Archived: Central Healthcare

We carried out an announced, comprehensive inspection of Central Healthcare on 26 February 2020, as part of our inspection programme. We rated the practice as inadequate overall, including all population groups. We identified four breaches of regulations and issued warning notices for three of the breaches and a requirement notice for the fourth. This inspection report for Central Healthcare can be found by selecting the ‘all reports’ link for Central Healthcare on our website.

We carried out a focused, unrated desktop inspection on 13 July 2020 to check whether the provider had taken steps to comply with the legal requirements set out within the warning notices regarding non-compliance with regulation 12(safe care and treatment), regulation 17 (good governance) and regulation 18(staffing).

We found improvements had been made in respect to patient safety, staffing, effectiveness, governance and leadership.

For example:

• Improved processes had been put in place to report and manage significant events’, safeguarding concerns and the management and mitigation of risk.
• Patient safety issues were being reviewed, assessed and actioned appropriately.
• Improvements had been made with regard to effective governance and management within the service, including training, staff support, and recruitment.
• Patient management and care plans had been reviewed and systems implemented to improve the care and overall patient experience.

The service is on a trajectory of development and improvement. The team found that during the review on 13 July 2020, the risks highlighted in the warning notices issued to the provider had significantly reduced. Special measures give people who use the service the reassurance that the care they get should improve. The service will still be kept under review and if needed could be escalated to urgent enforcement action.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced, comprehensive inspection of Central Healthcare, Lawrence House medical centre, 1a Belgrave Crescent, Scarborough, YO11 1UB and the two branch sites Prospect Road surgery, Scarborough, YO12 7LB and Peasholm surgery, 98 Tennyson Avenue, Scarborough, YO12 7RE as part of our inspection programme.

This practice has not previously been inspected as it is a new registration following the merger of four previously registered practices.

Our judgement of the quality of care at this service is based 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, including all population groups, overall.

We identified four breaches of regulations and issued warning notices for three of the breaches.

We rated the practice as inadequate for providing safe services because:

•Clear systems, practices and processes to keep people safe and safeguarded from abuse were not in place.

•Recruitment systems and processes were not always adhered to.

•The practice did not have complete fire safety and health and safety systems in place.

•Reliable infection prevention and control practices were not in place.

•There were gaps in systems to assess, monitor and manage risks to patient safety.

•Systems and processes to ensure staff had the information they needed to deliver safe care and treatment were ineffective.

•The practice did not have an effective system to learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

•Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance.

•Some performance data was significantly below local and national averages.

•Outcomes from the monitoring of care and treatment were not always acted on in a timely way or monitored to ensure improvement achieved and sustained.

•The practice was unable to demonstrate that staff always had the skills, knowledge and experience to carry out their roles. Not all staff were appropriately trained to fulfil their roles and responsibilities, specifically pertaining to safeguarding, infection prevention and control, fire safety, chaperoning, basic life support, sepsis, vaccination and immunisations, information governance and general data protection regulations (GDPR).

•The practice was unable to demonstrate a system of clinical supervision and appraisal, particularly for the nursing team.

•Staff did not always work together and with other organisations to deliver effective care and treatment.

•Staff were not always consistent and proactive in helping patients to live healthier lives.

•The practice was unable to demonstrate that it always obtained consent to care and treatment in line with legislation and guidance.

This area affected all population groups; so, we rated all population groups in the effective domain as inadequate.

We rated the practice as good for providing caring services because:

•National GP patient survey data was comparable to the England average for the way patients were treated.

•Feedback from patients was mixed about the way staff treated people.

We rated the practice as inadequate for providing responsive services because:

•Sufficient numbers of staff were not always available resulting in services not always meeting patients’ needs.

•People were not able to access care and treatment in a timely way. There were lengthy delays accessing routine appointments and accessing the practice via the telephone.

•Complaints were listened to but not always used to improve the quality of care.

This area affected all population groups; so, we rated all population groups in the responsive domain as inadequate.

We rated the practice as inadequate for providing well-led services because:

•Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.

•The practice did not have clear and effective processes for managing risks, issues and performance. Measures to address many of the known risks such as significant events, patient feedback regarding attitude of staff, timely access to services, staffing levels and management of patient information were not managed and actioned in a timely way.

•While the practice had a clear vision, that vision was not supported by a credible strategy.

•The practice culture did not effectively support high quality sustainable care.

•The overall governance arrangements were ineffective. Lack of oversight in areas included; staff training, appraisal and supervision of staff, management of health and safety and fire safety, infection prevention and control, dealing with medical and non-medical emergencies, safe recruitment, management of patient information and the management of prescription stationery coming into the practice.

•The practice did not always act on appropriate and accurate information. This included areas such as information not being added onto patients notes and patients being referred to other services in a timely way

•We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

This area affected all population groups; so, we rated all population groups in the well-led domain as 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.

•Ensure staff receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties they are employed to perform. Ensure sufficient numbers of staff are always available to meet patients’ needs.

•Ensure recruitment procedures are operated effectively.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. 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 is set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care