Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stonecroft Medical Centre on the 4 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 4 May 2016 inspection can be found by selecting the ‘all reports’ link for Stonecroft Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 February 2017. 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 4 May 2016. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

Overall, the practice is now rated as good in the safe, effective and well-led domains and good overall.

Our key findings were as follows:

• At our previous inspection on 4 May 2016 we found that the records relating to significant event review and analysis and patient safety alerts did not provide an audit of actions taken. At this inspection we found that the practice manager kept a log of all national patient safety alerts and the actions staff had taken.

• At our previous inspection on 4 May 2016, we found the provider had not completed the necessary recruitment checks prior to staff commencing work. These arrangements had significantly improved when we undertook a follow up inspection on 15 February 2017. We reviewed a member of staff's recruitment file. This member of staff   had recently commenced work at the practice. We found appropriate recruitment checks had been carried out prior to employment. However, the recruitment policy required further development. The practice manager agreed to update the policy following the inspection.

• At our previous inspection on 4 May 2016 we found that staff acted as chaperones but had no DBS checks. (A Chaperone was a person who acted as a safeguard and witness for a patient and health care professional during a medical examination or procedure.) At this inspection, we found that that staff who carried out chaperoning had completed chaperone training and had a DBS check in place.

• At our previous inspection on 4 May 2016, we found that the nursing staff did not have the required medical indemnity insurance in place as required by The Health Care and associated Professions (Indemnity Arrangements) order 2014. At this inspection, we found that the correct medical indemnity was in place for the nursing staff.

• At our previous inspection on 4 May 2016 we found staff monitored vaccine fridge temperatures but the fridges had one thermometer which staff calibrated annually. At this inspection we found the nursing staff had checked and reviewed the temperatures daily using the data logger and the fridge thermometers.

• At our previous inspection on 4 May 2016, we saw that the blinds in the practice did not meet the Department of Health guidance issued February 2015 relating to blinds and blind cords. Some of the blinds had looped cords, which could create a risk of serious injury due to entanglement. At this inspection, the practice manager informed us that in clinical areas the provider had ensured blind cords were secured using a cleat to make sure they were safe. We observed the provider had carried this out in the reception, a treatment room, and a consulting room.

• At our previous inspection on 4 May 2016, we found that the practice did not have a defibrillator available on the premises and the provider had not completed a risk assessment to support this decision. At this inspection, we found that the practice had a defibrillator and the provider had trained staff in its use. The staff had checked to see if it was working correctly weekly but had not recorded this. In addition, the defibrillator did not contain any pads for use on children.

• At the previous inspection we found that the practice had not responded to the GP survey which demonstrated that patients had found it difficult to get through on the telephone and to access a appointment. At this inspection, we reviewed the GP survey and found out of 62 patients asked about telephone access, 30 stated it was very or fairly easy and 18 said it was not very easy. In response the provider had increased the opening hours of the service and improved the telephone system to improve access.

• At our previous inspection on 4 May 2016, we found that the provider did not do all that was reasonably practicable to ensure staff received appropriate support, training, professional development supervision and appraisal to enable them to carry out their duties. At this inspection, we found the practice manager had a system in place to ensure that staff received training updates and staff had completed firemanagement, control of infectious diseases, and safeguarding training. The nursing staff held a regular support meetings and attended a person centred care meeting with the GPs. Staff had completed Mental Capacity Act 2015 and basic life support training.

• At our previous inspection on 4 May 2016, we found that the provider had not done all that was reasonably practicable to assess, monitor, manage, and mitigate risks to the health and safety of patients. For example, staff had not completed fire drills,  the provider had not completed a general risk assessment of the building, and a legionella risk assessment. At this inspection, we found the provider had arrangements in place to identify risk and staff had completed the necessary training.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Review the recruitment policy and includes all of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18, Schedule 3.

• implement procedures which follow the manufacturers instructions and Resuscitation Council guidance to check and record whether the defibrillator is working correctly .  In addition, carry out a risk assessment to establish whether the practice needs to purchase children’s defibrillator pads.
• implement procedures to ensure there is sufficient oxygen for use in an emergency and the appropriate oxygen masks are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stonecroft Medical Centre on the 4 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 4 May 2016 inspection can be found by selecting the ‘all reports’ link for Stonecroft Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 February 2017. 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 4 May 2016. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

Overall, the practice is now rated as good in the safe, effective and well-led domains and good overall.

Our key findings were as follows:

• At our previous inspection on 4 May 2016 we found that the records relating to significant event review and analysis and patient safety alerts did not provide an audit of actions taken. At this inspection we found that the practice manager kept a log of all national patient safety alerts and the actions staff had taken.

• At our previous inspection on 4 May 2016, we found the provider had not completed the necessary recruitment checks prior to staff commencing work. These arrangements had significantly improved when we undertook a follow up inspection on 15 February 2017. We reviewed a member of staff's recruitment file. This member of staff   had recently commenced work at the practice. We found appropriate recruitment checks had been carried out prior to employment. However, the recruitment policy required further development. The practice manager agreed to update the policy following the inspection.

• At our previous inspection on 4 May 2016 we found that staff acted as chaperones but had no DBS checks. (A Chaperone was a person who acted as a safeguard and witness for a patient and health care professional during a medical examination or procedure.) At this inspection, we found that that staff who carried out chaperoning had completed chaperone training and had a DBS check in place.

• At our previous inspection on 4 May 2016, we found that the nursing staff did not have the required medical indemnity insurance in place as required by The Health Care and associated Professions (Indemnity Arrangements) order 2014. At this inspection, we found that the correct medical indemnity was in place for the nursing staff.

• At our previous inspection on 4 May 2016 we found staff monitored vaccine fridge temperatures but the fridges had one thermometer which staff calibrated annually. At this inspection we found the nursing staff had checked and reviewed the temperatures daily using the data logger and the fridge thermometers.

• At our previous inspection on 4 May 2016, we saw that the blinds in the practice did not meet the Department of Health guidance issued February 2015 relating to blinds and blind cords. Some of the blinds had looped cords, which could create a risk of serious injury due to entanglement. At this inspection, the practice manager informed us that in clinical areas the provider had ensured blind cords were secured using a cleat to make sure they were safe. We observed the provider had carried this out in the reception, a treatment room, and a consulting room.

• At our previous inspection on 4 May 2016, we found that the practice did not have a defibrillator available on the premises and the provider had not completed a risk assessment to support this decision. At this inspection, we found that the practice had a defibrillator and the provider had trained staff in its use. The staff had checked to see if it was working correctly weekly but had not recorded this. In addition, the defibrillator did not contain any pads for use on children.

• At the previous inspection we found that the practice had not responded to the GP survey which demonstrated that patients had found it difficult to get through on the telephone and to access a appointment. At this inspection, we reviewed the GP survey and found out of 62 patients asked about telephone access, 30 stated it was very or fairly easy and 18 said it was not very easy. In response the provider had increased the opening hours of the service and improved the telephone system to improve access.

• At our previous inspection on 4 May 2016, we found that the provider did not do all that was reasonably practicable to ensure staff received appropriate support, training, professional development supervision and appraisal to enable them to carry out their duties. At this inspection, we found the practice manager had a system in place to ensure that staff received training updates and staff had completed firemanagement, control of infectious diseases, and safeguarding training. The nursing staff held a regular support meetings and attended a person centred care meeting with the GPs. Staff had completed Mental Capacity Act 2015 and basic life support training.

• At our previous inspection on 4 May 2016, we found that the provider had not done all that was reasonably practicable to assess, monitor, manage, and mitigate risks to the health and safety of patients. For example, staff had not completed fire drills,  the provider had not completed a general risk assessment of the building, and a legionella risk assessment. At this inspection, we found the provider had arrangements in place to identify risk and staff had completed the necessary training.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Review the recruitment policy and includes all of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18, Schedule 3.

• implement procedures which follow the manufacturers instructions and Resuscitation Council guidance to check and record whether the defibrillator is working correctly .  In addition, carry out a risk assessment to establish whether the practice needs to purchase children’s defibrillator pads.
• implement procedures to ensure there is sufficient oxygen for use in an emergency and the appropriate oxygen masks are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we inspected Dr Muggleton’s practice at Stonecroft Medical Centre in November 2013 we found the provider had not taken reasonable steps to; ensure that staff had the knowledge to identify possible signs of abuse. We also found the provider's arrangements to maintain appropriate standards of cleanliness and hygiene were ineffective and the non-clinical staff had not received sufficient support to improve their knowledge and skills.

After our visit we asked Dr Muggleton to send us a report of the actions he was going to take to meet these essential standards. We revisited Stonecroft Medical Centre to check that these actions had been carried out and standards had improved.

We found that the provider had made an number of changes to improve standards.

Staff had received training in the safeguarding of adults and children. Standards of cleanliness and infection control had improved. Staff felt well supported and had undertaken further training and development relating to their role.

Most of the patients spoken with told us that they were treated with dignity and respect by staff at the practice. Some patients were concerned about patient’s confidentiality not being maintained. One person commented: “the receptionist staff are generally helpful but I’m concerned about confidentiality, you can hear everything they say”.

We found that the practice needed to improve the information available for patients.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. During our inspection, we looked at ten patient medical records and saw evidence that patients had been engaged in their care. We also looked at a random selection of referrals and found these to be clear and consistent.

We found that the provider had not taken reasonable steps to ensure that all staff had the knowledge to identify the possibility of abuse.

The practice did not have an effective system in place to ensure appropriate standards of cleanliness and hygiene were maintained.

We found that non-clinical staff had not been supported to improve their knowledge, to update and maintain their skills.