This practice is rated as outstanding overall. Previous rating October 2018 (date of inspection, not publication) – Good:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Good

The key question at this inspection (27 November 2018) is rated as:

Are services safe? – Good

We carried out an announced focused inspection at Foundations – Harris Street on 27 November 2018. This was done as part of our inspection programme, in response to areas which are rated as ‘requires improvement’. We undertook a full comprehensive inspection of this service in October 2018 and found that the ‘safe’ key question was rated as ‘requires improvement’. This was because:

• There was no medical oxygen kept on site at Foundations.
• Staff did not have the proper authorisation in place to administer medicines, under a Patient Specific Direction.

At this inspection we found:

• The practice had stocked a medical oxygen cylinder which had, in addition, appropriate masks and tubing for use in a medical emergency.
• All staff were familiar with the location of the oxygen and emergency equipment.
• There was a monitoring checklist which was signed and dated and demonstrated regular checking of all this equipment.
• Patient Specific Directions were signed, dated and authorised in the correct way.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as good overall. (Not previously inspected)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at Foundations (Harris Street) on 18 October 2018. This was part of our routine inspection programme for new registrations.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. There was a strong focus on trauma-related health conditions.
• Staff had a high-level understanding of the difficulties faced by refugees and asylum seekers and treated all patients with compassion, kindness, dignity and respect.
• Patients reported that they were able to access care when they needed it, and were supported in attending appointments.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The provider employed its own named nurse for safeguarding. This gave all staff access to safeguarding supervision and minimised the risks of harm to vulnerable adults and children on the practice list.
• There was a flexible and supportive approach to patients who were late or did not attend appointments. The practice made immediate efforts to telephone patients, and would hold their appointment open for them, even if they arrived late. There was a strong emphasis on ensuring that their health needs were met, rather than seeking explanation for missed or late appointments.
• Staff were motivated and inspired to offer good kind and compassionate care. For example; they provided fresh fruit and chilled water in the waiting room. There were large stocks of sanitary products provided in the patients’ toilet, free of charge. Toothpaste was freely available to patients. When patients were unable to find the practice, staff would actively go out to meet them in the nearby town centre, to support their attendance at an appointment.

The areas where the provider should make improvements are:

• Improve the way it records staff immunisations and take action to ensure all staff are fully immunised, or, that there are risk assessments in place for those who decline vaccinations.
• Update and improve its infection control policy.
• Improve the way that Patient Specific Directions are used to ensure safe and effective administration of vaccinations by health care assistants.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.