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We are carrying out a review of quality at Orient Practice. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 5 January 2019 and 7 January 2019

During a routine inspection

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

Inspection carried out on 22 January 2019

During an inspection to make sure that the improvements required had been made

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.

Inspection carried out on 21 December 2018

During an inspection to make sure that the improvements required had been made

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.

Inspection carried out on 2 July 2018

During a routine inspection

This practice is rated as overall Inadequate

The key questions are rated as:-

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an unannounced comprehensive inspection at Orient Practice on 2 July 2018. This inspection was undertaken as the there was a new provider of services at this location and we had received concerns regarding the leadership at the practice. The information we received rasied concerns that the provider had significantly reduced the number of clinical appontments available to patients since registering the service without assessing the level of clinical sessions required. In addition, there were concerns specific to the supervision of staff, governance processes and access to care and treatment. The current provider of services commenced provision of services from this location in October 2017.

At this inspection we found:

  • There was limited evidence that practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • There were no comprehensive risk assessments in relation to safety issues. For example, the practice did not have in place a risk assessment for not having certain emergency medicines on site.
  • At the time of inspection we only had supporting data relevant to the previous registered provider, however the practice were unable to demonstrate how they are monitoring their current performance or the impact of signi
  • We saw staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice did not follow-up on information of concern provided by professional bodies.
  • The practice had systems to manage risk so that safety incidents were less likely to happen.
  • Infection prevention and control processes were not embedded within the practice.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • Patients did not always have timely access to initial assessment, test results, diagnosis and treatment.
  • The practice could not evidence effective processes to develop leadership capacity and skills. This included planning for the future of the practice or providing a strategy and supporting business plans to achieve priorities identified at the practice.

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

  • 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:

  • To review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
  • Establish a consistent approach in relation to practice contact with recently bereaved patients.
  • Review how patients are able to access appointments at the service.

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.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice