Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Life Line Screening UK Corporate Office 3rd Floor, Suite 8, 31 Chatsworth Road, Worthing, BN11 1LY Date of Inspections: 06 March 2014 05 March 2014 Tel: 01903223360 Date of Publication: March 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Cleanliness and infection control Safety, availability and suitability of equipment Requirements relating to workers Assessing and monitoring the quality of service provision Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Life Line Screening UK Limited Mr. MacDara Edward Jordan Life Line Screening UK Corporate Office is an independent health care service which provides mobile health screenings. Diagnostic and/or screening service Diagnostic and screening procedures Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Cleanliness and infection control 10 Safety, availability and suitability of equipment 11 Requirements relating to workers 12 Assessing and monitoring the quality of service provision 14 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 5 March 2014 and 6 March 2014, observed how people were being cared for and talked with people who use the service. We talked with staff. What people told us and what we found Our inspection of Life Line Screening included a visit to the office on 5th March 2014 and at a mobile screening clinic on 6th March 2014. During our visit we spoke with six people who use the service and nine staff members including the director of operations who was the registered manager and the clinical manager. People were given detailed information prior to their screening and an assessment was undertaken to ensure they were having appropriate tests. We saw that people's privacy and dignity were respected during the screening process and that the clinic was managed in a way that promoted people's safety and wellbeing. People we spoke with told us they were generally happy with the service. One person told us "It's my third time here. It's a good service. Staff are discreet and friendly." Another person told us "I can't fault them. It's a good service and staff are very kind and professional." We observed staff following guidance in terms of infection control and people we spoke with told us the service was very clean and efficiently managed. We saw that equipment was well maintained and the accuracy of test results was maintained through a process quality testing. We saw that staff were employed in line with appropriate recruitment and selection processes and that appropriate employment checks were carried out prior to workers commencing in post. Staff we spoke with told us they were satisfied with the quality of service they were able to provide. You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 4
number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement During our visit to Life Line Screening we saw that people who use the service were given appropriate information and support regarding their screening tests. We spoke with six people who were using the service and were told that people had generally received adequate information on the service and knew what to expect. One person we spoke with told us that they had felt unclear about the instructions on whether or not they needed to fast before their screening. However they had been contacted with the information prior to attending their appointment and told us their experience of the service on the day had been "fine". We viewed information leaflets and fact sheets for people on the different types of screening available to them and the types of health issues the screening might detect. We saw that the information was written in a clear way, giving people information on what a specific test was for, the equipment used and what would happen on the day. People we spoke with told us they had received an information leaflet prior to attending the screening appointment. We observed staff welcoming people to the clinic and ensuring they understood the tests they were having. We saw staff going through a safety notice with people to ensure the tests they were having were appropriate for them. The screening service on the day of our visit was held in a local community hall. We saw that a separate screening area was created using screens to ensure that people using the service had their privacy and dignity maintained. Each screening station was private and we observed staff being mindful of people's dignity and confidentiality. People we spoke with told us they felt their privacy and dignity had been respected. One person told us "I can hear voices but not what they're saying" in reference to staff conversations with other people who use the service. Another person told us "Staff are discreet and friendly." Staff we spoke with told us that one of the aims of their initial conversation with people Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 6
when they arrive at the clinic is to make sure they are aware of the tests they are having, why they are having them and when they are likely to receive their results. We viewed the assessment notes of three people who use the service and saw that in all cases people had signed their consent to specific screening tests. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 7
Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement During our visit to Life Line Screening we viewed the records of three people who use the service and spoke with six people about their experience on the day of their screening. We were told that decisions about the types of screening people had depended on factors including their age, medical and family history and any previous screening. We saw that people were asked to complete an assessment form on arrival and that information was gathered relating to people's medical history, family history and diagnosed medical conditions. We observed staff talking through the information with people and were told that this was an opportunity for staff to clarify people's understanding and any safety issues relating to their screening. Staff told us that the questions they asked people at this point were also geared towards ensuring that the screening tests people were having were appropriate. We were told that tests were recommended based on identified risk factors such as a person's body mass index (BMI) or their medical history. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We were told there were a number of measures in place to ensure the accuracy of test results, including monitoring of the equipment and corroboration of results by a second person when irregularities were found. The clinical manager also told us of the use of both internal and external metrics to ensure accuracy. We viewed a report from a clinical advisory committee that verified the results of carotid artery (250) and abdominal aortic aneurysm (130) screenings as being 100% accurate. We saw that arrangements were in place to send people their test results within twenty one days but that if an issue was visible at the time of the screening they would be advised of this at the time. Staff told us they supported people to access their GP and we viewed literature that included answers to frequently asked questions that arose in these types of situations. We saw that people's care and treatment reflected relevant research and guidance. Staff informed us that they had attended relevant training to ensure they remained up to date and were working in a way that kept pace with relevant guidance. One staff member told us they had spent time training at an affiliated hospital and we viewed training records that supported this. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 8
We saw that there were arrangements in place to deal with foreseeable emergencies. We viewed records of staff having received training in basic life support and we viewed an emergency protocol that instructed staff in the types of situations where emergency services would be called. We observed staff interacting with people who use the service in a patient, calm and professional manner. We saw that time was taken to answer people's questions and give a full explanation of the process of screening. People we spoke with told us they were happy with the quality of care they received. One person told us "Staff are kind and polite, they are genuinely nice." Another person told us "Staff are very nice. I'm impressed with how efficient they are. There was no waiting and everything was very clear." Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 9
Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. Reasons for our judgement During our visit we saw that there were effective systems in place to reduce the risk and spread of infection. We viewed an up to date infection control policy that provided staff with details of infection control measures during a screening clinic. We observed a clean and tidy clinic space and the team manager told us that part of their role when attending a new community venue was to assess the risk, including risks relating to infection control. We were told that control measures included the use of sanitising gels and sprays and to work with the venue manager to ensure the room was appropriately clean. During our visit to the screening clinic we observed that hand sanitising gel was out on tables at each screening station, at the reception desk and on other tables in the waiting area and we saw staff regularly using the hand sanitiser. We viewed detailed infection control protocols for each screening station and item of equipment. We saw that instructions included the use of sanitiser spray on examination tables and pillows and the use of paper towels. Each item of equipment had specific cleaning instructions and these instructions included cleaning of some equipment after each use. We viewed signed records that demonstrated staff having followed the protocol and this was supported by feedback from people who use the service. We viewed the use of sharps and clinical waste bins and viewed a service level agreement for the disposal of clinical waste. People we spoke with told us they were happy with the level of cleanliness they saw while using the service. One person we spoke with told us "They sprayed the table and cleaned it while I was there so I was happy everything was clean. I saw them using the hand gel as well." Another person told us "It's very clean. I saw them wiping everything down." Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 10
Safety, availability and suitability of equipment People should be safe from harm from unsafe or unsuitable equipment Our judgement The provider was meeting this standard. People were protected from unsafe or unsuitable equipment. Reasons for our judgement During our visit we saw that people were protected from unsafe or unsuitable equipment because the provider had in place a system of quality assurance, maintenance and replacement of essential equipment. We viewed a number of agreements in place for the supply and quality check of equipment that included service level agreements, external audits and leasing arrangements. We saw that equipment in use included ultrasounds, doppler machines, blood analysis machines, electrocardiogram machines and blood pressure monitors. We viewed a service level agreement in place for the equipment supply, provision of quality assurance and performance monitoring of the blood analyser machines and we saw arrangements in place for quality checking of other equipment. We were told that quality checking included arrangements for 'side by side' studies to ensure the quality of results of ultrasound equipment and we viewed a report that reflected this from an external provider. We viewed instruction manual guidance for blood pressure monitors that stated machines should be inspected every two years to ensure accuracy. The provider might find it useful to note that there was no record of this having been done, however the manager told us that blood pressure monitors were replaced on a regular basis. We viewed purchase records for blood pressure machines that demonstrated the machines in use had been purchased in the last two years. The manager told us that they would add blood pressure monitors to an annual equipment inventory and audit this against the manufacturer's guidance. We viewed equipment in use and saw that portable appliance (PAT) testing had been carried out and that equipment had been tested within the last year. The manager told us that arrangements were in place for the annual testing of all portable appliances. Staff we spoke with told us that they were happy with the quality and supply of equipment they needed to provide the screening service. The team manager we spoke with told us that equipment was checked regularly and that in the event of identified faults, arrangements were in place to replace equipment quickly and avoid undue disruption of the service. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 11
Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Reasons for our judgement During our visit to Life Line Screening we saw that there were effective recruitment and selection processes in place and that appropriate checks were undertaken before staff began work. We viewed recruitment and selection processes that included internal and external job advertisements and the use of recruitment agencies as required. We were told that applications were collated by the human resources department and that shortlisting was carried out by a relevant manager against key criteria of the role applied for. We viewed an interview scoring sheet that included whether the specific quality was essential or desirable, how it was measured and the evidence supplied, and a mark between one and four relating to the quality of the evidence. We saw that interview questions were based on a candidate's qualifications, knowledge, experience, skills and abilities. We saw that appropriate checks were carried out prior to staff commencing in post. Checks included Disclosure and Barring Service (DBS) checks, references, evidence of a right to work and where appropriate professional registration with the Health and Care Professions Council. The human resources manager showed us a log of an audit that was in the process of being carried out to ensure all checks had been undertaken as appropriate. We viewed information about staff induction and saw that detailed induction plans were in place for each role within the organisation. We saw that the induction plan included developing an understanding of relevant policy areas, getting to know the company as a whole, observing screening clinics where appropriate and understanding quality assurance processes. Staff we spoke with told us they had received appropriate training to be able to undertake their role. One staff member told us that induction training was thorough and included a probationary review. "New staff will shadow us until they feel confident. The probationary period is usually signed off within three months." Staff told us they attended annual clinical training with a specialist and that this included Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 12
the use of equipment and 'side by side' tests every six months to ensure that staff skills were up to date and the accuracy of the tests they carried out was high. Because of this people were cared for, or supported by, suitably qualified, skilled and experienced staff. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 13
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement During our visit we saw that people who use the service were asked for their views about their care and treatment and they were acted on. We viewed an example of a customer survey where people who use the service were asked for feedback. People were asked about aspects of the service including the instructions they received prior to their appointment and the approach of the staff. We viewed comments that included praise for the manner of the staff and some suggestions on areas that could be improved. We saw that the results of the survey were collated centrally and sent to each clinic team in order that action could be taken where needed. We viewed a complaints policy that was visible to people who use the service and included details of response times and how complaints were dealt with. We saw an example of a complaint where a person had felt misinformed about preparation for their screening, staff told us that this had led to further staff training following an investigation. We saw that the Care Quality Commission (CQC) was cited in the complaints policy as the regulator of the service, however the provider might find it useful to note that there was no information about how to contact CQC in relation to the policy. Staff told us they had the opportunity to be involved and listened to through staff meetings and training days, including an open forum where they were able to raise concerns should they need to. The manager told us that staff in the field had regular contact with the management of the organisation through a process of audit, review and field visits. We saw that monitoring of the quality of the service was the responsibility of the clinical manager who works with guidance from an expert medical board who advise on research and development. We were also told that a clinical advisory committee are responsible for reviewing and endorsing clinical protocols, advising on training and acting as an external assessor of quality control mechanisms and audit. We saw that membership of these groups included a consultant cardiologist and other relevant experts. During our visit we reviewed an external quality report following 'side by side' studies that were used to verify the quality of the screening. We saw that there were a number of mechanisms in place for quality assurance of Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 14
screening procedures. Staff told us that the clinical manager visited every few weeks to carry out quality control activities which included conducting a random audit that would be benchmarked and reviewed by the chief medical officer. We were told that the clinical manager also undertook six monthly competency evaluations on all clinic staff. There was a process in place where staff assessed as being less than proficient would be placed on a performance enhancement programme and re-evaluated two weeks later. We viewed risk assessments relating to the screening clinics that included risks relating to setting up the clinic as well as risks relating to the venue. We viewed control measures in place that included allowing time to set up based on the number of staff available and the use of protective cases and trolleys. Control measures relating to the venue included the use of a venue booking questionnaire and a field check visit to ensure suitability. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 15
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social 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 essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 16
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 17
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 18
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 19
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 20
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Life Line Screening UK Corporate Office March 2014 www.cqc.org.uk 21