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Archived: Hillside Bridge Surgery Inadequate

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Inspection Summary


Overall summary & rating

Inadequate

Updated 16 October 2018

We carried out an announced comprehensive inspection at Hillside Bridge Surgery on 3 July 2018. The overall rating for the practice was inadequate and the service was placed in special measures. The full comprehensive report for the July 2018 inspection can be found by selecting the ‘all reports’ link for Hillside Bridge Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 September 2018 to confirm that the practice had responded to the warning notice dated 24 July 2018 and met the legal requirements in relation to the breach of Regulation 12 (1), Safe Care and Treatment, identified in our previous inspection on 3 July 2018. The practice was required to be compliant with the concerns documented in the warning notice by 1 September 2018.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

  • We found a number of areas where the practice was not compliant with regulation 12 as was required.
  • The provider had taken steps to improve the management of medicines in the practice. However, we identified a number of further concerns in this area which needed improvement.
  • The provider had reviewed their approach to the management of significant events. We saw that recent events had been reviewed, managed and discussed at staff meetings. We saw evidence that changes were made as a result of the event.
  • A process to manage the appropriate use, distribution and storage of prescription pads had been introduced but did not fully meet NHS Protect guidance.
  • The system in place to manage the administration of medicines under patients group directions (PGDs) did not meet standards and had not improved. We asked the provide to review this with immediate effect.
  • The practice had requested DBS checks for five member of staff who had been transferred from the previous provider; only one of these checks had been returned on the day of our inspection. We asked the provider to further review this to ensure that patients were safe.
  • The provider had reviewed their approach to the management of infection prevention and control in the practice. However, a number of related issues had yet to be addressed and additional concerns were found on the day of inspection.

Importantly, the areas where the provider must make improvements as they are in breach of regulations are:

  • The provider must ensure that safe care and treatment is provided in a safe way to patients.

We are taking further action in line with our enforcement processes. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice


Inspection areas

Safe

Inadequate

Updated 16 October 2018

At our previous inspection on 3 July 2018, we rated the practice as inadequate overall and inadequate for providing safe services. Breaches of the regulations were found which included issues with the safe storage of medicines, the signing of patient group directions, (PGDs), the safe storage of prescription stationary and a lack of assurance that five members of staff who had transferred from the previous provider were suitable to work with children and vulnerable adults. The practice did not have an effective system in place for the discussion, review and management of changes following significant events and were found to be failing to assess the risk of the prevention, detection and control of the spread of infections.

At this inspection on 19 September 2018 we found that the provider had taken some actions to improve the provision of care at the practice. However; the practice had not taken all the steps necessary to ensure that care and treatment was provided in a safe way for service users and additional issues were identified.

Safety systems and processes

  • At the inspection of 3 July 2018, we found that five members of staff who had transferred from the previous provider did not have Disclosure and Barring Service checks in place. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.) We saw the provider had now requested these checks but only one was available on the day of our inspection; the other applications were still being processed by the Disclosure and Barring Service. Therefore, the provider was still not able to assure themselves that every member of the team was suitable to work with children and vulnerable adults and had failed to meet the requirements of regulation 12 within the timescale required. Until the outstanding DBS applications had been processed and returned we asked the provider to take interim measures to assure themselves that these staff were suitable to work with these patient groups.
  • During the week of our inspection a new system had been introduced to manage the appropriate use, distribution and storage of prescription stationary. The process did not fully meet NHS Protect guidance and we were not assured that the actions taken were embedded within the team.
  • At the previous inspection on 3 July 2018 we made the practice aware of several issues relating to the prevention, detection and control of the spread of infections. At this inspection we saw that the practice had:

  • Reviewed the immunisation status of some members of the staff team. However, these records were incomplete.
  • The practice had completed an interim infection prevention and control audit and requested a further external audit to be undertaken. We saw that action had been taken as a result of the audit. However, on the day of inspection we saw that cleaning schedules for at least one clinical area had not been completed as per practice requirements.

Information to deliver safe care and treatment

  • We saw that a new system had been introduced to enable the discussion, review, and management of changes following significant events. Staff we spoke with told us they were aware of significant events and these had been discussed and reviewed in recent meetings. However, we did not see that any issues raised in our previous inspection had been captured as significant events.

Safe and appropriate use of medicines

  • The practice had reviewed their approach to the management of vaccines. Designated staff monitored the vaccination refrigerator temperatures twice daily. An electronic data logger (to monitor refrigerator temperatures) had also been purchased, however this was not yet in use. In addition, the practice had updated their cold chain policy.
  • At the inspection on 3 July 2018, we observed an open storage container in an unlocked utility room which contained a large amount of unaccounted for medicines. At this inspection on 19 September 2018 we saw that the provider had removed the unwanted medicines and had paperwork in place to evidence safe disposal.
  • At this inspection we identified a medicines cabinet which was locked. The practice did not have a key for this cabinet and did not know what was stored inside. We asked the provider to arrange for the cabinet to be opened and for any contents of the cabinet to be managed or disposed of appropriately.
  • The practice had maintained records for the review of their emergency medicines but had not monitored the emergency oxygen cylinder or completed checks to ensure that the defibrillator was fit for purpose.
  • We reviewed 17 PGDs currently in use at the practice. (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.) We identified issues with nine of the PGDs we reviewed. In most cases the authorisation signature for the administration of the vaccine was signed before the relevant nurse had signed the paperwork. This meant that the authorised signatory was invalid. We saw that additional signatures were added to the paperwork and not countersigned or authorised and that one PGD had not been signed by a nurse. The nurse assured us they had not administered the vaccine in question. Therefore; we found that PGDs at the practice did not meet the requirements in line with the Human Medicines Regulations 2012. The nursing staff employed by the practice are not authorised by their profession to administer medications unless an appropriately authorised PGD is in place. We asked the practice to review this with immediate effect.

Track record on safety

  • The provider had reviewed risk assessments relating to the control of substances hazardous to health (COSHH). Chemicals stored in the practice had a corresponding risk assessment and advice sheet.

Effective

Inadequate

Caring

Requires improvement

Responsive

Inadequate

Well-led

Inadequate
Checks on specific services

People with long term conditions

Inadequate

Families, children and young people

Inadequate

Older people

Inadequate

Working age people (including those recently retired and students)

Inadequate

People experiencing poor mental health (including people with dementia)

Inadequate

People whose circumstances may make them vulnerable

Inadequate