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Inspection Summary


Overall summary & rating

Good

Updated 10 July 2020

This is a focused desk top review of evidence supplied by Kenton Clinic, for areas within the key question safe. This review was completed on 01 July 2020.

Upon review of the documentation provided by the practice, we found the practice to be good in providing safe services. Overall, the practice is rated as good.

The practice was previously inspected on 12 July 2019. The inspection was a comprehensive

inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). At the inspection, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation in respect of providing safe services. The practice was issued a requirement notice under Regulation 12, Safe care and treatment.

For this desk top review, the provider sent us an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation 12 Safe care and treatment. These improvements have been documented under the safe section of the report. In addition to the breaches of Regulation 12 the practice had implemented a number of ‘should’ actions identified at the July 2019 inspection. In response to these recommendations the practice had;

  • Reviewed safeguarding children and vulnerable adult training to ensure it was in line with intercollegiate guidance (updated January 2019).
  • Taken action to improve national GP patient survey results to bring in line with local and national averages.
  • Initiated some quality improvement activity by carrying out clinical audit.

Inspection areas

Safe

Good

Updated 10 July 2020

The practice is rated as good for providing safe services. At the inspection in July 2019 we found shortfalls in the provision of safe care. The following concerns were identified which were breaches of Regulation 12 Safe care and treatment;

  • The practice could not demonstrate an effective system to ensure the healthcare assistant administered vitamin injections to patients with the authority of Patient Specific Directions (PSDs) from a prescriber.
  • The practice could not demonstrate that medical oxygen and the defibrillator were regularly checked to ensure they were fit for purpose.
  • The practice could not demonstrate that clinical specimens were stored appropriately, and they had not ensured that all actions from an infection prevention and control audit had been completed.
  • The practice had not ensured that all clinical staff knew what action to take in the event of an inoculation injury.
  • The practice could not demonstrate that all non-clinical staff were trained in identifying deteriorating or acutely unwell patient’s suffering from potential illnesses such a sepsis.
  • The practice had failed to ensure learning from significant events was shared with the whole practice team.

For this desk top review, the provider sent us evidence to show that they had addressed the breaches of Regulation 12 Safe care and treatment;

  • The Practice had raised the lack of PSDs as a significant event and a PSD policy was created for staff to follow. From July 2019 the practice ensured all medicines requiring a PSD were administered in line with the new policy. For additional assurance, the practice carried out an audit of all injections administered by the healthcare assistant from July 2018 to June 2019 without a PSD and it was found that all the injections administered were clinically appropriate with no adverse events noted.
  • The practice provided evidence of a system for the recording of medical oxygen and the defibrillator in the treatment room.
  • The practice had reviewed their policy for specimen collection. The practice now ensured that all specimen taken are collected on the same day by the courier. No specimens were kept overnight or stored in any refrigerators at the practice.
  • Needle stick injury poster had been displayed in all clinical rooms to ensure staff knew the steps to follow in the event of a needlestick injury and actions from the most recent infection prevention and control audit had been implemented.
  • All staff had been trained in recognising the signs and symptoms of Sepsis and red flag posters displayed.
  • The practice provided documentation to show that significant events were being discussed in monthly practice meetings, where all staff were present. Action taken and learning from significant events had been recorded in the minutes of meeting.

Effective

Good

Updated 10 July 2020

The practice is rated as good for providing effective services. This rating was given following the comprehensive inspection in July 2019. A copy of the full report following this inspection is available on our website:

Caring

Good

Updated 10 July 2020

The practice is rated as good for providing caring services. This rating was given following the comprehensive inspection in July 2019. A copy of the full report following this inspection is available on our website:

Responsive

Good

Updated 10 July 2020

The practice is rated as good for providing responsive services. This rating was given following the comprehensive inspection in July 2019. A copy of the full report following this inspection is available on our website:

Well-led

Good

Updated 10 July 2020

The practice is rated as good for providing well-led services. This rating was given following the comprehensive inspection in July 2019. A copy of the full report following this inspection is available on our website:

Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Older people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good