Archived: Orient Practice

We carried out an announced comprehensive inspection at The Orient Practice on 5 and 7 February 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 2 July 2018.

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 this practice inadequate overall.

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

• The practice did not have clear systems to keep patients safe.
• Risks were not adequately assessed and monitored.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not have appropriate recruitment processes.
• There was insufficient learning when things went wrong.

We rated the practice as inadequate for providing effective services because:

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• The practice was unable to demonstrate that patients’ needs were fully assessed.
• No action had been taken to improve the uptake of childhood immunisations.
• Staff learning and development needs were not assessed.

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

• There had been minimal improvements made since our inspection on 2 July 2018, it had not appropriately addressed the Warning Notice in relation to learning from significant events, safeguarding systems, governance processes and management capacity. At this inspection, we also identified additional concerns that put patients at risk.
• Leaders could not show that they had the capacity and skills to deliver high quality sustainable care.
• While the practice had a vision, this was not supported by a strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance was ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The practice did not promote an environment where learning and improvement was a priority.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing responsive services because:

• The practice did not mitigate risks of cancelling appointments when they had advanced notice.
• There was insufficient learning from complaints and they were not handled appropriately or in a timely way.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect.
• Patients rated the practice favourably in questions relating to the practice being caring in the national GP patient survey.

Following this inspection on 5 and 7 February 2019, urgent action was taken. The provider was served with a Section 30 conditions of registration and The Orient Practice was removed from Living Care as one of their registered locations. The practice was subsequently placed in the care of a care taking provider.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

We carried out an announced focussed inspection at The Orient Practice on 22 January 2019.

At this inspection we followed up on a breach of regulation identified at a previous inspection in December 2018. This inspection was not rated, but was used to ensure that actions had been put in place and work was underway to rectify the breach.

Our key findings were:

• The practice had put a system in place to reduce the number of un-summarised patient notes.
• The practices action plan was not updated and did not include all identified risks.
• There was no risk assessment in place considering the notes summarising issue.

There were areas where the provider could make improvements and should:

• Review the process for summarising patient records including risk assessments to mitigate all risks.

We previously carried out an unannounced comprehensive inspection of Orient Practice on 2 July 2018 and found that the service was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17: ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes we issued two warning notices which required Orient Practice to comply with the Regulations by 24 October 2018. The full report of the 19 June 2018 inspection can be found by selecting the ‘all reports’ link for Orient Practice on our website at .

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was now meeting the Regulations of the Health and Social Care Act 2008.

The previous inspection on 2 July 2018 identified areas where the provider had not complied with Regulation 12: ‘Safe care and treatment’. We found:

• The registered provider did not do all that was practicable to ensure that systems in place kept patients safe.
• Infection and prevention control processes were not effective. There was no evidence of discussion and learning from significant events.
• Not all emergency medicines recommended were held on site, and of those on site, not all were in date and fit for purpose.
• The practice did not have evidence of calibration of medical equipment used or evidence of a recent fire risk assessment.
• External concerns regarding staff members had not been acted upon and safeguarding systems were not consistent throughout the practice.
• Medical indemnity insurance for the practice was not available when requested.

The inspection on 2 July 2018 also identified areas where the provider had not complied with Regulation 17: ‘Good governance’. We found:

• The registered provider did not do all that was practicable to ensure that systems in place provided good governance.
• There was no evidence of clinical leadership and adequate management capacity on site.
• There was no monitoring of Patient Group Directions (PGD’s) used by nursing staff.
• Policies and procedures were not practice specific.
• Safety alerts were not effectively investigated and recorded.

This inspection on 21 December 2018 took place to follow up on the Regulation 12 and 17 Warning Notices that were issued and to check that they had been complied with. We found that although the provider had taken some action in relation to the provision of safe and well-led care, there were still some areas of non-compliance.

Our key findings were:

• A new safeguarding lead had been appointed.
• The fire safety policy had been updated and relevant risk assessments, training and drills completed.
• Staff were now aware of their roles and responsibilities
• New infection control procedures had been introduced with findings discussed and action points implemented.
• Updated PGDs were in use and all had been correctly completed and signed.
• A review had been undertaken and all policies and procedures were now practice specific.
• Safety alerts were now recorded, discussed and acted upon and an efficient recording and monitoring system was in place.

We identified regulations that were not being met and the provider must:

• Ensure that there is leadership and adequate management capacity on site to support staff and deliver treatment in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.