and safety alerts were shared with all staff effectively.
• The service had introduced a clear system to ensure training for staff was monitored.
• Mental Capacity Act training had been undertaken by clinical staff and managers of the service.
• There were systems for monitoring and checking that medical equipment was adequately maintained.
• Chaperoning services were clearly advertised to patients in the reception area and in consulting rooms in both Polish and English.
• The service had reviewed and strengthened systems for recording routine vaccinations for clinical staff.
• The service had implemented policies and procedures for verifying a patient’s identity at each consultation, although checks could not always be recorded on the electronic system used by reception staff.
• There was a policy outlining considerations for sharing information with patients’ GPs.
• There was evidence of some quality improvement measures that had been initiated since the last inspection to monitor whether medical assessments and treatments are carried out in line with evidence based guidance and standards.
• The service had implemented written dental patient assessment templates to ensure dental care records considered relevant nationally recognised evidence-based guidance.

There were areas where the provider could make improvements and should:

• Monitor the updated dental care record systems to ensure they are in line with guidance and standards.

• Continue to develop quality improvement systems that monitor whether medical assessments and treatments are carried out in line with relevant and current evidence based guidance and standards.

Background to this inspection

Tooting Med Centre Ltd is an independent provider of medical, dental and aesthetic services and treats both adults and children. The address of the registered provider is 5 London Road, London, SW17 9JR. Tooting Med Centre Ltd is registered with the Care Quality Commission to provide the regulated activity diagnostic and screening procedures, surgical procedures, termination of pregnancies and treatment of disease, disorder or injury. Regulated activities are provided at two clinic locations in South London; we inspected the location Tooting Medical Centre.

The organisation is run by the nominated individual for the provider. There are two registered managers, who are the general managers of the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The clinic is housed over three floors in leased premises in Tooting. The premises consist of a patient waiting room and reception area, three dental surgeries and a phlebotomy/consultation room on the ground floor, a decontamination room and two treatment rooms in the basement, a staff room, office and three medical consultation rooms which are located over the first and second floors.

The clinic is open between 9am and 9pm seven days a week. Services are available to people on a pre-bookable appointment basis and their clientele is primarily patients of Polish origin.

Regulated services offered at the clinic include general medical, gynaecological and emergency dental services. The service also provides termination of pregnancies and psychiatric services which were not inspected or reported on at this inspection.

At Tooting Med Centre Ltd the aesthetic treatments that are provided by therapists are exempt from CQC regulation and as such were not inspected or reported on.

Practice staff providing dental services consists of nine dentists, one dental nurse and three trainee dental nurses. Medical services are provided by 25 part time doctors, 17 of which are specialists across a range of medical fields including obstetrics and gynaecology, general medicine, cardiology and general psychiatry. Nine doctors reside in Poland and regularly travel to England to provide services for the provider. The medical team also consists of a nurse and a phlebotomist. Other employed health care staff, that are exempt from CQC registration, include a psychologist, colonic therapist, speech therapist and body analysis specialist. Administrative support for the medical and dental teams is provided by five reception staff members and two service managers.

Why we inspected the service:

The service has received 11 previous inspections since 2013 in response to concerns and to follow up on previous breaches of regulations. Since the inspection in November 2016, some areas of concern were identified from queries raised with us.

We undertook a comprehensive inspection of Tooting Medical Centre on 27 and 28 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found that this service was not providing well-led care in accordance with the relevant regulations. The full comprehensive report for the comprehensive inspection can be found by selecting the ‘all reports’ link for Tooting Medical Centre on our website at www.cqc.org.uk.

We undertook this follow up focused inspection of Tooting Medical Centre on 26 July 2018. This inspection was carried out to review in detail the actions taken by the service to improve the quality of care and to confirm that the service was now meeting legal requirements.

How we inspected the service:

Our inspection team on 26 July 2018 was led by a CQC Lead Inspector.

Before visiting, we reviewed a range of information we hold about the service.

As part of the inspection we:

• Spoke with the phlebotomist.

• Spoke with the two registered managers of the service.
• Spoke with the nurse ahead of the inspection.
• Spoke with a doctor on the telephone after the inspection.
• Looked at the systems in place for the running of the service.
• Viewed changes in key policies and procedures.

On this focussed inspection we asked the following question about the service:

• Is it well-led?

This question therefore formed the framework for the areas we looked at during the inspection.

We carried out an announced comprehensive inspection on 27 and 28 March 2018 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We also planned the inspection to check on concerns raised which we had received.

Tooting Med Centre Ltd provides private medical, dental and aesthetic services at Tooting Medical Centre in the London Borough of Merton. Services are provided to both adults and children.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by a medical or dental practitioner, including the prescribing of medicines. At Tooting Med Centre Ltd the aesthetic treatments that are provided by therapists are exempt from CQC regulation.

We received feedback from 26 people about the service, including comment cards, all of which were very positive about the service and indicated that patients were treated with kindness and respect. Staff were described as helpful, caring, thorough and professional.

Our key findings were:

• The practice was clean and well maintained.
• There were safe systems for the management of medicines and infection control.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk although medical equipment was not always monitored effectively.
• There was a system for recording and acting on adverse events, incidents and safety alerts although it was not clear that these were shared with medical staff effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had completed thorough staff recruitment checks in most cases.
• There was evidence of some quality improvement.
• The practice had an effective clinical supervision system for medical staff.
• Systems for monitoring safety training for medical staff were not always effective.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified regulations that were not being met and the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the systems for monitoring and checking medical equipment.
• Review how chaperoning services are advertised to patients.
• Review the systems for recording vaccinations for clinical staff.
• Review the system for documenting identification checks that have been carried out.
• Review the processes for gaining consent to share information with patients’ GPs.
• Review the provision of Mental Capacity Act training for clinical staff.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice's protocols for dental patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.
• Review the systems that ensure medical assessments and treatments are carried out in line with relevant and current evidence based guidance and standards.