The Care Quality Commission
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Archived: Cranbrook Surgery

Overall: Good read more about inspection ratings

465 Cranbrook Road, Gants Hill, Ilford, Essex, IG2 6EW (020) 8554 7111

Provided and run by:
Cranbrook Surgery

Important: This service is now registered at a different address - see new profile
Important: We are carrying out a review of quality at Cranbrook Surgery. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

24 February to 24 February 2020

During a routine inspection

At the previous inspection published in February 2019. The practice was rated as requires improvement overall, requires improvement for providing a safe service, inadequate for providing a well-led service and good for providing an effective, caring and responsive service. This was because:

Lack of safe systems for the safety alerts, follow up of cervical screening, and the administration of medicines, the prevention of infectious diseases and recruitment. In addition, areas of the premises were unsafe.

At this inspection, we found that the provider had addressed these areas but due to moving premise and the change in practice management further time was required to embed the new systems and processes.

We based our judgement of the quality of care at this service is 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 service as Good overall.

We rated all of the population groups as Good, with the exception of: -

  • Children and families which we rated requires improvement in responsive because of a lack of staff awareness of the protocol regarding children who regularly did not attend appointment or regularly attended A&E.
  • Working age people which we rated requires improvement because of the practice required further improvement to enable it to reach the national targets for cervical screening.

We rated the practice as Good for providing safe, effective caring and responsive services because:

  • The practice had made improvements to the management of infection control, staff recruitment, safety alerts and medicines management.
  • The practice had moved premises and had taken all the appropriate actions to ensure the safety of both patients and staff.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff dealt with patients with kindness and respect 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.
  • The GP survey and the practices own survey both demonstrated positive feedback about the practice.
  • Patients received effective care and treatment that met their needs.

We rated the practice as requires improvement for providing a well-led service because; -

  • Although we found the practice and the new practice manager had made improvements in the short time they have been in post, further work was required to ensure the new systems and processes were reviewed, updated and fully embedded. Such as the development of protocols, the continued review of patient records workflow, the lack of a training overview and the lack of staff awareness regarding the protocol for children who regularly did not attend appointment

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue to take action to improve the systems to improve the uptake rates of cervical screening and child immunisation.
  • Take action to ensure staff clinical staff are aware of their accountable officer for controlled drugs.
  • Take action to and carry out daily checks of the vaccine fridge thermometer to ensure medicines are stored at the appropriate temperatures.

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.

24 April 2019

During an inspection looking at part of the service

We previously carried out an announced comprehensive inspection at Cranbrook Surgery on 5 December 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Cranbrook Surgery on our website at www.cqc.org.uk. At this inspection we issued the practice with a warning notice in repsect of key question 'Well-Led' as we found that not all the practice systems to manage the day-to-day governance at the practice functioned well.

This inspection was a warning notice follow-up inspection carried out on 24 April 2019 to confirm that the practice had met the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 December 2018. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

Our key findings were as follows:

  • The practice had established a system which allowed effective management of blank prescriptions received at the practice.
  • There was evidence that the majority of actions on the latest infection and prevention control audit had now been conducted.
  • Staff appraisals were up-to-date

At the inspection on 24 April 2018 we found that the requirements of the warning notice had been met.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

5 December 2018

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous rating 12 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced inspection at Cranbrook Surgery on 5 December 2018. This inspection was undertaken in line with our inspection programme of re-inspecting practices where a breach or breaches of regulations was identified at our previous inspection.

At our previous inspection in December 2017, we issued the practice with requirement notices in respect of regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Act (Regulated Activities) Regulations 2014, as the practice had not addressed all concerns identified at a previous inspection held in August 2016.

At this inspection we found:

  • The 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.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Not all the practice systems to manage the day-to-day governance at the practice functioned well. We noted that there was no system in place to ensure blank prescriptions pad were logged when delivered to the practice.
  • Some patients found they could not always gain appointments which suited their needs.
  • Patient Group Directions (PGD’s) used by the practice nurses to allow them to administer medicines, were not kept in an organised manner, making it difficult to identify patients who should be in receipt of medicines.
  • The practice and PPG worked together to ensure that quality care was delivered and could be accessed easily at the practice.
  • Staff appraisals had not been completed during the last 12 months for the majority of administrative staff.
  • Some actions on the latest NHS England infection and prevention control audit had not been actioned, despite a timescale for completion being agreed.
  • The practice premises are in need of refurbishment and one of the clinical rooms was not compliant with the criteria identified in the national infection and prevention control standards.

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

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

The areas where the provider should make improvements are:

  • Monitor systems and process to address continuing patient concerns in relation to access to care at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

5 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

The last inspection of this practice took place in August 2016. At that time the overall rating for the practice was requires improvement, with the key question of safe rated as inadequate and the key question of effective rated as good. All other key questions were rated as requires improvement. Our concerns at that time centred around lack of good governance as the practice had weakness regarding lack of robust policies and procedures for safeguarding patients from possible abuse and not ensuring that the practice provided safe care and treatment at all times. At this time, we issued the practice with requirement notices in respect of regulation 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we rated the practice as follows for the key questions :-

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) – Requires Improvement

We carried out an announced comprehensive inspection at Cranbrook Surgery on 5 December 2017. This inspection was conducted as follow-up full comprehensive inspection to ensure that the practice had put into action the changes they had informed the Commission they would implement following the last inspection in August 2016.

At this inspection we found:

  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
  • There was no regular oversight by the GP partners of the nursing provision provided at the practice.
  • Staff encouraged and supported patients to be involved in monitoring and managing their health.
  • Some patients found it difficult to obtain appointments when they required one.
  • The National GP Patient Survey showed that patient satisfaction scores with the practice was below the national average.
  • The practice learned lessons from individual concerns and complaints, and used this information to improve services at the practice.
  • There was no evidence of a failsafe system for checking and monitoring cervical screening results.
  • We saw evidence that clinical audits had a positive impact on quality of care and outcomes for patients.
  • The practice premises are in need of refurbishment and one of the clinical rooms is not compliant with national infection control compliant standards.

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:

  • Establish effective systems and processes to address continuing patient concerns highlighted in the National GP Patient Survey scores.
  • Ensure that job descriptions are devised for all members of staff.
  • Establish an effective system to record actions following receipt of safety alerts.
  • Look at ways to conduct effective pre-travel assessments for patients requiring vaccines.
  • Continue progress on recording complaints in an effective and detailed manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cranbrook Surgery on 19 August 2016. Overall, the practice is rated as requires improvement.

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

  • There was a system for recording and reporting significant events however, there was no system in place to monitor that lessons learnt were shared with all staff and there were no monitoring systems in place to ensure action was taken to improve safety in the practice.

  • Patients were at risk of harm because systems and processes did not ensure their safety. Policies were out of date and the provider had failed to monitor and mitigate risks identified in infection control audits.

  • We found concerns in relation to medicines management. There was no system in place to follow-up patients who failed to collect their prescriptions and we found an example of a patient being prescribed a high-risk medicine outside of recommended guidelines.

  • The practice had only identified 0.3% of their practice population as carers.

  • Information about services was available but not everybody would be able to access it.

  • Feedback from patients reported that access to a named GP was not always available quickly, although urgent appointments were usually available the same day.

  • The practice was equipped to treat patients and meet their needs.

  • There was a lack of managerial oversight and risks to patients, staff and the running of the practice were not always assessed and mitigated against. Governance arrangements did not ensure the practice was run safely and effectively, and performance was not being monitored in all areas.

  • The practice did not have an effective system for managing complaints. The practice had adequate arrangements in place to respond to emergencies and major incidents.

  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure care and treatment is provided in a safe way for patients. This includes introducing effective processes for significant events, medicines prescribing and infection prevention and control.

  • Ensure procedures and policies protect people from the risk of abuse.

  • Ensure effective systems are in place for receiving and recording complaints.

  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

In addition, the provider should:

  • Review and respond to the GP national survey regarding patient satisfaction scores for nurse consultations.

  • Advertise within the practice the provision of services including online services and translation services for patients and consider improving the layout for leaflets and notices displayed in the practice to make them accessible to patients.

  • Review the information displayed on the practice website and monitor this regularly so patients are up to date with information.

  • Proactively identify and support patients who are carers.

  • Consider improving communication with patients who have a hearing impairment.

    Consider improving facilities for parents such as baby changing facilities.

  • Review the appointment system to ensure patients have timely access to appointments.

  • Ensure patients can have access to a GP of the same gender as them if they wish.

  • Review ways to increase take up of cervical screening, to improve patient outcomes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice