This service is rated as Good overall.
This service has been inspected previously, but not rated. Those reports can be found by selecting the ‘all reports’ link for LMCS Ltd on our website at www.cqc.org.uk.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive at LMCS Ltd on 31 May 2019 as part of our inspection programme.
LMCS Limited is in Edgware in the London borough of Brent.
The services doctor 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.
Twenty people provided feedback about the service through Care Quality Commission comment cards. The feedback received was all positive.
Our key findings were:
- The clinic was clean and hygienic, and staff had received training on infection prevention and control.
- The service had good systems to manage risk so that safety incidents were less likely to happen. When safety incidents did happen, the service learned from them and improved their processes.
- Staff treated service users with kindness, respect and compassion and their privacy and confidentiality was upheld.
- Feedback from patients was very positive in relation to the quality of service provided.
- Patients could access the service in a timely way.
- There was a complaints policy and procedure, both of which were accessible to patients.
- Governance arrangements were in place and staff felt supported, respected and valued by the provider.
We rated effective as requires improvement because:
- The service did not always review the effectiveness and appropriateness of the care it provided. It did not ensure that care and treatment was delivered according to evidence-based guidelines.
- Quality improvement activity, systems and processes were not comprehensive and there was limited evidence to show the provider reviewed the effectiveness of the care and treatments provided.
- Consent processes for children requiring care and treatment did not follow General Medical Council guidance for obtaining consent from all adults with parental responsibility.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure systems are implemented to assess, monitor and improve the quality and safety of the service provided.
- Ensure systems are implemented to mitigate risks relating to the health, safety and welfare of services users.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care