Stratum Clinic

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 7 quality statements from this key question. We found that although a governance process was evident, there was a lack of clinical leadership and clinical input into audit and monitoring of care. This limited the ability to identify where improvements could be made to care. There was a minor risk identified regarding the storage of emergency medicines. However, since the previous inspection, there had been significant improvement to the governance arrangements, specifically in management of non-clinical aspects of the service. We identified a breach of regulation 17 and requested an action plan from the provider regarding how they intended to improve.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had enhanced the leadership team by recruiting a compliance lead, which improved oversight and governance of non-clinical aspects of the service.

There was a strategy and shared direction among the staff group. There was a focus on patients’ experiences and their wellbeing.

Staff feedback suggested the culture among the staffing team was positive and inclusive. However, from interviews with leaders it was apparent there were not clear lines of clinical leadership or means of ensuring local clinicians were involved in quality improvement. The medical director was not leading the design of audit activity which was in place.

The culture among the staffing team was positive and inclusive. However, there were not clear lines of clinical leadership or means of ensuring local clinicians were involved in quality improvement. Audit work did not demonstrate there was appropriate clinical input into audits in their design and application. They did not accurately reflect the clinical records we reviewed, included minimal numbers of patients and did not contain all the checks required in line with national guidance.

Staff told us they were aware of where the policies were stored and would access them if needed in regards to raising any concerns. Staff were aware of how to raise internal concerns for incident reporting.

There were processes and a policy for staff to follow in regards speaking up. These were reviewed annually. The provider made the policy available to staff and they were informed of the process at their inductions.

The leadership team assured us staff undertook training in equality, diversity and human rights. The culture among the staffing team was positive and inclusive.

There were policies related to equality and diversity and guidance on ensuring peoples rights were protected.

Leaders informed us there had been a role recruited to for ensuring improvements in governance we established. The compliance lead had ensured significant improvements to non-clinical governance processes had taken place. This included functioning systems for monitoring staff training, background and health checks, equipment and premises safety and ensuring policies were up to date and relevant to the service. However, leaders were not aware of some systems which were not operating effectively and we identified some minor risks which had not been identified as part of a system of governance. There was no smoke evacuation risk assessment required for certain procedures. Medicines management systems which had been implemented since the last inspection enabled improved monitoring of medicines. However stock and expiry checklists were not accurate. These issues were rectified following the inspection. There had been a newsletter implemented for staff to promote and share learning from incidents, complaints, changes to clinical guidance and patient feedback. This had enhanced communication within the service.

There were clearly defined structures, processes and systems to support good governance. Accountabilities with regards to effective governance arrangements had improved since September 2023. There were proper policies, procedures to cover all aspects of the service. However, there was not appropriate clinical oversight of quality improvement. Clinical governance at the location was not being led by those with the appropriate clinical expertise. Some emergency medicines were not stored on the emergency crash trolley, but there was no information with this set of medicines as to where they were being kept. This posed a risk in the event of an emergency.

People received referrals from and to other services via processes which were embedded at the service.

Staff and leaders informed us they worked with external services in receiving referrals, making referrals and undertaking multi-disciplinary team meetings regarding patients’ care.

We did not receive any feedback from partners as part of this assessment. We spoke with commissioners of NHS services but they did not have any information regarding the service. There was no feedback from NHS providers regarding the service.

We looked at patient records and found the service worked effectively with external services in receiving referrals, making referrals and undertaking multi-disciplinary team meetings regarding patients’ care.

There were systems for ensuring staff could report and receive outcomes from incidents, as a result of learning from the previous CQC inspection. This was corroborated by the log and evidence of outcomes regarding incident reporting.

We saw that complaints and incidents were used to identify learning and improvements. There were clear channels of communication to ensure improvements were communicated. Our review of clinical quality improvement identified that audits were not designed appropriately to review the care they were designed to audit. There was insufficient auditing taking place of clinical records to ensure learning was always identified where necessary.