We carried out an announced comprehensive inspection of Water Eaton Health Centre on 2 October 2018. The overall rating for the practice was inadequate and the practice was placed into special measures.

We undertook a focused inspection in February 2019 to follow up on warning notices we issued to the provider in relation to Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance. During the inspection in February 2019 we found the provider had made significant improvements to address the concerns identified in the warning notices issues and was compliant with both Regulation 13 and Regulation 17.

From the inspection on 2 October 2018, the practice was told they must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment. Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the practice was told they should:

• Continue to work in line with the recently revised system for managing safety alerts ensuring records are kept to support appropriate dissemination and discussion of alerts.
• Continue with efforts to identify and support carers within the practice population.
• Continue with efforts to improve patient satisfaction with particular regard to the areas highlighted in the results of the national GP patient survey as being in need of improvement.
• Review registration processes to ensure that all patients, including those with no fixed abode are able to access care and treatment when needed.
• Continue to encourage patients to attend appointments in relation to national screening programmes.

The inspection reports from the October 2018 and February 2019 inspections can be found by selecting the ‘all reports’ link for Water Eaton Health Centre on our website at .

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection at Water Eaton Health Centre undertaken on 1 April 2019 as part of our inspection programme to follow up on concerns identified at our previous inspection.

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 practice as good overall and requires improvement for all population groups.

The practice is rated as requires improvement for providing responsive services because results of the national GP patients survey demonstrated the practice was performing significantly below local and national averages for questions relating to access.

Our key findings were as follows:

• The practice had continued to comply with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• Systems in place to safeguard children and vulnerable adults had been improved.
• Evidence of pre-employment checks was now available and all staff had a disclosure and barring service (DBS) check.
• Measures had been put in place to ensure staff competencies prior to employment.
• Training records for staff were maintained and all mandatory training had been completed according to practice policy. However, training records for one locum were incomplete.
• Records of significant events and complaints were maintained and handled according to practice policy. Areas of learning and improvement were shared and actions taken where needed.
• Processes had been implemented to ensure the management of safety alerts received.
• Governance arrangements in the practice had been strengthened. Meetings were formalised and policies and procedures had been updated and reviewed.
• Much of the improvement work had been undertaken by the practice manager and administrative team, with the support of the local Clinical Commissioning Group.
• The practice advised of ongoing strategic and succession planning to ensure the future sustainability of the practice.

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

• Record all staff training in accordance with practice polices, including training records for locum staff.
• Continue with efforts to improve patient satisfaction with particular regard to the areas highlighted in the results of the national GP patient survey as being in need of improvement.
• Ensure adequate leadership support is provided to the practice manager to support the sustainability of improvements made.

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

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

We carried out an announced focused inspection of Water Eaton Health Centre on 5 February 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notices we issued to the provider in relation to Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance.

The practice received an overall rating of inadequate at our inspection on 2 October 2018 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the October 2018 inspection can be found by selecting the ‘all reports’ link for Water Eaton Health Centre on our website at .

Our key findings were as follows:

• The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• Systems in place to safeguard children and vulnerable adults had been improved.
• Evidence of pre-employment checks was now available and all staff had received a disclosure and barring (DBS) check.
• Measures had been put in place to ensure staff competencies prior to employment.
• Training records for staff were well maintained and all mandatory training had been completed.
• Records of significant events and complaints were well maintained and handled according to practice policy. Areas of learning and improvement were shared and actions taken where needed.
• Processes had been implemented to ensure the management of safety alerts received.
• Governance arrangements in the practice had been strengthened. Meetings were formalised and policies and procedures had been updated and reviewed.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

This practice is rated as inadequate overall.

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 Water Eaton Health Centre on 2 October 2018. This inspection was carried out 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:

• The practice did not have clear systems in place to manage risk so that safety incidents were less likely to happen. The practice could not demonstrate that they learned from safety incidents and other events such as complaints and improved their processes.
• The governance of the practice was poorly managed. Leaders lacked the capacity and capability to manage the practice effectively.
• Policies and procedures had not been established to enable the practice to operate safely and effectively. The management of safety systems was not evident particularly in relation to safeguarding, employment checks and risk assessments.
• The practice had failed to identify and support all vulnerable children within their patient population. Records kept in regard to safeguarding were incomplete and inaccurate.
• There was no management oversight of staff training and some staff had not undertaken required training.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system difficult to use and reported that they were not always able to access care when they needed it.
• The provider was aware of and had systems to encourage compliance with the requirements of the duty of candour however evidence that these were consistently followed was lacking.

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. (Please refer to the requirement notice section at the end of the report for more detail).
• Ensure patients are protected from abuse and improper treatment. (Please refer to the enforcement section at the end of the report for more detail.)
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please refer to the enforcement section at the end of the report for more detail.)

The areas where the provider should make improvements are:

• Ensure that the recently expanded system for managing safety alerts is followed and that records are kept to support appropriate dissemination and discussion of alerts, as good practice.
• Continue with efforts to identify and support carers within the practice population.
• Continue with efforts to improve patient satisfaction with particular regard to the areas highlighted in the results of the national GP patient survey as being in need of improvement.
• Review registration processes to ensure that all patients, including those with no fixed abode are able to access care and treatment when needed.

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 FRCGPChief Inspector of General Practice

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