What is the Quality of Facilities at St Mary's Urgent Treatment Centre

Positive

"The service is GPled with a multidisciplinary team consisting of emergency department doctors advanced nurse practitioners ANPs nurse practitioners NPs emergency nurse practitioners ENPs and emergency care practitioners ECPs."

Neutral

"The team included a GP specialist adviser and a nurse specialist adviser."

Neutral

"We spoke with the provider’s human resources director and head of workforce management and were able to access the recruitment database to review employment files for nonclinical doctor and nurse staff members."

Positive

"The service is GPled with a multidisciplinary team consisting of emergency department doctors advanced nurse practitioners ANPs nurse practitioners NPs emergency nurse practitioners ENPs emergency care practitioners ECPs and an associate physician AP."

Neutral

"The team included a GP specialist adviser and a nurse specialist adviser."

Positive

"The service is GPled with a multidisciplinary team consisting of emergency department doctors advanced nurse practitioners ANPs nurse practitioners NPs emergency nurse practitioners ENPs and emergency care practitioners ECPs."

Neutral

"The local management team in the centre comprises a clinical director lead nurse and service operational manager."

Positive

"The service is GPled with a multidisciplinary team consisting of emergency department doctors advanced nurse practitioners ANPs nurse practitioners NPs emergency nurse practitioner ENPs and emergency care practitioners ECPs."

Positive

"The provider utilised a combination of GPs emergency department doctors advanced nurse practitioners ANPs nurse practitioners NPs emergency nurse practitioners ENPs and emergency care practitioners ECPs to deliver the service."

Positive

"The interim nurse lead was the infection prevention and control IPC clinical lead and had undertaken online IPC training but no enhanced training to support them in this role."

Positive

"We saw that all nonclinical staff had undertaken online IPC training but there was no record of any of the salaried GPs only one of the sessional GPs and only two of the nurse practitioners having received training."

Positive

"The interim lead nurse was providing a secondary oversight of this process."

Neutral

"The team included a GP specialist adviser and a nurse specialist adviser."

Neutral

"The local management team in the centre comprises a clinical director lead nurse and service operational manager."

Neutral

"During our visit we: • Spoke with a range of staff including the interim management team recruitment duty doctors nurse practitioners and reception staff."

Neutral

"We found that from eight nurse practitioners identified on the training matrix only three had received safeguarding children level three training in line with the provider’s policy."

Neutral

"We randomly selected and reviewed three personnel files of a substantive GP nurse and nonclinical staff member and two agency files of a doctor and nurse."

Neutral

"However not all substantive GPs and nurse practitioners had a record of training."

Neutral

"We reviewed three assessments for GPs and one for a nurse practitioner and found that these were satisfactory."

Neutral

"Some staff we spoke with told us there had been limited clinical supervision due to no clear leadership and the absence of a lead nurse role for a number of months."

Positive

"Risks to patients • There were arrangements for planning and monitoring the number and mix of staff needed."

Positive

"The provider told us this had had a positive impact on the process of controlling and monitoring prescriptions."

Positive

"Additional monitoring had been put in place at regional level to manage the incident and complaints processes."

Positive

"Track record on safety • The service had acted upon findings of previous inspections and were able to demonstrate improvements for example the xray monitoring process for missed fractures."

Positive

"Performance outcomes was shared with staff and commissioners as part of contract monitoring arrangements."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Positive

"The provider told us this had had a positive impact on the process of controlling and monitoring prescriptions."

Positive

"Performance was shared with staff and the local clinical commissioning group as part of contract monitoring arrangements."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"For example monitoring of xray reporting adverse events and serious incidents safeguarding and clinical notes reviews."

Positive

"• Implemented a daily risk management meeting within the UCC which included monitoring of xrays."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"• Reestablished its standard operating procedure for the monitoring of xrays."

Neutral

"• Reviewed systems and processes implemented for the monitoring management and followup of xrays."

Positive

"Opportunities to prevent or minimise harm were missed as there was insufficient oversight and monitoring of ongoing incidents and risks both at local and organisational level."

Positive

"Furthermore opportunities to prevent or minimise harm were missed as there was insufficient oversight and monitoring of ongoing incidents and risks both at local and organisational level."

Positive

"Furthermore there was insufficient oversight and monitoring of ongoing incidents and risks at both local and organisational level."

Positive

"Management monitoring and improving outcomes for people The urgent care centre was contractually required to meet a range of quality and performance indicators and provide performance reports to the clinical commissioning group CCG."

Positive

"Monitoring risks to patients There were procedures for assessing monitoring and managing risks to patient and staff safety."

Positive

"The provider told us it was working in collaboration with the commissioners on addressing the issues identified which included cold chain management safeguarding clinical leadership workforce capacity monitoring xray reports and the organisational escalation policy."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"However the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs had been inconsistent and there were periods of understaffing."

Neutral

"However the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs had been inconsistent."

Neutral

"The arrangements for planning and monitoring the number of staff and the mix of staff needed to meet patients’ needs had been inconsistent."

Neutral

"• A system of planning and monitoring the number of staff and mix of staff needed to meet patients’ needs and the requirements of the service."

Positive

"Track record on safety • The service had acted upon findings of previous inspections and were able to demonstrate improvements for example the xray monitoring process for missed fractures."

Positive

"The provider demonstrated improvement in the systems and processes for crosschecking xray reports."

Positive

"All patients presenting to the UCC with a suspected fracture had an xray undertaken by the hospital trust which was then interpreted by a UCC clinician and a diagnosis and appropriate management provided at the time of consultation."

Neutral

"For example monitoring of xray reporting adverse events and serious incidents safeguarding and clinical notes reviews."

Positive

"• Systems and processes were failing to alert the provider to the backlog of xray clinical reviews."

Positive

"All patients presenting to the Urgent Care Centre UCC with a suspected fracture had an xray undertaken by the hospital trust which was then interpreted by a UCC clinician and a diagnosis and appropriate management provided at the time of consultation."

Positive

"• Undertook a clinical review of each patient s consultation and xray result to identify any missed fractures."

Positive

"• Compared the trust s patient list with its own to ascertain the number of patients whose xray had not been crosschecked by the urgent care centre UCC team and created a single patient database."

Positive

"• Ascertained the number of patients whose xray had not been crosschecked by the urgent care centre UCC team and created a single patient database."

Neutral

"We asked the provider to demonstrate its operating procedure and saw a single database of all patients who had had an xray undertaken."

Positive

"For example a recurrence of a breach of the cold chain process and failure of the system to crosscheck xray reports."

Positive

"• All patients presenting to the Urgent Care Centre UCC with a suspected fracture had an xray undertaken by the hospital trust which was then interpreted by a UCC clinician and a diagnosis and appropriate management provided at the time of consultation."

Positive

"• We found that systems and processes were failing to alert you to a backlog of xray clinical reviews."

Positive

"• An effective response when the backlog of xray reporting was identified."

Positive

"The provider told us it was working in collaboration with the commissioners on addressing the issues identified which included cold chain management safeguarding clinical leadership workforce capacity monitoring xray reports and the organisational escalation policy."

Positive

"• Where patients were waiting for a long time in the centre there was visual awareness of the waiting area and signs had been placed in the area advising patients to speak to a receptionist if their condition worsened."

Positive

"• The service was provided primarily for patients living in northwest London but there were no restrictions to access and the service was utilised by patients transiting through the area via one of the major transport hubs and a significant number of homeless patients."

Positive

"The service was provided primarily for patients living in northwest London but there were no restrictions to access and the service was utilised by patients transiting through the area via one of the major transport hubs and a significant number of homeless patients."

Positive

"The service was provided primarily for patients living in northwest London but there were no restrictions to access and the service was utilised by patients transiting through the area via one of the major transport hubs and a significant number of homeless patients."

Positive

"• Leaders had established proper policies procedures and activities to ensure safety and assured themselves that they were operating as intended."

Positive

"• Leaders had established proper policies procedures and activities to ensure safety and assured themselves that they were operating as intended."

Positive

"• There was a programme of quality improvement including clinical audit which had a positive impact on quality of care and outcomes for patients."

Positive

"At our previous inspection we found the provider could not demonstrate an effective clinical audit programme to drive improvement in patient outcomes."

Positive

"• A system of clinical audit to drive improvement in patient outcomes."

Positive

"• There was limited evidence that clinical audit was driving improvement to patient outcomes."

Neutral

"• There was an inadequate clinical audit programme to drive improvement in patient outcomes."

Positive

"• The provider provided staff with ongoing support which clinical supervision onetoone meetings and appraisals."

Neutral

"This included clinical supervision onetoone meetings and appraisals."

Neutral

"At this inspection we saw staff had received an annual appraisal and there were structures in place for mentorship clinical supervision and onetoone meetings for both substantive and sessional staff."

Neutral

"Some staff we spoke with told us there had been limited clinical supervision due to no clear leadership and the absence of a lead nurse role for a number of months."

Positive

"• Staff told us they received safety information from the service as part of their induction and ongoing training which included health and safety and moving and handling."

Positive

"The provider had an induction programme for all newly appointed staff which included health and safety role specific training and policies and procedures."

Positive

"Staff told us they received safety information from the service as part of their induction and ongoing training which included health and safety and manual handling."

Positive

"• There was an effective system to manage infection prevention and control IPC which included a nominated IPC lead training for all staff relevant to their role and regular audit."

Positive

"There was an effective system to manage infection prevention and control IPC which included a nominated IPC lead training for all staff relevant to their role and regular audit."

Positive

"• The provider could not demonstrate that all staff had undertaken identified training in line with its policy which included safeguarding children safeguarding adults fire safety awareness infection prevention and control and basic life support."

Positive

"The interim nurse lead was the infection prevention and control IPC clinical lead and had undertaken online IPC training but no enhanced training to support them in this role."

Positive

"• The provider had identified a range of training for all staff which included safeguarding children and adults basic life support fire safety awareness infection prevention and control equality and diversity and information governance."

Positive

"This indicated there were gaps in training for clinical staff in safeguarding basic life support fire safety awareness infection prevention and control equality and diversity and information governance."

Positive

"• Staff had received training which included safeguarding children safeguarding adults fire safety awareness infection prevention and control and basic life support in adherence to the provider policy."

Positive

"The hospital trust cleaning team was responsible for cleaning the premises and we saw that appropriate standards of cleanliness and hygiene were maintained."

Positive

"The hospital trust cleaning team was responsible for cleaning the premises and we saw that appropriate standards of cleanliness and hygiene were maintained."

Positive

"• The hospital trust cleaning team was responsible for cleaning the urgent care centre and we observed the premises to be clean and tidy."

Neutral

"The service had replaced the previous fabric chairs with wipeable chairs and a television and patient information screen had been installed."

Neutral

"There was a wheelchair available for patients requiring assistance."

Positive

"The induction included a corporate and local overview safeguarding incident reporting information governance and rolespecific topics such as assessing mental capacity medicine management streaming guidance identifying serious illness and red flags."

Positive

"• The service had been lacking a clear management and clinical leadership structure and staff had not felt supported in their daytoday roles."

Positive

"• There had been a lack of clear management and clinical leadership and staff had not felt supported in their daytoday roles."

Positive

"Staff we spoke with told us there had been a lack of clear management and clinical leadership and staff had not felt supported in their daytoday roles."

Positive

"The provider told us it was working in collaboration with the commissioners on addressing the issues identified which included cold chain management safeguarding clinical leadership workforce capacity monitoring xray reports and the organisational escalation policy."