- GP practice
Archived: Moorfield Road Health Centre
All Inspections
5 July 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Moorfield Road Health Centre on 22 June 2016. The overall rating for the practice Requires Improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Moorfield Road Health Centre on our website at www.cqc.org.uk.
At our previous inspection in June 2016, we rated the practice as Requires Improvement for providing safe and effective services. At this time included amongst the issues we identified, was the practice could not provide sufficient evidence that there were clear processes in place to identify where improvements in clinical care could be made, that there was not a programme of regular fire drills being conducted at the practice and that there was a lack of information throughout the practice informing patients of what to do in the event of a fire.
This inspection was an announced focused inspection carried out on 5 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 22 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. At this inspection, we found that the practice had made improvements to provide safe and effective services. As a result of these findings, the practice is now rated as good for providing safe and effective services.
The change in the ratings for safe and effective, means that the practice overall is now rated as Good.
Our key findings were as follows:
- Clinical audits were being conducted at the practice as part of a system of ensuring effective clinical care was being delivered to patients.
- The practice had introduced regular fire drills. All staff members had been trained in what to do in the event of a fire and there was signage within patient areas informing them what to do in the event of the fire alarm sounding.
- We saw evidence that patient care plans (in particular for patients at risk of un-planned or readmission to hospital) were up-to-date and contained relevant personalised information.
- The practice now attends regular multi-disciplinary meetings with other health care professionals to discuss complex needs patients.
- All staff members had received an appraisal within the last 12 months.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
22 June 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Moorfield Road Health Centre on 22 June 2016. Overall the practice is rated as Requires Improvement.
Our key findings across all the areas we inspected were as follows:
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
- Effective care plans were not in place for those at risk of unplanned admission/readmission to hospital.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- The practice had not attended a multi-disciplinary meeting with other health care professionals during the last nine months.
- Information about services and how to complain was available and easy to understand.
- The practice had not recently conducted a fire drill and there was no information for patients regarding what to do in the event of a fire.
- There was little evidence of quality improvement for patients through clinical audits
- There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- Staff received ongoing support, one-to-one meetings, coaching and mentoring, clinical supervision and facilitation and support for revalidating GPs. However, not all staff had received an appraisal within the last 12 months.
The areas where the provider must make improvement are:
- Ensure there are processes for identifying where improvements in clinical care can be made and monitored; including regular two-cycle clinical audits
- Establish regular fire drills and to make efforts to ensure that patients are aware of what to do in the event of a fire.
The areas where the provider should make improvement are:
- Ensure care plans are updated and relevant to patient requirements.
- To engage with patients and local community to encourage higher uptake of childhood vaccinations.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
3 June 2014
During a routine inspection
Moorfield Road Health Centre is located in the London Borough of Enfield. The practice provides primary medical services to around 4,100 patients.
We carried out an announced inspection on 3 June 2014. The inspection took place over one day and was led by a lead inspector, a GP and a practice manager. An expert by experience was also part of the inspection team.
During our inspection we spoke with 13 patients who used the practice, and we received and reviewed four comments cards. We spoke with seven members of staff.
The regulated activities we inspected were diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease and disorder or injury.
Overall we saw that the service was responsive to the needs of older people, people with long term conditions, mothers, babies, children and young people, the working age populations and those recently retired, people in vulnerable circumstances and people experiencing poor mental health. People with long term conditions such as diabetes received regular reviews of their health condition at the practice.
The practice had systems in place to report and record safety incidents, concerns and near misses. However, measures were not in place to investigate, learn from these incidents and prevent them from happening again.
Safeguarding policies and procedures were in place and all staff had received training in safeguarding children and vulnerable adults. Staff were able to identify and respond to abuse appropriately.
Medicines for dealing with medical emergencies were held at the practice and staff had received training in Cardiopulmonary resuscitation (CPR). There were safe systems for the management of medicines, specifically controlled drugs which had been monitored and recorded in line with requirements. However, there were a number of medicines that were not accounted for and there was no stock record for them.
There was not a nominated lead for infection control at the practice. This had impacted on the cleanliness of the premises and clinical areas. The lack of infection control auditing also lead to insufficient cleaning procedures to continue.
There were formal processes in place for the recruitment of staff. However, these were not being followed. A disclosure and barring service (DBS) check (formally known as a criminal record bureau (CRB) check) had not been obtained for non clinical staff who acted as chaperones. Assessments had not been completed for those staff assessed as not in need of a check. This meant patients were not fully protected against the risks associated with the recruitment of staff.
The practice provided a caring, effective and responsive service. Patients’ needs were suitably assessed and treatment was delivered in line with current legislation and best practice. GP’s received an alert on their computer system when health checks were due. The practice arranged for people with long term conditions to attend for regular health care reviews on at least a six monthly basis. Health promotion and prevention took place through various health clinics held by the practice nurse. For example, patient's with diabetes automatically received regular blood checks and their weight monitored. There was good access to appointments. Home visits were undertaken according to patient's needs.
Patient's told us they felt cared for. Patients could speak to reception staff in private if required as the reception area did not provide a private environment. A hearing loop was available on the telephone system for people with hearing impairments. Although a telephone interpretation service was available which was regularly used by clinical staff, non clinical staff were not aware of it. They told patients to bring someone with them to interpret for them, which was not good practice.
The practice was not well-led on a day-to-day basis. It lacked leadership and a clear management structure. The provider did not have an effective system in place to analyse incidents or significant events that resulted in, or had the potential to result in, harm of people using the service. There were no audit systems in place to assess and manage risks to the health and welfare of people who used the practice and others.