Archived: Dover House Surgery

At that inspection we found that emergency procedures and equipment did not meet requirements and put patient safety and welfare at risk.

We also identified that the principle GP did not have the appropriate knowledge of safeguarding and policies for safeguarding adults and children were not up to date.

During that inspection we found that the updated infection control policy was not reflective of what the surgery undertook, there had been no recent infection control training. Cleaning did not meet required standards and no risk assessments had been undertaken and no action plan in place to make the appropriate improvements.

We looked at the arrangements for quality assurance and found a toolkit for managing incidents such as significant events had been put in place but none had reported or recorded. We found that risk assessments and audits of the environment or health and safety and infection control audits had not been carried out to ensure the premises were safe for patients.

At our inspection of the service on 30 April 2014 we found that improvements had been made in regard to care and welfare, safeguarding, infection control and quality assurance.

We found that emergency procedures had been developed and all emergency equipment now met UK Resuscitation Council guidance and appropriate equipment for health checks were being used and regularly tested.

The practice had improved its approach to safeguarding adults and children. Policies and procedures were now up to date and reflected best practice and the appropriate leads were in place who t had attended the required training.

Significant improvements to the management of infection control within the surgery had been undertaken with a complete refurbishment to all clinical and non clinical areas to ensure that any unnecessary risks were reduced. New cleaning arrangements were in place and regular checks were underway to ensure standards remained high.

Arrangements for quality assurance had improved. Patients were now participating regularly in the how the surgery was run. There were appropriate risk assessments in place and the surgery had improved its clinical review process to take account of significant events.

At our last inspection in October 2013 we found that the provider was non-compliant with standards relating to care and welfare, safeguarding, infection control, medication, quality assurance and complaints. We found that emergency procedures and equipment did not meet requirements and put patient safety and welfare at risk. We identified that the principle GP had not undertaken level 3 child protection and adult safeguarding training and there were no up to date policies for safeguarding adults and children to protect patients from the risks of abuse. The infection control policy was not fit for purpose or up to date, No staff training and no risk assessments in relation to infection prevention and control.

The storage of medication in the surgery had improved since the last inspection. The provider has ensured that medication is stored correctly and has produced a prescribing policy to follow.

We looked at standards in relation to quality at the last inspection in October 2013. We found that the surgery was non- compliant with both quality assurance practices and complaints management. The provider was not identifying, assessing and managing risks related to the health, welfare and safety of patients. This included the analysis of incidents.

We found that complaints procedures were not in place at the last inspection. Since that inspection the provider has developed a complaints policy and ensured that patients are fully aware of how to make a complaint and who is responsible. The provider achieved compliance in regard to meeting this standard.

During this inspection we looked again at standards relating to care and welfare, safeguarding, infection control, medication, quality assurance and complaints.

We found that there were still no emergency procedures in place and equipment for supporting patients during an emergency did not meet the required standards. However, emergency medication was now up to date and stored appropriately.

We looked at safeguarding, we found that although some review of policies had been undertaken the procedures and protocols were not localised to the surgery. The provider (principle GP) had still not undertaken the required level of training for safeguarding adults and children and their continued to be a general lack of awareness across the staff group about this standard.

During this inspection we found that the updated infection control policy was not reflective of what the surgery does, there had been no infection control training. Cleaning did not meet required standards and no risk assessments had been undertaken and no action plan in place to make the appropriate

We looked again at quality assurance and found a toolkit for managing incidents such as significant events had been put in place but there had been none reported or recorded since our last visit. We found no risk assessments and audits of the environment or health and safety and infection control audits had not taken place to ensure the premises were safe for patients. Further action is being considered as a result of the continued breaches of the regulations.

During this visit we found that the provider was undertaking surgical procedures without registration. Due to the issues with infection control and premises risks the provider informed us and the NHS England body that they would not conduct these procedures until they had registered and sort to remedy the issues found by both bodies.

However, there were not sufficient arrangements in place to deal with foreseeable emergencies. There were no systems in place to ensure that the right emergency equipment was in place and that it was checked and fit for purpose.

We found no protocol for the recording of incidents or significant events. We asked the GPs whether they were aware of national patient safety guidance for significant events and they said they were but were not implementing it. This meant that the provider was not analysing and learning from incidents that could have resulted in harm to a patient.

The surgery was described by one patient as having 'a good standard of cleanliness." Patients said they had seen clinical staff washing their hands before examining them or carrying out a procedure. However, there was no effective system in place designed to assess the risk of and prevent, detect and control the spread of health care associated infections.

Medicines were prescribed appropriately. A patient told us "the doctor checks my medication regularly" and "they advise me of when is best to take it." The arrangements for obtaining repeat prescriptions of medication were effective and patients were happy with this service.

Patients were not clear how they would go about making a complaint and were not aware of the surgery's complaints procedure. In addition there was no complaints policy or procedure in place.