Lakeside Healthcare at Bourne

We carried out an announced inspection at Lakeside Healthcare at Bourne on 28 June 2022.

Overall, the practice is rated as Good

The ratings for each key question:-

Safe - Good

Effective -Good

Caring - Good

Responsive - Good

Well-led - Good

This comprehensive inspection carried out on 28 June 2022 covered all key questions.

The practice was also rated Good at our previous inspection on 28th February and 27th March 2018.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for on our website or https://www.cqc.org.uk/location/1-6682225845

Why we carried out this inspection

This inspection was a comprehensive inspection as part of our inspection programme and included an on-site visit.

How we carried out the inspection/review

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 included:

• Completing remote 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 to be submitted to us electronically from the provider.
• Speaking with staff from two local care homes and the chairperson of the patient participation group.
• A 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 Good overall

We found that:

• Staff we spoke with felt they were supported and valued in their work.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff had the skills, knowledge and experience to carry out their roles. There was a system in place to monitor compliance with staff training. Staff were encouraged and supported to develop their skills and knowledge.
• Systems were in place to assure the provider of the competency of staff working in advanced roles
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

• Review and improve the documentation in relation to significant events and complaints to ensure investigations are fully documented and learning and outcomes are shared.
• Improve the protocol for safety alerts so that you are assured that clinical staff have read them in a timely manner.
• Improve the practice protocol in place for medication reviews to ensure the medical record links to the medication prescribed in the patient record.
• Continue with efforts to complete staff immunisations records.

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