The Care Quality Commission
  • Doctor
  • GP practice

Horizon Health Centre Also known as (within) For All Healthy Living Centre

Overall: Inadequate read more about inspection ratings

68 Lonsdale Avenue, Weston-super-mare, Somerset, BS23 3SJ 0345 350 3973

Provided and run by:
Pier Health Group Limited

Important: The provider of this service changed. See old profile

All Inspections

20 September 2023

During an inspection looking at part of the service

We carried out an announced inspection on 20 September 2023. This inspection was conducted to follow up on Warning Notices issued on 9 June 2023. The practice was inspected, but not rated, which means we carried on the rating from the last inspection in May 2023. Overall, this practice is rated inadequate and is in special measures.

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

Why we carried out this inspection

We carried out an announced comprehensive inspection at Horizon Health Centre on 25 May 2023. Overall, the practice was rated as inadequate, and the practice was placed into a Special Measures. We found breaches of Regulation 12 and Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued a Warning Notice.

Following our previous inspection on 25 May 2023, the practice was rated inadequate for the safe and well-led key questions and requires improvement for effective, caring and responsive.

We carried out this inspection on 20 September 2023 to follow up breaches of regulation from the previous inspection that resulted in a Warning Notice being issued on 9 June 2023, in line with our inspection priorities. This report covers findings in relation to those requirements and was not rated.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • 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 found that:

  • The practice had taken action to implement improvements to address breaches in regulations previously identified in the Warning Notice.
  • There was improved oversight to ensure processes were operating effectively. However, some systems were still being embedded within the practice.
  • Improvements had been made to address the previous breaches in regulation. However, there were some aspects of safety and governance that required further improvement and embedding.
  • The practice was able to demonstrate improvements in the way individual care records were managed. However, further improvements were required in relation to the management of patients with asthma and medicine reviews.
  • The practice had taken action to ensure medicines were appropriately authorised before being administered by staff.
  • There were appropriate systems and actions in place to improve infection prevention and control.
  • Staff had received training in relation to appointment access, including identifying concerns that needed escalating to GPs.
  • The practice had taken action to manage backlogs of activity in relation to correspondence received into the practice, coding and appropriate follow up. However, incoming routine correspondence to be coded was taking 2 to 3 weeks to be processed.
  • There were clear processes for identifying and addressing when things went wrong, including sharing learning with staff to ensure improvements.
  • Non-medical prescribers received supervision and monitoring of their prescribing practice.
  • There were improvements to the way 2-week-wait referrals were monitored.

We found breaches of Regulation 12 Safe care and treatment and Regulation 17 governance . The provider must:

  • Ensure 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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

25 May 2023

During a routine inspection

We carried out a short notice announced comprehensive inspection at Horizon Health Centre on 25 May 2023. Overall, the practice is rated as Inadequate.

The key questions are rated:

Safe - inadequate

Effective - requires improvement

Caring - requires improvement

Responsive - requires improvement

Well-led - inadequate

Following our previous inspection on 4 July 2022, the practice was rated as requires improvement overall and for providing safe, effective and well led services. They were previously rated as good for providing caring and responsive services.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.

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 found that:

  • The practice had not implemented necessary improvements to address breaches in regulations previously identified.
  • The practice was unable to demonstrate that individual care records were managed appropriately; and that staff had access to relevant information to ensure safe care and treatment.
  • The practice had not ensured medicines were appropriately authorised before being administered by staff.
  • Positive outcomes from GP national patient surveys remained below national averages.
  • There were no appropriate arrangements to manage backlogs of activity.
  • Oversight was not effective to ensure processes were embedded and operated effectively.

At this inspection we found that not enough improvements had been made to address previous breaches in regulation identified during our last inspection in July 2022 and additional areas of risk were also identified. We served warning notices to the provider for breaches of Regulation 17 Good governance.

The areas where the provider must make improvements:

  • Ensure 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.

The areas where the provider should make improvements:

  • Continue to identify and take action to improve uptake of childhood immunisations and cervical screening.
  • Take action to improve the patient experience and address areas of concern identified in national GP patient surveys.

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 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 vary the provider’s registration 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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

4 July 2022

During a routine inspection

We carried out an announced inspection at Horizon Health Centre on 4 July 2022. Overall, the practice is rated as Requires Improvement.

Safe - Requires improvement

Effective - Requires improvement

Caring - Good

Responsive - Good

Well-led – Requires improvement

Following our previous inspection on 18 August 2021 the practice was rated Requires Improvement overall and for key questions Safe, Effective and Well Led. The key questions Caring and Responsive were rated as Good. We found breaches to regulation 12 and 17 of the Health and Social Care Act Regulations 2014.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on breaches of Regulation 12 and 17 of the Heath and Social Care Act Regulations 2014 from August 2021. The inspection looked at all the five key areas Safe, Effective, Caring, Responsive and Well Led.

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

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 Requires Improvement overall.

We found that:

  • Improvements had been made to the areas highlighted in the previous report. However, we found examples where further improvements were required.
  • Risk assessments were incomplete and it was not always clear who was responsible for actions and completion of tasks.
  • Staff recruitment files and vaccination records were incomplete.
  • Management and oversight of patients on long term conditions had improved to provide effective care to patients.
  • Improvements had been made to the telephone system increasing patient access.
  • The process of managing complaints had been overhauled to be more responsive and lessons learned however it was not always clear how they would be actioned.
  • Leaders did not have oversight of risk assessments.
  • Some clinical governance systems did not always include reviewing and auditing of the system to ensure it was robust.

We found one breach of regulations. The provider must:

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

The provider should:

  • Ensure all locum staff files contain a signed confidentiality agreement.
  • Continue to improve patient uptake of cervical screening and childhood immunisations.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

18 August 2021

During an inspection looking at part of the service

We carried out an announced inspection at Horizon Health Centre on 18 August 2021. Overall, the practice is rated as Requires Improvement.

Set out the ratings for each key question

Safe - Requires Improvement

Effective - Requires Improvement

Well-led - Requires Improvement

Following our previous inspection on 4 November 2019 the practice was rated Requires Improvement overall and for the key questions Safe, Effective and Well Led. The key questions Caring and Responsive were rated as Good. We found breaches to regulation 12, 17 and 18 of the Health and Social Care Act Regulations 2014.

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

Why we carried out this inspection

This was a follow-up inspection from the 2019 inspection incorporaing remote searches and interviews of staff and a site visit to follow up on:

  • The domains rated as requires improvement (safe, effective and well-led).
  • Breaches to regulation 12, 17 and 18 as well as any ‘shoulds’ identified in previous inspection.
  • The ratings for caring and 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 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 repeated the rating of this practice as Requires Improvement overall, because:

  • There was evidence of improvements to areas identified at the previous inspection. However, we found new areas which required improvement.
  • The practice has been engaging well with the Clinical Commissioning Group and the Care Quality Commission, implementing actions and demonstrating improvements made.
  • There were now appropriate systems in place for the safe management of medicines. However, not all of these had time to be fully embedded and we found some areas which required revisiting to ensure patient safety was maintained. The practice evidenced acting upon these when brought to their attention.
  • Staff recruitment records were complete, containing evidence of required checks.
  • There was a risk to staffing becoming strained as a result of a need to support the staffing shortages at the other registered location under the provider.
  • The practice had made some improvements to their quality and outcome framework monitoring although these were still below local and national averages. The practice demonstrated plans to address these although there was insufficient evidence to demonstrate impact at this time.
  • The COVID-19 pandemic significantly impacted the delivery of health services within two months of the last inspection and is ongoing. The practice made adaptions to ensure service provision remained as accessible as possible within the constraints.

We found two breaches of regulations:

  • Regulation 12 HSCA (RA) Regulations 2014 Safe care and Treatment
  • Regulation 17 HSCA (RA) Regulations 2014 Good governance

The provider should:

  • Continue to improve performance to ensure positive patient outcomes for patients with long term conditions (including diabetes, asthma and COPD); and mental health conditions.

  • Improve performance in uptake of childhood immunisations; and cervical cancer screening for eligible women.

  • Provide continuing support for staff to reduce the burden of workload, by ongoing engagement of external specialists to maintain reduced record backlogs until new staff are competent to undertake this work.

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

04 November 2019

During a routine inspection

We carried out an announced comprehensive inspection at Horizon Health Centre on 4 November 2019 as part of our inspection programme.

We decided to undertake an inspection of this service following the practice being taken over by a new provider and in line with our published process. It was noted that the new provider, Pier Health Group Ltd, took over responsibility for the location in November 2018 which was part way through the 2018/19 reporting period for the Outcomes Framework (QOF). Some performance data related partly to the previous provider’s activities from April to September 2018.

This inspection looked at the following key questions:

  • Safe
  • Effective
  • Responsive
  • Caring
  • Well Led

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 Requires Improvement overall.

We rated the practice as Requires Improvement for providing safe services because:

  • The practice did not have fully embedded systems and processes to keep patients safe.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • Some staff recruitment records were not complete or up to date.

We rated the practice as Requires Improvement for providing effective services because:

  • Some performance data was below local and national averages and this affected the outcomes for patients including those with some long term conditions; patients with mental health conditions; the prescribing of some medicines; and uptake of screening for cervical cancer and some childhood immunisations.
  • A new clinical model of care (advanced healthcare professional led) was not fully embedded.

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

  • Some governance arrangements were not yet fully implemented or embedded. For example, these included arrangements for safe management of medicines; clinical governance of non-medical prescribers; monitoring of safety alerts; and the effectiveness of the new clinical model in relation to staffing capacity. 
  • Leaders were, actively involved in driving the implementation of arrangements for high quality sustainable care, however improvements and implementation plans were still in progress and it was too early to test the effectiveness.
  • There were clear plans in place and implementation was underway to provide long term, sustainable solutions to the challenges faced by the practice over the last few years. For example, the practice was implementing effective business intelligence systems to provide analysis of patient needs to inform service review, redesign and capacity requirements.

We rated the practice as Good for providing caring and responsive services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated four of the patient population groups (people with long term conditions; families, children and young people; working age people; and people experiencing poor mental health) as requires improvement as care for these groups was not effective.

We rated the two remaining patient population groups (older people; and people whose circumstances may make them vulnerable) as good.

The areas where the provider must make improvements are:

  • Ensure 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
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

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

The areas where the provider should make improvements are:

  • Complete the review of patient records to confirm or identify patients considered vulnerable; and to create or review their care plans.
  • Continue to improve performance to ensure positive patient outcomes for patients with long term conditions (including diabetes, asthma and COPD); and mental health conditions.
  • Improve performance in uptake of childhood immunisations; and cervical cancer screening for eligible women.
  • Continue to analyse patient population data and complete the remodelling of services and capacity to better address needs.
  • Continue to monitor and improve phone access for patients.

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