The Care Quality Commission
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  • GP practice

Archived: Dr Lionel Dean

Overall: Good read more about inspection ratings

Melrose House, 73 London Road, Reading, Berkshire, RG1 5BS (0118) 959 5200

Provided and run by:
Dr Lionel Dean

Important: The provider of this service changed. See new profile

All Inspections

27 September 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection in January 2016, found issues relating to the safe, effective and well led domains and we asked the practice to make further improvements. We found Dr Lionel Dean’s practice required improvement for the safe, effective and well led domains. The practice was rated good for providing caring and responsive services.

The follow up focussed inspection on 27 September 2016 was undertaken to check whether the practice had made necessary changes following our inspection in January 2016. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 12 January 2016.

At our inspection on the 27 September 2016, we found the practice had made improvements since our last inspection. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective and well led services.

Specifically we found:

  • The practice had taken number of steps to improve the governance arrangements in the practice. This included policies and procedures being updated and reviewed. The practice had improved processes to identify, manage and mitigate safety risks.

  • The patient participation group (PPG) was still in a formative stage, however new patients had joined the group and there had been two PPG meetings.

  • The cleanliness of the practice had improved and there were effective systems to monitor the cleaning standards.

  • Infection control had been improved. The infection control lead had ensured all staff had received training and they had sought support for their lead role. Infection control audits had been completed and actions taken. A legionella risk assessment had taken place and actions implemented.

  • Staff had received appropriate recruitment checks and the recruitment policy had been amended to state which documentation was required for newly recruited staff. Disclosure and barring service checks had been completed for staff undertaking chaperone duties.

  • Clinical performance and patient outcomes had improved for those patients with Asthma and Diabetes.

  • Medical records from another practice which merged with Dr Lionel Dean had been summarised by July 2016.

  • Medication reviews for all the practice patients were conducted in a timely manner.

  • All staff had complete training records. The practice had implemented a system to highlight training which was due for update.

  • The number of carer’s identified had increased since the last inspection.

The areas where the provider should make improvements are:

  • Continue to develop the patient participation group, ensuring the group is effective and can influence and recommend improvements to the services provided to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

12 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Lionel Dean on 12 January 2016. The practice was rated as requires improvement for safe, effective and well-led and good for caring and responsive. Overall the practice is rated as requires improvement.

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

  • Not all risks to patients were assessed. For example, risk assessments of the building (maintenance and security) and utilities (gas, electrics, heating and boiler) had not been undertaken recently.
  • Not all recruitment and background checks had been completed such as current Disclosure and Barring services checks for nurses, GPs and non-clinical staff undertaking chaperoning or phlebotomy duties.
  • The majority of patients said they were treated with compassion, dignity and respect.

  • Information about services was available but not everybody would be able to understand or access it. For example, there were no information leaflets available in Nepalese despite there being a large number of Nepalese patients registered with the practice.

  • Urgent appointments were usually available on the day they were requested.
  • The practice had a number of policies and procedures to govern activity, however some were overdue a review.
  • The practice had sought feedback from patients, through the friends and family test and had a virtual patient participation group, although it was not active.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Information about services and how to complain was available and easy to understand, although it was all in English.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 improvements are:

  • Ensure recruitment arrangements include all necessary employment checks for all staff and ensure staff training records and yearly appraisals are kept up to date and documented.

  • Ensure a safe environment for all staff and patients through an effective building maintenance policy (including boiler checks) and risk assessments, including Control of substances hazardous to health and fire safety checks are documented and evidenced.

In addition the provider should:

  • Provide practice information in appropriate languages and formats.
  • Review how carers are recorded on the patient record system to ensure information, advice and support is made available to them.
  • Monitor and maintain cleanliness of high surfaces and electrical equipment and ensure infection control policies are adhered to.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice


16 September 2014

During an inspection looking at part of the service

This inspection was to check whether improvements to the service had been made since our last inspection on 25 April 2014. We spoke with a GP and the practice manager. We checked whether the service patients received was being monitored to ensure it was safe and of good quality.

We found new systems to monitor the quality and safety of the services provided were in place. The practice had systems to identify whether equipment and premises were safe. Staff were designated with responsibilities to ensure they understood their roles in monitoring the services provided.

The practice had robust systems for improving the quality of clinical care provided to patients. Changes to protocols and procedures in patient care were communicated through staff meetings. Patient feedback was considered and complaints were acted on to ensure learning from patient feedback was taking place within the practice.

21 May 2014

During a routine inspection

We visited the practice on 21st May 2014 to look at medicines management, we spoke with staff but on this occasion we did not speak with people using the service. We found that medicines were available, stored and monitored appropriately and were fit for use. The practice had effective systems in place to ensure that people were protected against the risks associated with medicines.

25 April 2014

During an inspection looking at part of the service

During our last inspection on 6 December 2013 we found the service was not meeting national standards which providers are required to meet. At this inspection we checked whether the concerns we found previously had been addressed.

During this visit a specialist advisor looked at the service's hygiene and infection control practices and assess the environment. We found the service had made improvements to the cleanliness of treatment rooms. We saw examples where hygiene and infection control guidance had been followed. A nurse explained to us how clinical equipment in their treatment room was cleaned. We found clinical equipment was clean.

The service had implemented action following a fire risk assessment undertaken in June 2013. This included exit signs and fire and smoke restrictors on doors.

We found that the practice was not monitoring whether cleaning equipment was segregated for different areas of the practice, in line with hygiene and infection control guidance. We saw some mops were stored in one bag and the manager could not verify whether this was used or unused.

We saw medical equipment and drugs stored in a clinical room were past their expiry date. Staff were not certain who was responsible for checking the medical equipment and drugs in the treatment room.

We have requested a meeting with the provider to share our concerns and gain assurances that the practice will make necessary improvements to meet national standards of quality and safety.

6 December 2013

During a routine inspection

During this inspection we followed up on concerns raised during our last visit on 18 June 2013. We spoke with the practice manager and a nurse during the inspection. We did not need to speak with patients to review the concerns we identified during our last inspection.

We saw improvements in the standards of hygiene and cleanliness. However, we saw thick dust in treatment rooms which was not identified by the provider's system for assessing cleanliness.

Patient feedback was sought through a survey. The manager told us the results were due to be analysed in early 2014. Information on the complaints system was available for patients and there was a system for reviewing feedback from complaints. Risks to patients were identified through the provider's system for identifying and assessing risks associated with the provision of the service. However, not all risks identified were managed appropriately.

18 June 2013

During a routine inspection

Patients received appropriate care and treatment. We spoke with eight patients and they all gave us positive feedback about the care they had received. One patient said "Patients are at the forefront of the GPs mind' and 'we get the best care'.

Patients were protected from the risk of abuse. Staff had received information and training in protecting patients from abuse. The patients we spoke with told us they felt safe with the GPs and staff of the practice.

We found that not all areas of the practice were clean and hygienic. There was no effective cleaning schedule in place.

Staff were supported in their roles. We noted that staff had received appraisal and training which aided their personal development.

The practice registered with the Care Quality Commission (CQC) in 2013. During the registration process concerns were identified with how the practice assessed and monitored the quality of service. During the inspection we found these issues had not been addressed by the agreed action date of 30 April 2013. For example, patients were not asked regularly for their feedback about the practice. We found that there had been no patient survey completed since 2011/12.

There was an appropriate complaints system and process. We found this was displayed in the practice waiting rooms, within the practice leaflet and on their website. Patient complaint's had been investigated and responded to in accordance with the practice complaint policy.