The Care Quality Commission
  • Doctor
  • GP practice

Oaks Place surgery

Overall: Good read more about inspection ratings

Widnes HCRC, Oaks Place, Caldwell Road, Widnes, WA8 7GD (0151) 495 5140

Provided and run by:
Dr Madhavi Latha Meda

Important: The provider of this service changed - see old profile

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Oaks Place surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Oaks Place surgery, you can give feedback on this service.

During an assessment under our new approach

We carried out an announced assessment of one quality statement, equity of access, under the key question responsive at Oaks Place Surgery on the 27 February 2024. Responsive assessments are remote focused reviews to help us understand what practices are doing to try to meet patient demand and the current experience of people who use these services and of providers. The responsive key question is still rated as good. The service remains rated as good overall. We recognise the work that GP practices have been engaged in to continue to provide safe, quality care to the people they serve. We know staff are doing this while demand for general practice remains exceptionally high, with more appointments being provided than ever. In this challenging context, access to general practice remains a concern for people. These assessments of the quality statement equity in access in the responsive key question include looking at what practices are doing innovatively to improve patient access to primary care and sharing this information to drive improvement. At this assessment we found: People can access services when they need to, without physical or digital barriers, including out of normal hours and in an emergency. People are given support to overcome barriers to ensure equal access. The practice understood the challenges to patient access and responded to patient needs.

15 July 2022

During a routine inspection

We carried out an announced inspection at Oaks Place Surgery on 15 July 2022. Overall, the practice is rated as Good with the following key question ratings:

Safe -Good

Effective -Good

Caring – Good (rating awarded at the inspection 21 August 2019).

Responsive – Good (rating awarded at the inspection 21 August 2019)

Well-led -Good

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

Why we carried out this inspection

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This inspection included:

  • A site visit by the lead inspector.
  • Conducting staff interviews remotely and on site.
  • Completing clinical searches remotely on the practice’s patient records system and discussing findings with the provider.
  • Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • Gaining feedback from staff by using staff questionnaires.

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 have rated this practice as Good overall

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • More fully document in the clinical record when a medication review or a review of patients with a long-term condition has taken place.
  • Continue the catch up programme of medication reviews for patients where recall has lapsed due to the pandemic.
  • Review and monitor the process for acting on safety alerts, to minimise the risk of any patients not receiving the required monitoring required for the medicines they are prescribed.
  • Continue to work with patients to encourage the uptake of cervical screening.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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

11 May 2021

During an inspection looking at part of the service

At our previous inspection on 21 August 2019, the practice was rated Good overall and for all population groups but Requires Improvement for providing safe services.

We carried out an announced focussed review of Oaks Place Surgery on 11 May 2021. Overall, the practice is rated as Good.

The rating for the key question followed up was:

Safe - Good

The other key questions remain unchanged as does the overall rating.

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

Why we carried out this review

This was a follow up review of information without undertaking a site visit inspection, to assess the Safe key question.

We reviewed the breach identified at the last inspection of Regulation 13 HSCA (RA) Regulations 2014 (Safeguarding service users from abuse and improper treatment). The regulation was not being met because systems were not in place for following up on vulnerable adults and children, who had missed appointments in secondary care.

We also reviewed the area where the previous inspection identified that the provider should make an improvement by:

  • Consider alerts on patients records where they are subject to a Deprivation of Liberty Safeguard (DoLS).
  • Providing formal training to non-clinical staff in the Mental Capacity Act 2005 and DoLS.
  • Formalising the system for reviewing the practice of clinical staff to ensure consultations, referrals and prescribing are appropriate.
  • Completing and reviewing the risk assessment for determining the medicines available at the practice in the emergency medicines kit.
  • Completing and reviewing risk assessments for not taking medicines on home visits.
  • Fully demonstrating the changes made as a result of audit findings.
  • Monitoring hypnotic prescribing to effectively reduce this where possible.
  • Recording the role specific induction covered with clinical staff.

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out in a way which enabled us to not conduct a site visit. This was in line with all data protection and information governance requirements.

This review included:

  • Speaking with staff using video conferencing.
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting and reviewing evidence from the provider.

Our findings

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

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

We found that:

  • The breach of regulation has been addressed and the practice had improved processes to provide care in a way that kept patients safe and protected them from avoidable harm.
  • Alerts were on placed on patient records when they were subject to a DoLs.
  • The practice ensured that non-clinical staff completed formal training in the Mental Capacity Act 2005 and DoLs.
  • There was a formal system for reviewing the practice of clinical staff to ensure consultations, referrals and prescribing were appropriate.
  • Risk assessments had been completed for determining the medicines available at the practice and in the emergency medicines kit as well as not taking medicines on home visits.
  • Audit reports documented the changes in practice.
  • Documentation of role specific induction for clinical staff was in place.
  • There was ongoing monitoring and work to reduce hypnotic prescribing however the practice remained above local and national averages.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

21/08/2019

During a routine inspection

We carried out an announced comprehensive inspection at Oaks Place Surgery on 21 August 2019 as part of our inspection programme.

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 have rated this practice as good overall.

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

There was not a system in place for following up on vulnerable patients, who had missed appointments in secondary care.

We rated the practice as good for providing effective, caring, responsive and well-led services because:

  • The needs of patients were identified and appropriately responded to.
  • Staff dealt with patients with kindness and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • There was good communication between staff and staff felt well supported. There was a commitment to improving the service and the practice responded to feedback from patients and other stakeholders.

We rated the population groups as good.

The area where the provider must make improvements are:

  • Ensure patients are protected from abuse and improper treatment.

The areas where the provider should make improvements are:

  • Put alerts on patients records where they are subject to a deprivation of liberty safeguard.
  • Formalise the system for reviewing the practise of clinical staff to ensure consultations, referrals and prescribing are appropriate.
  • Record the risk assessments for determining the medication to be available for use at the practice in an emergency and for not taking medicines on home visits and keep them under review.

  • The recording of audits should fully demonstrate the changes made as a result of the findings.
  • The provider to monitor hypnotic prescribing to effectively reduce this where this is possible.
  • Record the role specific induction covered with clinical staff.
  • Provide formal training to non-clincial staff in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care