This practice is rated as Inadequate overall. (Previous inspection March 2015 – Good)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Requires improvement
Are services responsive? – Requires improvement
Are services well-led? – Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those recently retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
We inspected Oldham Medical Services on 5 March 2015. The practice was rated as good in all domains and overall good. There were some areas where we suggested improvements should be made, but not all these had been carried out. During 2017 an assistant practice manager had joined the practice. They left in October 2017 and the practice manager left in November 2017. The practice had had no manager in place until the current practice manager started work six weeks prior to the inspection.
We carried out an announced comprehensive inspection at Oldham Medical Services on 16 February 2018. This was part of our inspection programme. We found that the overall rating had reduced to inadequate.
At this inspection we found:
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The practice did not have systems in place to manage risk so that safety incidents were less likely to happen. For example the fire risk assessment was not adequate and fire checks were not up to date.
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The infection control audit was not adequate and it had not been identified that some items were not stored hygienically.
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Minor surgery took place approximately every month but the last recorded audit for minor surgery was in June 2013.
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Medicines were not securely stored.
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The cold chain was not effectively monitored.
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When incidents did happen, there was no evidence of learning from them.
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The practice had identified that 300 children had outstanding immunisations but the partners had not been informed of this by nursing or administrative staff..
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There was no evidence new safety guidelines or medicine alerts were disseminated to appropriate staff.
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There was no focus on continuous learning and improvement at any levels of the organisation.
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Staff were not well supported and there was little evidence of appraisal.
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Only 0.2% of patients had been identified as carers and no additional support was offered to carers.
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Not all complaints were investigated and responses to complaints did not contain all the required information.
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The governance in the practice did not support good practice.
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The practice was not correctly registered by the Care Quality Commission (CQC); the registered manager had left and CQC had received no application to register a new one.
The areas where the provider must make improvements are:
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The provider must ensure care and treatment is provided in a safe way to patients.
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The provider must ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation. The provider must ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
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The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
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The provider must ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
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The provider must ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. The provider must ensure specified information is available regarding each person employed.
In addition the provider should:
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice