This service is rated as Good overall.
The key questions are rated as:
Are services safe? – Requires improvement
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 The London Travel Clinic at London Bridge as part of our inspection programme. The London Travel Clinic at London Bridge is part of The London Travel Clinic which provides travel immunisations, treatment and advice to fee paying patients.
We had previously inspected this service as part of our unrated programme of independent health inspections. At our last inspection undertaken on 6 July 2018 we found that the service was in breach of regulation 12 (safe care and treatment) and regulation 17 (good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found that the provider had not adequately mitigated risks associated with infection control. The service was not monitoring ambient room temperatures to ensure that medicines were stored safely, the service had not risk assessed the need for all recommended emergency medicines and the accessibility of the nearest defibrillator and infection control risks and those associated with legionella and fire had not been adequately assessed or addressed. In addition we found that there was no ongoing quality improvement activity, there was no mechanism in place to review and act on patient feedback, there were no documented business continuity plans in place and there was insufficient oversight and management of patient group directions.
At this inspection we found that most of these concerns had been resolved; however, the provider still did not have adequate oversight of risk management activities undertaken by third parties, some risks had not been adequately assessed or mitigated including those associated with fire and legionella, there were two expired PGDs and some staff employed on a temporary basis had not signed a confidentiality agreement.
The clinical nurse lead for the service is 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.
Two patients provided feedback to CQC about the service. Both patients said that the service was of a high standard and that staff members were kind and helpful.
Our key findings were:
- The provider had systems in place in relation to safeguarding although one staff member was not clear on who acted as the lead for safeguarding.
- Some risks were not adequately assessed, addressed or mitigated. For example the risks associated with fire and legionella had not been assessed and staff were not clear who acted as the fire marshal.
- Appropriate emergency equipment was available on site and staff knew what to do If a patient presented with the symptoms of sepsis
- There were systems in place to report and discuss significant events. However staff were not clear on the reporting mechanisms.
- Medicines were appropriately managed in most respects and there were systems in place to respond to safety alerts. However we found that two patient group directions (PGDs) had expired.
- Care and treatment provided was effective and met patient needs.
- There were systems to review consultations, feedback to staff and implement improvements where needed.
- Feedback from patients was positive about access to treatment and the care provided and there was a system for managing complaints.
- Services were designed to respond to the needs of patients.
- Leadership was visible and staff said that they felt happy to raise concerns or issues that arose.
- Governance systems were present in most areas although there were some instances where the provider did not have effective systems in place to oversee risk.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure that care and treatment is provided in a safe way.
The areas where the provider should make improvements are:
- Consider ways to better accommodate patients with accessibility needs.
- Include details of all staff working at the site in the business continuity plan.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care