All inspections: Crawley Road Medical Centre

We carried out an announced comprehensive at Crawley Road Medical Centre on 3 and 9 May 2023. Overall, the practice is rated as requires improvement.

Safe - Requires improvement

Effective - Requires improvement

Caring - Requires improvement

Responsive - Requires improvement

Well-led - Requires improvement

Following our previous inspection on 30 June 2022, the practice was rated inadequate overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Crawley Road Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection on 3 and 9 May to follow up breaches of regulation from our previous inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

Conducting staff interviews using video conferencing.
Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A site visit.

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 found that:

The practice had established systems and processes that kept patients safe and protected them from avoidable harm.
Patients received care and treatment that met their needs, however the delivery of care was not consistent.
The practice had implemented a programme of clinical and quality improvement audits.
Not all staff had the skills and knowledge to carry out their role effectively. This meant that current clinical guidance was not being adhered to.
Services delivered at the practice had improved to meet patient needs, but there were still gaps in the delivery of services to meet needs.
The practice did not have a system in place to manage and mitigate risk relating to the practice.
A system and process to learn and improve from incidents that occurred at the practice required further embedding.
Supervision of staff undertaking clinical duties was now taking place.
Our clinical searches showed that asthmas reviews were not always occurring annually.
Patients access care and treatment in a timely way needed improving.
The practice did not have a patient participation group (PPG).

We found two breaches of regulations. The provider must:

Ensure that care and treatment is provided in a safe way
Establish effective system and processes to ensure good governance in accordance with the fundamental standards of care

Based on our overall findings in which we recognise the impact of improvements in governance, in delivery of care for patients at the practice, and the likely sustainability of these improvements due to changes in personnel and in the approach to the delivery of patient care, the practice is now rated requires improvement overall.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

We carried out an announced focused inspection on 06 and 07 October 2022.

The practice was previously inspected on 30 June 2022. Following this inspection, the practice was served with a notice to urgently suspend their registration as a service

Provider, in respect of regulated activities, for a period of three months. This notice was served under section 31 of the Health and Social Care Act 2008. The provider was rated inadequate overall and in all key questions and placed in special measures.

We previously inspected this provider on 24 November 2016 and the practice was rated requires improvement for safe and well-led services which resulted in an overall rating of requires improvement. A follow up inspection of the safe and well led key questions took place on 12 July 2017 where the practice was rated good overall.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Crawley Road Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This was a focused inspection, without undertaking a site visit inspection, to follow-up on we had issued at our last inspection.

Following this inspection, due to some improvements made by the provider, we have lifted the suspension on the provider’s registration.

We did not review the ratings awarded to this practice at this inspection.

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 included:

Speaking with staff using video conferencing.
Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting 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 inspected.
Information from our ongoing monitoring of data about services.
Information from the provider, patients, the public and other organisations.

We found the provider had made some improvements in providing safe services regarding:

The provision of safeguarding registers for children and vulnerable adults.
The management of patients who are prescribed high-risk medicines.
Emergency medicines held at the practice in the case of an emergency.

However, we found the provider had some continuing concerns in providing safe services regarding:

Although the provider had implemented a safeguarding register for children and vulnerable adults, they could not demonstrate when the registers had been regularly reviewed.
The management of patients who are prescribed medicines that require additional monitoring.
Regular prescribing audits for members of staff who are non-medical prescribers.
The lack of a practice system regarding Patient Specific Directions (PSDs).
Although the practice had implemented a policy regarding triaging patients, they could not demonstrate they had delivered appropriate training for non-clinical staff.

We found the provider had made some improvements in providing effective services regarding:

The management of some patients with long term conditions. For example, some patients with asthma who are prescribed rescue inhalers; patients who may have been diagnosed with chronic kidney disease (CKD) and hypothyroidism (under-active thyroid).
The management of care planning for vulnerable patients, including those patients who have a learning difficulty.

However, we found continuing concerns in providing effective services regarding:

The management of some patients with long term conditions. For example, hypertension (high blood pressure); some patients with Type Two Diabetes; some patients who have Diabetic retinopathy and patients who suffer with fluid build-up (Oedema).
Documented clinical supervision for clinical staff in the practice.

We found the provider had made some improvements in providing responsive services regarding:

The provision of appropriate information for patients relating to its complaints system.
Information was available for patients on the practice website regarding practice opening times and on ‘how to make appointments’.

We found continuing concerns in providing responsive services regarding:

Response to and the management of patients’ complaints.
The management of the practice E-Consult system in response to patients’ needs.
Although information was available on the practice website regarding appointments and opening times, it was unclear how this was managed for patients who are digitally excluded.

We found the provider had made some improvements in providing well-led services regarding:

The management of some high-risk medicines and long term conditions and some systems had been implemented.

However we found the provider had some consistent concerns in providing well-led services regarding:

Although some improvements had been implemented, leaders could not demonstrate that they had made improvements across all relevant areas.
The provider had some systems in place to identify, manage and mitigate risks, however these were not always effective.
The provider could not demonstrate they had oversight of all systems and processes to ensure effective care and to drive quality improvement.
The management team could demonstrate they had awareness of some challenges to delivering care and had taken actions to make improvements.

The areas where the provider must make improvements are:

Ensure that care and treatment is provided in a safe way.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The service will remain in special measures until we have undertaken the next inspection and this will be reviewed at that time. This will be kept under review and if needed could be escalated. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

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

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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

We carried out an announced inspection at Crawley Road Medical Centre on 30 June 2022. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring – Inadequate

Responsive – Inadequate

Well-led – Inadequate

Following our previous inspection on 24 November 2016, the practice was rated requires improvement for safe and well-led services which resulted in an overall rating of requires improvement. A follow up inspection of the safe and well led key questions took place on 12 July 2017 where the practice was rated good overall.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Crawley Road Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection on 30 June 2022 in response to concerns raised directly with CQC. This related to safety systems and processes and governance of the practice. In response to these concerns, we carried out an announced site visit inspection on 30 June 2022, in conjunction with a remote clinical records review.

This report covers our findings in relation to both the review and inspection.

How we carried out the inspection/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 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 included:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A site visit

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 Inadequate overall

We found that:

The practice did not have adequate systems, practices and processes to keep people safe and safeguarded from abuse.
There were gaps in systems to assess, monitor and manage risks to patient safety.
Patients’ needs were not assessed and care and treatment was not delivered in line with current legislation.
The practice did not have a comprehensive programme of quality improvement activity.
The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
Staff did not always work effectively together and with other organisations to deliver effective care and treatment.
Staff did not always treat patients with kindness, respect and compassion. Feedback from patients was negative about the way staff treated people.
Services did not always meet patients’ needs.
People were not able to access care and treatment in a timely way.
Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
The overall governance arrangements were inadequate.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

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

On 8 July 2022, Crawley Road Medical Centre was issued with an urgent notice to suspend their registration as a service provider in respect of regulated activities. This notice was served under Section 31 of the Health and Social Care Act 2008. This notice of urgent suspension of their registration was given because we believe that a person will or may be exposed to the risk of harm if we do not take this action. The provider is not to carry out any regulated activities at the location for a period of three months. We will inspect the practice again in three months to consider whether sufficient improvements have been made.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crawley Road Medical Centre on 24 November 2016. The practice was rated requires improvement for safe and well-led services which resulted in an overall rating of requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Crawley Road Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified during our previous inspection on 24 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

The lead for infection prevention and control at the practice was up to date with infection control training.
The practice provided evidence that they had made improvements to the premises in line with the infection control audit action plan.
There were systems in place for the safe management of medicines.
There were policies in place for managing significant events and uncollected prescriptions.
Portable electrical testing (PAT) was completed for all electrical items at the practice.
There was a portable oxygen cylinder available at the practice.
There was a system in place for monitoring the use of blank prescription pads.
All staff at the practice had completed information governance training.
There was a comprehensive system in place for pre-travel vaccination assessments.

However, there was an area of practice where the provider needs to make improvements.

The provider should:

Signpost the electrical outlets for both pharmaceutical fridges to reduce the risk of accidental disconnection from the power source.

At our previous inspection on 24 November 2016, we rated the practice as requires improvement for providing safe and well-led services as we found there were gaps in governance arrangements for managing medicines and infection prevention and control training for the infection control lead at the practice. At this inspection we found that the practice had improved systems for managing medicines. We found that the lead for infection control was up to date with infection control training. Consequently, the practice rating has improved to good for safe and well-led services resulting in an overall rating of good.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crawley Road Medical Centre on 24 November 2016. Overall the practice is rated as requires improvement.

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

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, despite significant events being reported and assessed, there was no policy for significant events to underpin the systems in use.
Non clinical staff who acted as chaperones had not received a Disclosure and Barring Service (DBS) check. We were provided with evidence of completed checks following the inspection.
Systems in relation to infection control were not fully implemented. There were no cleaning schedules for view on the day of the inspection for the cleaning of the building or clinical equipment such as spirometer or ear irrigator. However these were provided after the inspection day. The practice had an infection control policy in place. In addition, the lead for infection control was not appropriately trained and the practice had failed to act on the actions outlined in its August 2016 infection control audit which included ensuring that maximum and minimum temperatures were recorded on the vaccine fridges.
The medicine fridges were over stocked and the temperature for one of the fridges could not be effectively recorded. The practice agreed to purchase a further fridge to replace the fridge where the temperature could not be appropriately recorded.
The practice lacked a system to monitor the use of blank prescription forms and pads.
The practice lacked failsafe systems in place to follow up results of the cervical screening programme.
Data showed patient outcomes were comparable to the CCG and the national average
Patients said they were treated with compassion, dignity and respect.

The areas where the provider must make improvements are:

Ensure that the infection control lead has received appropriate infection prevention and control training.
Ensure medicines fridges are not over stocked so that there is appropriate air flow around the vaccines stored and that accurate temperatures are recorded.

In addition the provider should:

Produce a significant events policy to underpin existing processes.
Ensure that a process is put in place to ensure that uncollected prescriptions are checked by a GP.
Ensure portable electrical testing (PAT) is undertaken.
Provide a portable oxygen cylinder that could be easily transported.

Ensure there is a system in place to monitor the use of blank prescription forms and pads.
Ensure non clinical staff undertake information governance training.
Carry out pre travel vaccination assessments.
Continue to follow the recommendations of the infection control audit.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We did not speak to people using the service as part of this inspection because of the nature of the compliance actions we were following up.

At our previous visit on 28 April 2014, the provider had taken some steps to provide care in an environment that was more suitably designed, but there were shortfalls in terms of the maintenance of the premises and there was no clear and detailed plan to say what work was required and when the work would be completed.

At our inspection on 11 September 2014, we found that most of the maintenance work including hot water in the consulting rooms, repair to tiles and cracks in the ceiling, replacing floors, treatment of damp and painting of walls had been completed. There were plans in place to complete minor finishing touches such as ceiling light covers by October 2014

At our last inspection on 11 December 2013 we found the provider had not taken reasonable steps to ensure that medicines were kept safely. The provider had not taken steps to provide care in an environment that was suitably designed and adequately maintained and records were not kept securely.

At our inspection on 28th April 2014 we found the provider had taken reasonable steps to ensure that medicines and records were being kept safely. They were meeting these essential standards.

The provider had taken some steps to provide care in an environment that was more suitably designed, but there were shortfalls in terms of the maintenance of the premises and there was no clear and detailed plan to say what work was required and when the work would be completed.

We did not speak to people using the service as part of this inspection because of the nature of the compliance actions we were following up.

People we spoke with told us they were involved in making decisions about their care and treatment. People said, 'they put themselves out to respect your wishes' and 'they ask whether I would like to try X.' There was evidence that the practice accommodated people's needs with respect to religion, culture and disability.

People told us they were satisfied with the quality of the treatment. One person said, "it's been fantastic from day one." We found people's treatment reflected relevant research and guidance, including extra specialised training for staff.

We found evidence that the provider worked in cooperation with other providers, including regular information sharing meetings.

We found that people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. There were not adequate arrangements in place with regard to fire safety and maintenance. Some medicines were not appropriately stored.

People told us that the provider was not always able to cover doctors' absences but we did not find that this affected people's care. We saw evidence that staff had skills and experience relevant to their roles.

We found the service had a complaints system and policy and that the provider had followed this when responding to complaints.

We found there were suitable arrangements in place for the storage of records, but some were not securely stored.

Crawley Road Medical Centre

All Inspections

03 and 09 May 2023

During a routine inspection

06 and 07 October 2022

During an inspection looking at part of the service

30 June 2022

During a routine inspection

12 July 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGP

24 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

11 September 2014

During an inspection looking at part of the service

28 April 2014

During a routine inspection

11 December 2013

During a routine inspection