• Doctor
  • GP practice

Archived: Dashwood Medical Centre

Overall: Inadequate read more about inspection ratings

158-160 Grange Road, Ramsgate, Kent, CT11 9PR 0300 042 7007

Provided and run by:
Dr Michael David Cardwell

All Inspections

16 May 2023

During an inspection looking at part of the service

We carried out an announced focussed inspection at Dashwood Medical centre on 16 May 2023. The practice was not rated as a result of this inspection.

Following our inspection on 23 November 2022, the practice was rated as inadequate overall as well as for providing safe and well-led services, requires improvement for providing effective and responsive services and good for providing caring services. They were placed into Special Measures. Breaches in regulation were found and Warning Notices for Regulation 12 and Regulation 17 were issued.

The full report for the November 2022 inspection can be found by selecting the ‘all reports’ link for Dashwood Medical Centre on our website at www.cqc.org.uk.

Why we carried out this inspection

We carried out this inspection on 16 May 2023 to confirm that the practice had met the legal requirements as stated in the Warning Notices issued after the 23 November 2022 inspection. This report covers findings in relation to those requirements and was not rated.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected,
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

This inspection did not affect the provider’s rating which remains inadequate.

Our findings

  • Improvements to the practice’s systems, practices and processes were insufficient and did not always keep people safe and safeguarded from abuse.
  • The provider had made improvements to systems and processes to help maintain appropriate standards of cleanliness and hygiene. However, some infection prevention and control (IPC) issues were ongoing and had not been managed in a timely manner.
  • Improvements to the assessment, monitoring and management of risks to patients, staff and visitors had been made. However, some improvements were still ongoing.
  • Staff did not always have access to the information they needed to deliver safe care and treatment.
  • Improvements to the arrangements for managing medicines were insufficient and placed patients at continued risk of harm.
  • The provider had made improvements to the management of significant events. However, systems for dealing with safety alerts were still not effective.
  • Some patients’ needs were still not always assessed and care and treatment was not always delivered in line with current legislation and standards.
  • All staff were still not up to date with essential training and did not have access to regular appraisals.
  • Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms were still not being completed in line with legislation and guidance.
  • Complaints were investigated and responded to in a timely manner. However, we could not find evidence to show learning from complaints was being shared with relevant staff.
  • Leaders had not taken sufficient action on all required improvements to quality, safety and performance.
  • The provider was able to demonstrate compliance with the duty of candour.
  • Improvements had been made to the management of backlogs of laboratory results and outstanding documents that required action. However, management of tasks on the practice computer system as well as management of test requests was insufficient.
  • Improvements to processes for managing risks, issues and performance were insufficient.
  • Improvements were required regarding evidence of systems and processes for learning, continuous improvement, and innovation.

We found there continues to be breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Take action to ensure there is a completion date in the infection prevention and control action plan in relation to replacing the carpeted areas of the practice.
  • Take action to ensure the keypad lock to the reception area is in use.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

23 November 2022

During a routine inspection

We carried out an announced comprehensive inspection at Dashwood Medical Centre on 23 November 2022. Overall, the practice is rated as inadequate.

Safe - inadequate.

Effective – requires improvement

Caring – good.

Responsive - requires improvement.

Well-led – inadequate.

Following our previous inspection on 9 May 2017 the practice was rated requires improvement overall and for delivering safe, effective, responsive and well-led services, but rated good for providing caring services. At a follow up inspection on 8 November 2017 the practice was rated as good overall and in all domains.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dashwood Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We rated the practice as Inadequate for providing safe services because:

  • The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • Appropriate standards of cleanliness and hygiene were not always met.
  • There were gaps in systems to assess, monitor and manage risks to patient safety.
  • Staff had some information they needed to deliver safe care and treatment. However, improvements were required.
  • The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. However, improvements were needed.
  • The practice did not have a robust system to learn and make improvements when things went wrong.

We rated the practice as Requires Improvement for providing effective services because:

  • Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
  • The practice always obtained consent to care and treatment. However, DNACPR decisions were not always made in line with legislation and guidance.

We rated the practice as Requires Improvement for providing responsive services because:

  • Complaints were not used to improve the quality of care.

We rated the practice as Inadequate for providing well-led services because:

  • There was compassionate and inclusive leadership, however improvements were needed to ensure the delivery of high-quality sustainable care.
  • The practice had a culture which drove high quality sustainable care. However, the provider was unable to demonstrate they had an effective complaints procedure.
  • There were some responsibilities and roles to support good governance and management. However, improvements were needed to systems of accountability for the management of backlogs of activity.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way for service users.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Continue to improve cervical cancer screening uptake.
  • Continue to improve child immunisation uptake.
  • Use feedback from staff and patients to improve national GP patient survey satisfaction scores.

I am placing this service into 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 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

8 November 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dashwood Medical Practice on 5 May 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Dashwood Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 5 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • Medicines management procedures had been reviewed to ensure an effective process for managing medicine alerts from the Medicines and Healthcare products Regulatory Agency (MHRA). There was a system to ensure the timely review and actioning of safety alerts.
  • There was a system for monitoring high risk medicines and medicine reviews had been conducted or scheduled. Medicines were being prescribed with sufficient information to support safe prescribing.
  • Care plans were up to date and there were detailed journal entries which evidenced consultations and actions taken as a result.
  • There was an embedded system for the management of complaints.
  • The practice had established governance systems and processes.
  • The practice had identified an increased number of patients as carers. There were 95 patients on the carers register, approximately 1% of the patient list.
  • Trends in significant events were examined and learning from events shared across the practice.
  • An audit of patient attendance at accident and emergency services was due to be repeated in January 2018.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dashwood Medical Centre on 9 May 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • We found there were established and effective systems in place for reporting and recording significant events. However, there was as absence of documentation to demonstrate trend analysis and how learning had been embedded into practice.
  • The practice was clean and tidy and the practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Improvements were required for the safe management of medicines. There was a system to ensure the timely review and actioning of safety alerts and management of high risk medicines.
  • Staff were aware of current evidence based guidance.
  • Unverified data from the Quality and Outcomes Framework showed good patient outcomes. The practice had achieved 97% of the points available.
  • The practice worked with partner services to coordinate patient care and treatment. However, we found some care plans were last up dated two years ago and an absence of journal entries evidencing discussions.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • 80% of the patients surveyed by the practice would recommend the practice to others.
  • Patients we spoke with said they experienced difficulties with the practice telephone system but were able to get an appointment, often on the day requested.
  • Information about how to complain was available and evidence from complaints reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff. However, we found the practice were unable to locate paperwork relating to a complaint made in February 2017.
  • The practice acknowledged improvements were required to strengthen their governance systems and saw the appointment of salaried GP’s as fundamental to achieving this.
  • The lead GP encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The patient participation group told us they felt valued and listened to by the practice and were positive about how they could work together to improving services for patients.

We saw one area of outstanding practice:

The practice provided comprehensive clinical care to patients with poor mental health with a nominated clinical lead. The clinical lead GP had experience in psychiatry and substance misuse and was also section 12 approved under the Mental Health Act (medical practitioners with special experience in the diagnosis or treatment of mental disorder).

The practice provided appointments of 20 minutes or longer for those with poor mental health. They accommodated patients presenting with immediate needs and also scheduled regular appointments at a convenient time for the patients, to minimise anxiety and enhance the accessibility of the service. For patients requiring emotional support the practice linked in with the Improving Access to Psychological Services and for patients with complex needs the Primary Care Mental Health specialists attended the practice weekly. They focussed on providing care and coordinating services to support patients vulnerable to admission to acute medical and/or psychiatric services. The practice offered the service at the practice to help ensure convenience and continuity of care for patients. Clinicians could share information with ease. Patients could access specialist provision closer to their home and had the additional benefit of outreach provision.

The areas where the practice must make improvements are:

  • Ensure the safe prescribing and monitoring of medicines
  • Maintain accurate, complete and contemporaneous records in respect of each patient and ensure these are accessible to partner services, where appropriate.
  • Ensure there is an established, effective system for recording and responding to complaints.
  • We found an absence of documentation to evidence how the practice achieved the consistent and sustainable delivery of good quality care e.g. partners meetings, management meeting minutes and quality assurance systems.

The areas where the provider should make improvement are:

  • Improve their identification and support for carers
  • Evidence trends in significant incidents and how learning has been embedded into practice.
  • Review patient attendance at accident and emergency services and out of hour’s provision to identify trends and use it to reduce attendance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice