We carried out an announced inspection at Richmond Medical Centre on 25 May 2023, the practice was rated inadequate overall and for providing safe and well led services, requires improvement for providing effective and responsive services and good for providing caring services. The practice was placed into Special Measures and Warning Notices were issued in respect of breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We carried out an announced follow up inspection on 6 December 2023 to review actions taken regarding compliance with the Warning Notices and instigation of Special Measures following the inspection in May 2023. Whilst progress had been made in relation to the Warning Notices, insufficient improvements had been made to comply with all aspects. Therefore the Warning Notices remain in place. There remains a rating of inadequate for the safe key question and the provider remains in Special Measures. The service will be kept under review and where necessary, another inspection will be conducted in line with our priorities. If needed this could lead to further enforcement action.
Overall, the practice is now rated as requires improvement.
Safe - inadequate.
Effective - requires improvement.
Caring - not inspected, rating of good carried forward from previous inspection.
Responsive – requires improvement.
Well-led - requires improvement.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Richmond Medical Centre on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out this inspection to follow up findings from our previous inspection in line with our inspection priorities.
Focus of inspection to include:
- Well Led
How we carried out the inspection/review
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.
- 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 short site visit.
- Requesting feedback from patients.
- Completing interviews with key stakeholders.
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 that:
- Safeguarding systems and processes had been improved; further development was required to assure the providers patients were safe from abuse.
- Systems and processes in place to manage environmental risks were not always effective and monitoring of risks was not always undertaken by appropriately trained staff who fully understood the requirements to ensure safety in relation to Legionella risk.
- The system for processing information relating to new patients including the summarising of new patient notes had not been effective.
- Management of medicines and patients who are prescribed medicines who required monitoring had improved: further development and consistent embedding of the processes was required.
- Dissemination and recording of information to staff had improved but further development was required to ensure consistent information was relayed to all staff.
- Management of safety alerts had improved; further development was required in relation to historic alerts to ensure all patients receive safe care.
- Patient access to the services provided had improved and patients could access care and treatment in a timely way.
- Information was not readily available to patients without digital access in the practice.
- Leadership had improved within the practice. However, further development and assessment of effectiveness was required to ensure compassionate, inclusive and effective leadership was in place.
- Improvements had been made to the governance processes in place. Further development, understanding and embedding of these processes was required to manage risks, communication and ensure appropriate, effective leadership.
We found 2 ongoing breaches of regulations. The provider must:
- 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 provider should:
- Update the Safeguarding Policies and register to include up to date information and confirm this is correct.
- Improve access to information for patients who are digitally excluded.
- Update the management of FP 10 prescriptions transferred to the branch site.
I am leaving this service in special measures. This recognises that further improvements need to be made to the quality of care provided by this service.
Not all of the actions had been completed or embedded to meet the Warning Notices and as a result these remain in place.
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