The Care Quality Commission
  • Doctor
  • GP practice

Julian House Homeless Health Service

Overall: Good read more about inspection ratings

Julian House, Manvers Street, Bath, BA1 1JW (01225) 422911

Provided and run by:
Heart of Bath

All Inspections

4 August 2021

During an inspection looking at part of the service

We carried out an announced inspection at Julian House Homeless Health Service on 4 August 2021. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive – Good (carried over from last inspection)

Well-led – Good

At our previous inspection on 2 May 2019 the practice was rated Requires Improvement overall and for the Caring and Well-led key questions. The key questions Safe, Effective and Responsive were rated as Good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Julian House Homeless Health Service on our website at www.cqc.org.uk

Why we carried out this inspection

This was a follow-up inspection, incorporating remote searches and interviews of staff and a site visit to follow up on:

  • Key questions inspected were Safe, Effective, Caring and Well-led
  • Areas followed up including any breaches of regulations or ‘shoulds’ identified in previous inspection
  • Ratings for responsive were carried forward from previous 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:

  • 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 short site visit
  • Obtaining feedback from other stakeholders.

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 Good overall and Good for the population group: people whose circumstances make them vulnerable and those experiencing poor mental health. The service had no patients registered in the other population groups, older people and families, young people and children, which meant these were not rated. In the population groups, people with long term conditions and working age people (including those recently retired and students) there were not enough patients registered to make a judgement, which meant these groups were also not rated.

We found that:

  • Improvements had been implemented and were embedded in practice, including privacy and dignity of patients, obtaining their feedback and quality improvement audits.
  • The practice provided care in a way that kept patients safe and protected from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Privacy screening had been fitted since the last inspection in the treatment room to maintain patient dignity.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • There was now a system for patients to give feedback and be actively involved in ongoing development of the service, for example a planned extension of reproductive health services.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • There was a cohesive team of staff who were strong advocates for improving the quality of life and health of homeless people.
  • The way the practice was led and managed promoted the delivery of a high-quality, person-centre care. Quality improvement initiatives such as non-clinical and clinical audits and research were carried out across the organisation and findings were shared with the team.
  • Patients with long term conditions were encouraged to register with the mainstream provider and therefore included in clinical audits run there. An example we saw provided assurance of accurate identification, care and treatment of any patients with chronic kidney disease.

We also found the following area of notable practice:

  • The service led a successful COVID-19 vaccination programme across the city of Bath targeting hard to reach people experiencing homelessness. In total, 83% of patients receiving the first dose, were able to receive the second dose due to the high level of engagement, education and flexibility of the programme delivered by staff.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

2 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at Julian House Homeless Healthcare (Julian House) on 2 May 2019 as part of our inspection programme. The service had no patients registered in the population groups, older people and families, young people and children, which meant that they were not rated. In the population groups, people with long term conditions and working age people (including those recently retired and students) there were not enough patients registered to make a judgement, which meant these groups were also not rated.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen.
  • When incidents did happen, the practice learned from them and improved their processes.
  • Staff involved and treated patients with compassion, kindness, dignity and respect, however there were no screens or curtains in the treatment room to maintain patient privacy.
  • The involvement of other organisations and the local community were integral to how services were planned and ensured that services met patient needs.
  • Care was provided in a way that met the needs of different groups of people and to ensure they received the care to best meet their needs. However, there was no system in place for patients to provide feedback and therefore no opportunity for the service to be evaluated and improved from a patient perspective.
  • The practice was developing their services, for vulnerable people and people experiencing poor mental health. There was limited evidence of clinical audit or a quality improvement programme being in place.
  • There was a cohesive team that was well supported by management.

The areas where the provider must make improvements are:

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care