We carried out an announced comprehensive inspection on 15 December 2015 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Our key findings were:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named healthcare professional and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There was an effective system in place for reporting and recording significant events.

However,

• Risks to patients were not always assessed and well managed, including those relating to recruitment checks.
• The practice had a number of policies and procedures to govern activity, but some were missing or overdue a review.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patient Group Directions which were used to administer medicines had not been correctly authorised in line with legislation.
• Not all staff had the skills, knowledge and experience to deliver effective care and treatment.

We identified regulations that were not being met and the provider must:

• Implement formal governance arrangements, local policies and systems for assessing and monitoring risks to comply with the requirements for the control of substances hazardous to health, health and safety and Mental Capacity Act and best interest decisions.
• Implement and embed in practice a medical emergency policy, including a protocol for staff roles.
• Ensure assessment, monitoring and improvement in quality of service is evidenced through of a programme of completed clinical audit cycles.
• The provider must ensure they are complying with relevant Patient Safety Alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Carry out Disclosure and Barring Service checks or detailed risk assessments for non-clinical staff undertaking chaperone duties.
• Ensure all staff have evidence of an appropriate level of training suitable for their role, including; Mental Capacity Act 2005, Safeguarding and Health & Safety at work. Implement a programme of yearly appraisals and monitor ongoing training requirements and updates for all staff.
• Ensure that Patient Group Directions comply with current legislation and meet legal requirements.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider should make improvements:

• Review and update procedures and guidance.
• Liaise with the landlord to ensure cleaning schedules for shared facilities are reviewed and monitored.

We were unable to speak to people at the time of the inspection because no one was available.

People were given all the information they needed to make an informed decision about their care and treatment. Staff were observed to be respectful and helpful when speaking to people on the telephone and at reception.

Care was assessed and treatment delivered in a way to meet the needs of people who used the service. People were involved in discussions about their health and were able to make informed choices about their treatment.

There were safeguarding policy and procedures in place and some staff had received training.

There was a robust complaints procedure in place that was accessible to people using the service.

We did not speak to people during the visit due to the nature of the service. We however spoke to spoke and reviewed documents. Staff we spoke with told us that they were happy with their job. They stated that they were given the opportunity to learn on the job which was beneficial to them. Staff were supported to enhance their skills and knowledge by attending relevant training to meet the needs of people and job role. They were also confident of making a meaningful contribution to the development of the service. This was through various forums available which included staff meetings.