The Care Quality Commission
  • Doctor
  • GP practice

Archived: Cornerstone Surgery

Overall: Requires improvement read more about inspection ratings

Fingerpost Park HC, Atlas Street, St. Helens, Merseyside, WA9 1LN (01744) 738835

Provided and run by:
Cornerstone Surgery

All Inspections

8 and 15 September 2021

During a routine inspection

We carried out an announced inspection at Cornerstone Surgery on 8 and 15 September 2021. Overall, the practice is rated as requires improvement.

The ratings for each key question: -

Safe - Requires improvement

Effective – Requires improvement

Caring - Good

Responsive - Good

Well-led – Requires improvement

We carried out an announced inspection of Cornerstone Surgery on 13 February 2020. The practice was rated requires improvement overall and for being safe, responsive and well-led. Effective was rated as inadequate and caring was rated as good. We issued requirement notices in respect of breaches of Regulation 12 (safe care and treatment), Regulation 16 (receiving and acting on complaints) and Regulation 17 (good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Cornerstone Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive review of information which included a site visit to follow up on:

  • Breaches of regulations and ‘shoulds’ identified in the 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
  • Conducting an interview of Patient Participation Group members 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

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 the practice Requires improvement overall and for being safe,effective and well-led. Caring and responsive is now rated as good. We found continued breaches of Regulations 12 (safe care and treatment) and 17 (good governance).

We rated the practice as requires improvement for providing Safe services because:

  • Improvements were needed to the management of patient medication to ensure patient safety.
  • The provider could not provide checks of emergency equipment and medication to ensure it was safe.

We rated the practice as requires improvement for providing effective services because:

  • Performance data relating to childhood immunisations and cervical screening continued to be below the minimum target rates and the number of patients excluded from reviews and medical checks for long-term conditions was above the national average.
  • Improvements were needed to monitoring patients with possible long-term conditions.

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

  • A system of audit had recently been introduced but this was not embedded.
  • Better oversight of training was needed to ensure updates where completed in a timely manner.
  • Records relating to the service were not always accessible or held on-site

We found that:

  • At this inspection, on 8 and 15 September 2021, we found that some required improvements had been made and identified a few other areas that required improvement.
  • The systems to communicate with staff had improved. There were documented staff meetings and a computer system had been introduced to assist with information sharing.
  • Referrals and other correspondence were managed in a timely way.
  • Improvements had been made to information provided to patients about making a complaint and to how complaints are managed.
  • Training identified as being needed at the last inspection had been provided to staff.
  • There had been improvements to the management of significant events.
  • Performance data relating to the number of patients who had cervical screening and childhood immunisations continued to be low. Patients excluded from health monitoring and reviews continued to be high. At this inspection there was a plan as to how this was being addressed.
  • Improvements were also needed to monitoring patients with possible long-term conditions such as chronic kidney disease.
  • The systems to audit the clinical care provided were not embedded and reviewed in order to demonstrate the effectiveness and appropriateness of the care provided.
  • All records needed for the operation of the service were not available when requested. This included registration checks for GPs, checks of emergency medication and equipment and contractors checks of the fire alarm and emergency lighting.
  • The system for ensuring patients had the required monitoring when prescribed certain medicines was not effective. Medication reviews were not being fully documented. Historical safety alerts had not been monitored to ensure safe prescribing.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • 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.

We found breaches of regulations. The provider must:

  • Ensure that 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.

Whilst we found no breaches of regulations, the provider should:

  • Record the checks under taken to confirm the registration of clinical staff
  • Provide fire marshal training to sufficient staff to enable cover for staff absences.
  • Put in place a risk assessment for the security of doors at the practice.
  • Put in place guidance for non-clinical staff to refer to regarding sepsis management to support their training.
  • Continue to review patients prescribed hypnotic medicines to ensure appropriate prescribing.

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

13 February 2020

During an inspection looking at part of the service

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: safe; effective, responsive and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key question: Caring.  

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 rated the practice as requires improvement for providing safe services because:

We found that:

  • There was limited evidence of shared learning from significant events.

The practice did not have robust systems in place to keep patients safe.

  • Safeguarding policies did not provide staff with the information required to enable staff to deal with all kinds of abuse such as female genital mutilation (FGM) and radicalisation (PREVENT) and the policy in place was not readily available, however, staff had the appropriate level of safeguarding training and access to the safeguarding lead however.

The practice did not have appropriate systems in place for the safe management of medicines, in particular:

  • Medicine management systems did not reflect legal requirements.
  • Paper prescriptions were not stored securely, and uncollected prescriptions were not dealt with in a timely manner.
  • Systems for checking the emergency medicines needed to be tightened and systems to monitor the prescription of high- risk medicines were not robust.

Systems for managing staff needed to be strengthened in particular:

  • The practice had not ensured the immunisation status of staff was checked in-line with best practice guidance.
  • Training in some key safety topics had not been completed or were not up to date for example, sepsis; fire safety and chaperone training.

However:

  • The practice had started to review staffing issues and introduce data management systems to ensure recruitment processes were completed and clinical and professional registration monitored. The practice was also updating the topics for mandatory training and beginning to monitor staff completion.

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

  • Some performance data was significantly below local and national averages.
  • The practice did not have processes to ensure an appropriate response when data indicated their performance was below the national and local averages in relation to health promotion and health outcome.
  • Systems were not in place to provide a failsafe and make sure non-urgent correspondence was dealt with appropriately and in a timely manner.
  • Systems to ensure all clinicians had ready access to up-to-date best practice clinical guidance were not in place.

We rated the practice as requires improvement for providing responsive services because:

  • Patients did not have ready access to a complaints policy.
  • The complaints policy provided inaccurate information.
  • The provider did not have oversight of all complaints because informal comments and concerns were not logged.

However

  • The practice organised and delivered services to meet patients’ needs, patients could access care and treatment in a timely way and the practice had identified areas where there were gaps in provision locally and had taken steps to address them.

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

  • The overall governance arrangements were not formalised and comprehensive.
  • Clear and effective processes were not in place to provide oversight for a number of systems for example, managing correspondence; data security or monitoring commissioned services.
  • While the practice had a clear vision, that vision was not supported by a measurable strategy.
  • A comprehensive audit programme was not in place.

We rated the population groups as follows:

Older people, people with long term conditions; vulnerable people and people with poor mental health as: requires improvement and working age people and families and young people as: inadequate.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way to patients.
  • Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to carrying on of the regulated activity.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Take steps to enable an audit of which staff had checked emergency medicines and equipment, ensure emergency medicines are replaced before they go out of date and complete a risk mitigation plan for emergency medicines not available in the emergency medicines kit.
  • Ensure all relevant staff have a clear understanding about the systems to manage safety alerts.
  • Action should be taken to support regular patient participation group meetings.

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

10th March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Cornerstone Surgery which is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 10th March 2015 at the practice location in Fingerpost Park Health Centre. We spoke with patients, staff and the practice management team.

The practice was rated as Good. A safe, caring, effective, responsive and well- led service was provided that met the needs of the population it served.

Our key findings were as follows:-

  • There were systems in place to protect patients from avoidable harm, such as from the risks associated with medicines and infection control. There were clear processes in place to investigate and act upon any incident and to share learning with staff to mitigate future risk.
  • Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.
  • Feedback from patients showed they were very happy with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.
  • The practice planned its services to meet the differing needs of patients. The practice encouraged patients to give their views about the services offered and made changes as a consequence.
  • There was a clear leadership structure in place. Quality and performance were monitored, risks were identified and managed. The practice ensured that staff had access to learning and improvement opportunities.

We saw an area of outstanding practice:-

  • The practice had set up a GP service for the homeless. Homeless patients were able to register with the practice and the clinicians regularly saw these patients when they were unwell and provided them with health screening and health promotion services. The practice supported homeless patients to attend hospital appointments. For example, hospital appointment letters were sent to the practice and liaison took place with community homeless services to identify a person to accompany the patient to the appointment.

There were areas of practice where the provider needs to make improvements.

The provider should:

  • Make a record of the physical and mental fitness of staff during the recruitment process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice