We carried out an announced comprehensive inspection at Malling Health @ Blue Suite on 24 July 2018. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the July 2018 inspection can be found by selecting the ‘all reports’ link for Malling Health @ Blue Suite on our website at www.cqc.org.uk.

After our inspection in July 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

We carried out an announced focussed follow-up inspection on 18 September 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 July 2018. The practice was not rated as a consequence of this inspection.

At our inspection on 18 September we found that the practice had made some progress but had not fully met the Warning Notices issued on 6 August 2018 and we therefore issued requirement notices. The full comprehensive report on the September 2018 inspection can be found by selecting the ‘all reports’ link for Malling Health @ Blue Suite on our website at www.cqc.org.uk.

After the inspection in September 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection carried out on 12 March 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections on 24 July 2018 and 18 September 2018. This report covers findings in relation to those requirements.

Overall the practice is now rated as Requires Improvement.

The key questions are rated as:

Are services safe? – Good.

Are services effective? – Requires Improvement.

Are services caring? – Requires Improvement.

Are services responsive? – Requires Improvement.

Are services well-led? – Good.

At this inspection we found:

• The practice had continued to make improvements to the systems, processes and practices that helped to keep patients safe and safeguarded from abuse. These were now effective.
• The practice had continued to revise and improve their assessment and management of risks to patients, staff and visitors. These were now effective.
• There had been further improvements to the arrangements for medicines management in the practice and patients were now being kept safe as a result.
• The practice was able to demonstrate that they learned from and made improvements when things went wrong.
• The practice had action plans to improve quality and performance and was still in the process of implementing, embedding and reviewing their effectiveness.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• Improvements had been made to help ensure that multidisciplinary team meetings were being held and were effective.
• Improvements to the practice’s complaints system had taken place. It was now being operated effectively and had been made accessible to all patients.
• Governance arrangements had been improved and were being effective.
• There had been improvements to the practice’s systems and processes for learning, continuous improvement and innovation which were now effective.

The areas where the provider must make improvements as they are in breach of regulations are:

• 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 implement improvements to the practice’s computer system in relation to children on the at risk register.
• Continue to implement and evaluate planned activities to improve patient satisfaction scores.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Rosie Benneyworth
Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Malling Health @ Blue Suite on 24 July 2018. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. Three Warning Notices were served in relation to breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe care and treatment; Regulation 17 Good governance; Regulation 18 Staffing, found at this inspection. The full comprehensive report on the July 2018 inspection can be found by selecting the ‘all reports’ link for Malling Health @ Blue Suite on our website at www.cqc.org.uk.

After our inspection in July 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the Warning Notices served.

This inspection was an announced focussed follow-up inspection carried out on 18 September 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 July 2018. This report only covers findings in relation to those requirements. The practice was not rated as a consequence of this inspection.

At this inspection we found:

• The practice had made improvements to the systems, processes and practices that helped keep people safe and safeguarded from abuse.
• The practice had revised and improved their assessment and management of risks to patients, staff and visitors.
• There had been improvements to the arrangements for managing medicines in the practice to help keep patients safe.
• The practice was able to demonstrate that they learned from and made improvements when things went wrong.
• The practice had an action plan to improve quality and was in the process of reviewing the effectiveness and appropriateness of the care provided.
• There had been improvements to governance arrangements.
• The practice had revised and improved their systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements as they are in breach of regulations 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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Inadequate overall. (Previous rating November 2014 - Good)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Malling Health @ Blue Suite on 24 July 2018 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• Significant issues that threatened the delivery of safe care were not identified or adequately managed.
• The practice’s systems, processes and practices did not always keep people safe and safeguarded from abuse.
• Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.
• Patients were at risk of harm due to inadequate medicines management by the practice.
• The practice was unable to demonstrate that they always learned from and made improvements when things went wrong.
• The practice had an action plan to improve quality and was in the process of reviewing the effectiveness and appropriateness of the care provided.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• The practice’s complaints system was not operated effectively and was not accessible to all patients.
• Governance arrangements were not always effective.
• The systems and processes for learning, continuous improvement and innovation were not always effective.

The areas where the provider must make improvements are:

• Ensure 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 the carrying on of the regulated activity.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Consider reinstating multidisciplinary team meetings to help understand and meet the range and complexity of patients’ needs and to assist and plan ongoing care and treatment.
• Continue to identify patients who are also carers to help ensure they are offered appropriate support.
• Continue to monitor and improve national GP patient survey patient satisfaction scores.

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 population group, 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 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.

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.

Letter from the Chief Inspector of General Practice

A comprehensive inspection was undertaken at Malling Health @ Blue Suite on 11 November 2014. The provider operates two other services in the locality, although these were not inspected as part of this visit.

We found that overall, the practice was rated as providing a good level of care, treatment and support to the patients who used the services and was able to demonstrate how it achieved this across all five key domains inspected.

The level of service provided to all of the patient population groups was good and our key findings included:-

• there were arrangements in place to provide safe patient care
• the practice was clean and there were systems to ensure standards of hygiene were maintained
• patients received an effective, responsive service that identified and met their needs
• patients felt they were treated with respect and dignity
• patients said that staff were helpful, kind and considerate to their needs
• patient privacy and confidentiality was maintained

However, there were areas of practice where the provider should:

• Review its computerised administrative systems to ensure that the performance data and information analysed is specific to the patients registered at the practice, to enable the provider to respond to the needs of its local patient group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice