Review of compliance. McDiarmid-Hall Clinic Limited McDiarmid-Hall Clinic. South West. Region: 22 Imperial Square Cheltenham Gloucestershire GL50 1QZ

Transcription

1 Review of compliance McDiarmid-Hall Clinic Limited McDiarmid-Hall Clinic Region: Location address: Type of service: South West 22 Imperial Square Cheltenham Gloucestershire GL50 1QZ Doctors consultation service Date of Publication: March 2012 Doctors treatment service Acute services without overnight beds / listed acute services with or without overnight beds Overview of the service: McDiarmid-Hall Cheltenham Clinic is a surgeon-led organisation registered with the Care Quality Commission to provide pre- and post-operative consultations to adults patients for cosmetic surgery. Page 1 of 18

2 Summary of our findings for the essential standards of quality and safety Our current overall judgement McDiarmid-Hall Clinic was meeting all the essential standards of quality and safety. The summary below describes why we carried out this review, what we found and any action required. Why we carried out this review We carried out this review as part of our routine schedule of planned reviews. How we carried out this review We reviewed all the information we hold about this provider, carried out a visit on 27 February 2012, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services. What people told us We visited the McDiarmid-Hall Cheltenham Clinic on 27 February 2012 and spent the afternoon at the clinic. We met and talked with patients who were either being treated, having a post-operative assessment, or having a consultation. We met the consultant surgeon, Mr James McDiarmid, and discussed how the clinic met essential standards of quality and safety. After our inspection we contacted a nurse who worked for the clinic and asked them about their role, training, and experience. We looked at patient's confidentiality and the information they received about their proposed treatment or aftercare. We sat in on consultations with patients and we talked with them about their treatment and if it met their expectations. We looked at infection prevention and control protocols and procedures and checked the clinic for cleanliness. We looked at how the clinic assessed and monitored the quality and safety of treatment and care. We met with six patients who had undergone treatment, were coming for treatment or were prospective patients at the clinic. We were invited by patients to sit in with them during their assessment, consultation or procedure. We also reviewed the medical records for these patients. Patients said their treatment had been "fantastic" and "I am so pleased with the results". Patients said they had plenty of time to ask questions and did not feel they were pressurised "at any time" into taking a decision about proceeding with treatment. Patients said they signed consent where this was required. Information about patients and their medical records was kept confidential and safe. Patients who wanted to proceed with a surgical procedure that required an operating theatre were booked into one of two local private hospitals. The consultant surgeon, Mr Page 2 of 18

3 James McDiarmid, or another specialist surgeon recommended by Mr McDiarmid, carried out the surgery and met with the patient before the operation at the hospital. Patients said that their care at the hospital had been "fine" and "excellent". Mr McDiarmid told us he had all the equipment and staff at the two hospitals to carry out surgery. The clinic, consultation room and treatment room were clean and well equipped. Appropriate infection prevention and control measures were in place. Staff were supported to carry out their roles although there were no formal updates to appraisals of staff. The organisation assessed and monitored the quality of its service. At the time of our visit, the person registered with the Care Quality Commission as manager no longer worked for the organisation. Mr James McDiarmid was asked to prepare an application to register as manager. The information on the website also required updating in some areas. What we found about the standards we reviewed and how well McDiarmid-Hall Clinic was meeting them Outcome 01: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run People who come to McDiarmid-Hall Cheltenham Clinic have their privacy and confidentiality respected. People are given information and advice to enable them to make informed choices about their treatment. Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights People who come to McDiarmid-Hall Cheltenham Clinic receive safe and appropriate treatment and care. Outcome 08: People should be cared for in a clean environment and protected from the risk of infection People who come to McDiarmid-Hall Cheltenham Clinic are protected from the risk of acquiring an infection. The service has an effective system of cleaning and infection prevention and control. Outcome 14: Staff should be properly trained and supervised, and have the chance to develop and improve their skills Page 3 of 18

4 People who come to McDiarmid-Hall Cheltenham Clinic are treated by staff who are appropriately qualified, experienced, trained and skilled in their roles. Outcome 16: The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care People who come to McDiarmid-Hall Cheltenham Clinic receive safe care and treatment from an organisation that monitors and assesses the quality of its service and takes effective decisions. Other information Please see previous reports for more information about previous reviews. Page 4 of 18

5 What we found for each essential standard of quality and safety we reviewed Page 5 of 18

6 The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential Compliant means that people who use services are experiencing the outcomes relating to the essential A minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary improvements are made. Where there are a number of concerns, we may look at them together to decide the level of action to take. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety Page 6 of 18

7 Outcome 01: Respecting and involving people who use services What the outcome says This is what people who use services should expect. People who use services: * Understand the care, treatment and support choices available to them. * Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support. * Have their privacy, dignity and independence respected. * Have their views and experiences taken into account in the way the service is provided and delivered. What we found The provider is compliant with Outcome 01: Respecting and involving people who use services Our findings What people who use the service experienced and told us We met and talked with six patients who were visiting the clinic for consultations, procedures, or post-operative reviews. Patients told us they were treated with privacy and dignity. Records were made and personal information was given in a private consultation room or in the treatment clinic room. Patients said that they had not overheard information or seen records about other patients that should otherwise be confidential. Patients said they were given information about any proposed procedure and able to ask as many questions as they wanted to. We were told that patients understood the procedure being provided and were able to make an informed choice. Other evidence We observed care and treatment being delivered to patients. We observed six sessions with patients, including a surgical consultation. Patients were given time to ask any questions they had and seek further information. Consultations and procedures were carried out in private. Prospective patients, existing patients or anyone who had accompanied them waited at reception while other patients were being treated and were not able to overhear private consultations. The treatment room was not visible to people waiting in the reception area. Page 7 of 18

8 At the consultation we observed the person was given lengthy and detailed information about the proposed procedure. They were presented with various options and it was made clear where there were cost implications of one option over another. The person was not asked to agree to any procedure at the time and was invited to take information away to consider the options. The person was able to ask plenty of questions and seek clarity on, for example, aftercare and recovery time. People who come to McDiarmid-Hall Cheltenham Clinic have their privacy and confidentiality respected. People are given information and advice to enable them to make informed choices about their treatment. Page 8 of 18

9 Outcome 04: Care and welfare of people who use services What the outcome says This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. What we found The provider is compliant with Outcome 04: Care and welfare of people who use services Our findings What people who use the service experienced and told us We talked with the six patients we met at the clinic as to whether they received safe and effective care and treatment. Patients said their process "was excellent from start to finish". We were told the consultation and pre-operative assessment was thorough. Patients said they were asked to give relevant information, such as their medical history and any medications that they were currently taking. Patients said they were given appropriate and sufficient information about the procedure they were electing. They were able to ask questions about any aspects of the process and how they would feel after the surgery. Patients said they "actually felt better than I expected to" and "it all went as planned and as expected". Patients were given time to ask questions and given advice about their aftercare and how to look after themselves post-operatively. Other evidence During our visit we observed consultations and post-operative examinations with the consultant surgeon, Mr James McDiarmid. At post-operative examinations we saw patients were asked relevant and appropriate questions as to how they were feeling and if they were following the aftercare regime. Patients were able to discuss any concerns they might have. They were able to be reassured from the surgeon's experience of the procedure as to whether their concerns would be his normal postoperative expectations. Patients were given advice as to the next steps and what they should expect. They were told to contact the surgeon at any time if they had concerns. Page 9 of 18

10 During our visit we looked at patient notes and medical records. The notes only contained basic information and were not particularly detailed. The notes did not clearly record the discussions the surgeon had with the patient or what advice had been given. We looked at the treatment room and found it stocked with relevant and appropriate medical equipment. There was a small stock of medications on site that were in date and stored safely. Medicines that required refrigeration were stored in the fridge, and the temperature was monitored and recorded. There was a patient couch in the clinic and the consultation room which could be raised and lowered to assist the patient and staff. The consultation and treatment room windows could be or were obscured by blinds and not overlooked. There was a resuscitation kit that had recently been restocked with anaphylaxis drugs and medical equipment for use in an emergency. There was also an emergency oxygen kit with appropriate masks for adult patient use. The clinic had a hydraulic lift at the rear of the premises that could be used for people who needed wheelchair access. The clinic had fire exits to front and rear that were marked. The fire extinguisher in the clinic room had not been serviced and no contract was in place for regular servicing. After our visit we contacted and talked with an experienced theatre nurse who had worked alongside Mr James McDiarmid, the consultant plastic surgeon, for many years in different locations. The nurse worked at the clinic one day every fortnight to provide chaperone services and counselling to patients. The nurse was able to address the anxieties of patients from a long and experienced career in operating theatre work. We were told patient safety and the mitigation of risks was "the highest priority for the clinic". We heard examples of patients being told the risks and rewards of any procedure clearly and accurately. We also heard that the clinic had a "strong ethical leaning" and patients were turned away if there were any concerns with their mental health and recommended for further professional counselling. Patients would also be turned away if their expectations were too high or unrealistic or the procedure they wanted was unsafe considering their medical history. People who come to McDiarmid-Hall Cheltenham Clinic receive safe and appropriate treatment and care. Page 10 of 18

11 Outcome 08: Cleanliness and infection control What the outcome says Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance. What we found The provider is compliant with Outcome 08: Cleanliness and infection control Our findings What people who use the service experienced and told us Patients we met said they found the clinic to be clean and following infection control protocols. We were told gloves were used during treatment or examinations and the treatment room was "always clean". Other evidence We inspected the premises for infection and prevention control procedures. The clinic room and consultation room had couches where paper roll was used and disposed of between patients. The consultant surgeon wore gloves when treating patients and the gloves were disposed of as clinical waste. The clinic and treatment room had 'sharps' boxes for the disposal of single-use clinical waste. They were collected and disposed of by a professional company every two weeks. Any surgical instruments that were not single-use items were sent for sterilisation to an NHS Theatre Sterile Services Unit and returned in sterile packs. There was an elbow-operated sink in the clinic room with soap, hand sanitizer and paper towels available. The clinic was clean and well organised. The majority of instruments, medication, and appropriate equipment were stored in cupboards to enable surfaces to be more easily cleaned. Although gloves were worn, we did not observe regular thorough hand washing before or after treating patients. People who come to McDiarmid-Hall Cheltenham Clinic are protected from the risk of Page 11 of 18

12 acquiring an infection. The service has an effective system of cleaning and infection prevention and control. Page 12 of 18

13 Outcome 14: Supporting staff What the outcome says This is what people who use services should expect. People who use services: * Are safe and their health and welfare needs are met by competent staff. What we found The provider is compliant with Outcome 14: Supporting staff Our findings What people who use the service experienced and told us We did not ask patients anything specifically about their impression of staff training and support. Other evidence Mr James McDiarmid, the consultant surgeon, was a member of a number of registered bodies for plastic surgeons in the UK and internationally. This included, among others, being a Fellow of the Royal College of Surgeons, a member of the British Association of Plastic Reconstruction and Aesthetic Surgeons (BAPRAS), British Association of Aesthetic Plastic Surgeons (BAAPS). Mr McDiarmid was registered with the General Medical Council (GMC). After our inspection we contacted and talked with a nurse who worked at the clinic for one day every fortnight. The nurse had almost 40 years of experience in theatre and was a member of the Nursing and Midwifery Council (NMC), the Royal College of Nursing and The Association for Perioperative Practice (formerly the National Association of Theatre Nurses). We checked and found the valid and up-to-date registration for the nurse on the NMC register. The nurse's training and clinical practice experience was mostly gained in other organisations, including the NHS and independent hospitals in the Gloucestershire area. The nurse did not have reviews of her work with the consultant surgeon as a routine, but had training and appraisals at other hospitals. The nurse had made her training certificates and curriculum vitae available to Mr McDiarmid. Page 13 of 18

14 People who come to McDiarmid-Hall Cheltenham Clinic are treated by staff who are appropriately qualified, experienced, trained and skilled in their roles. Page 14 of 18

15 Outcome 16: Assessing and monitoring the quality of service provision What the outcome says This is what people who use services should expect. People who use services: * Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety. What we found The provider is compliant with Outcome 16: Assessing and monitoring the quality of service provision Our findings What people who use the service experienced and told us We did not ask patients anything specifically about how the service monitored quality and safety. Other evidence The clinic was a small consultant-led practice that carried out pre- and post-operative assessments and consultations. The clinic also carried out minor cosmetic surgical procedures, most of which were not part of the clinic's registration with the Care Quality Commission. There was no specific governance structure to assess and monitor the service. However, the consultant personally handled complaints and they were responded to quickly and appropriately. The consultant told us the clinic would be able to quickly identify if there was a trend developing in these complaints. Appropriate adjustments to address any concerns would be made if they affected patient safety and care. The consultant attended conferences both in the UK and internationally to be updated on the latest best practice in and around plastic and reconstructive surgery. The nurse that we talked with had attended conferences on cosmetic surgery and been recognised for her work by The Kings Fund and The Association for Perioperative Practice. People who come to McDiarmid-Hall Cheltenham Clinic receive safe care and treatment from an organisation that monitors and assesses the quality of its service and Page 15 of 18

16 takes effective decisions. Page 16 of 18

17 What is a review of compliance? By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. When making our judgements about whether services are meeting essential standards, we decide whether we need to take further regulatory action. This might include discussions with the provider about how they could improve. We only use this approach where issues can be resolved quickly, easily and where there is no immediate risk of serious harm to people. Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actions or compliance actions, or take enforcement action: Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying with essential standards, but we are concerned that they will not be able to maintain this, we ask them to send us a report describing the improvements they will make to enable them to do so. Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people. Page 17 of 18

18 Information for the reader Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public / Copyright (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Quality Commission Website Telephone address Postal address enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Page 18 of 18