Archived: Blundell Park Surgery

We carried out an announced comprehensive inspection of Blundell Park Surgery on 26 February 2020. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notice we issued to the provider in relation to Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing.

The practice received an overall rating of inadequate at our inspection on 9 July 2019.

The full comprehensive report from the July 2019 inspection can be found by selecting the ‘all reports’ link for Blundell Park Surgery on our website at www.cqc.org.uk.

Our key findings in July 2019 were as follows:

We found that:

•Care and treatment was not provided in a safe way

•The provider did not have a system to effectively deal with complaints

•Recruitment checks did not comply with Schedule 3 of the Care Quality Commission regulations 2009

•The provider did not have effective systems and processes to ensure good governance in accordance with the fundamental standards of care

•We were not assured that the practice employed sufficient numbers of skilled and experienced staff to deliver safe care and treatment.

At our inspection on 26 February 2020 we found

• The practice had not fully complied with the warning notice we issued but had taken some action needed to comply with the legal requirements.

• Significant events and complaints were standing items on the regular practice meeting agenda to ensure areas of learning and improvement were shared with all staff.

• A system for recording and acting on safety alerts had been implemented.

• We found documented evidence of fire drills and testing having taken place.

• The monitoring and risk assessment of emergency equipment was not adequate.

• Most of the appropriate risk assessments had been undertaken.

• Staff had been trained to identify a deteriorating or acutely unwell patient and on actions to take.

• Safeguarding policies were accessible to all staff and staff had had safeguarding training.

• Training records for staff were maintained and all mandatory training had been completed.

• There was a regular schedule of appraisals or supervision sessions for all staff.

• Patient Group Directions had been signed.

However,

• The practice had not fully responded to concerns identified in relation to staff immunity status for specific infections as not all staff’s vaccination status had been risk assessed.

• Blank prescriptions were kept securely however their use was not monitored in line with national guidance.

• The process for monitoring high-risk medicines was not embedded.

• We reviewed systems for managing recruitment and found appropriate pre-employment checks had not been undertaken for all recently recruited staff and not all staff had received a disclosure and barring (DBS) check or a risk assessment as appropriate.

• Policies and procedures essential to good governance (including training, recruitment and occupational health) were in place in the practice but not being fully applied.

As a result, the practice has been rated as requires improvement overall (requires improvement for the provision of safe and effective services; good for the provision of caring and responsive services, inadequate for well-led). The population groups relating to people with long term conditions and working age people have been rated as requires improvement; the population groups relating to older people, vulnerable people, people experiencing poor mental health and families, children and young people have been rated as good.

The practice must:

•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 sufficient numbers of skilled and experienced staff are employed at the practice to deliver safe care and treatment.

•Establish an effective system for responding to and learning from significant events.

This service was placed in special measures in July 2019. Insufficient improvements have been made such that there remains a rating of inadequate for the provision of well-led services. Therefore, the practice will remain in special measures. We will return to the service to review whether necessary improvements have been made at a later date and report on this in due course.

We carried out an announced focused inspection of Blundell Park Surgery on 4 December 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notice we issued to the provider in relation to Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing.

The practice received an overall rating of inadequate at our inspection on 4 July 2019 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the July 2019 inspection can be found by selecting the ‘all reports’ link for Blundell Park Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

• The practice had not fully complied with the warning notice we issued but had taken some action needed to comply with the legal requirements.
• We reviewed systems for managing recruitment and found improvements had been made to ensure appropriate pre-employment checks were undertaken and all staff had received a disclosure and barring (DBS) check.
• Significant events and complaints were standing items on the regular practice meeting agenda to ensure areas of learning and improvement were shared with all staff. However the process for managing significant events had not been implemented.
• A system for recording and acting on safety alerts had been developed but had not been implemented.
• The practice had responded to concerns identified in relation to staff immunity status for specific infections. However, not all staff’s vaccination status had been risk assessed.
• Staff advised that staffing levels were improved.
• Safeguarding policies were accessible to all staff and staff had had safeguarding training.
• We found documented evidence of fire drills and testing having taken place.
• Appropriate risk assessments had been undertaken.
• Staff had been trained to identify a deteriorating or acutely unwell patient and on actions to take.
• Blank prescriptions were kept securely however their use was not monitored in line with national guidance.
• Patient Group Directions had been signed.
• Policies and procedures essential to good governance (including training, recruitment, locum staff and occupational health) were in place in the practice.
• Training records for staff were maintained and all mandatory training had been completed.
• There was a regular schedule of appraisals or supervision sessions for all staff.

We carried out an announced comprehensive inspection at Blundell Park Surgery on 9 July 2019 as part of our inspection programme.

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.

The practice was rated as inadequate for providing safe, effective and well-led services and requires improvement for responsive and good for caring.

We found that:

• The practice did not have clear systems and processes to keep patients safe.
• Receptionists had not been given sufficient guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.
• The practice did not have appropriate systems in place for timely reviews of medicines.
• The practice did not learn and make improvements when things went wrong.
• The arrangements in respect of infection prevention and control needed improving.

We rated the practice as inadequate for providing safe, effective and well-led services because:

• The monitoring and risk assessment of emergency equipment was not adequate.
• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• Information was not acted on in a timely way.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.
• We found no documented process for the managing of complaints.
• Recently released data from the National GP Patient Survey showed patient satisfaction had deteriorated.

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 sufficient numbers of skilled and experienced staff are employed at the practice to deliver safe care and treatment.
• Establish an effective system for responding to and learning from complaints.

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

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care