What is the Quality of Safety at Loughton Health Centre

Neutral

"We served warning notices in respect of the governance and safety at the practice."

Neutral

"Two warning notices were served one in respect of the safety and the other in relation to governance."

Positive

"Lessons learned and improvements made • The practice had implemented effective systems to ensure that they acted on patient and medicine safety alerts and changes to NICE guidelines."

Positive

"• The practice had implemented a system of search and audit to identify and recall patients who required additional monitoring or those who needed to be reviewed as a result of NICE guidance or safety alerts."

Positive

"All staff had now received uptodate safeguarding and safety training appropriate to their role and policies were up to date and available for reference."

Positive

"Practice leaders had oversight of safety alerts medicines management NICE guidelines and QOF achievement."

Positive

"Following that inspection the practice was served with two warning notices one in respect of the safety and another in respect of the governance at the practice."

Positive

"There was no health and safety risk assessment."

Positive

"Track record on safety The practice had reviewed its safety systems."

Positive

"There was a comprehensive health and safety risk assessment and staff had received health and safety training."

Positive

"• Practice leaders had reviewed and updated policies procedures and activities to ensure safety and assure themselves that they were operating as intended."

Positive

"Our key findings were as follows: • Patients who were subject to patient safety alerts were now being recalled and reviewed as necessary as were patients who were prescribed medicines that required monitoring."

Positive

"Staff had not received health and safety training."

Positive

"• Risk assessments in relation to safety issues had been completed."

Neutral

"• There was an up to date health and safety risk assessment and staff had now received health and safety training."

Neutral

"Two warning notices were served one in respect of the safety and the other in relation to governance."

Positive

"Track record on safety The practice did not have a good safety record."

Positive

"The practice learned and shared lessons and took action to improve safety in the practice."

Positive

"The practice had safety policies which included those concerning safeguarding vulnerable adults and children although these were difficult to locate on the computer systems incomplete or not being adhered to."

Positive

"• The health and safety risk assessment to consider possible risks at the premises had not been completed."

Positive

"• There was not an effective system for acting on safety alerts."

Positive

"There was no health and safety risk assessment."

Positive

"• There was no health and safety risk assessment."

Positive

"Staff had not received health and safety training."

Positive

"• Staff had not received health and safety training."

Positive

"• Whilst partners were knowledgeable about issues in the locality and challenges the practice were facing in a wider sense they had failed to prioritise the safety and review of patients."

Positive

"Inspectors identified risks to patient safety which included managing MHRA alerts adherence to current prescribing guidelines and monitoring patients who were prescribed highrisk medicines."

Positive

"• The practice had failed to implement effective systems to mitigate the risks to the safety of staff patients and others."

Positive

"Other risks had not been identified in respect of health and safety and professional competence of clinical staff for example."

Positive

"• The practice did not have effective systems to identify that staff had not received health and safety infection control or safeguarding vulnerable adults training."

Neutral

"There was limited measurement and monitoring of safety performance."

Positive

"Reliable safety systems and processes including safeguarding Are services safe?"

Positive

"Information about safety was recorded monitored appropriately reviewed and action taken where required."

Positive

"Information about safety was recorded monitored appropriately reviewed and addressed."

Positive

"Monitoring safety and responding to risk The practice had systems processes and policies in place to manage and monitor risks to patients staff and visitors to the practice."

Positive

"A health and safety risk assessment had taken place that identified the risks to both patients and staff."

Positive

"There was an effective system in place to monitor national patient safety and medicines alerts."

Positive

"Where a situation arose that required a more formal meeting such as important learning from a safety incident an ad hoc full staff meeting was arranged."

Positive

"We also found that the partner GPs assumed responsibility for safety issues and discussed them at monthly partners meetings and sooner if required."

Positive

"The practice was able to assure us that safety issues had been managed consistently over time and so could show evidence of a safe track record over the long term."

Positive

"Learning and improvement from safety incidents The practice had a system in place for reporting recording and monitoring significant events incidents and accidents."

Positive

"We found that although there was a system in place to notify nonclinical staff of the learning from safety incidents due to the absence of a formal meeting there was no opportunity to discuss the issues and seek other ideas for improvements."

Positive

"National patient safety and medicines alerts were received by the practice and sent to the GPs after a search of their computerised record system had identified those patients affected by the alert."

Positive

"Staff spoken with were aware of safety incidents that had occurred as there was a system in place for notifying staff of those that were relevant to their role at the practice."

Positive

"Minutes of the partner and clinical meetings reflected that safety was discussed at each meeting."

Positive

"Where issues had been discovered timely repairs had taken place Other systems were in place to monitor risk including medicine reviews for patients handling national patient safety and medicines alerts dealing with emergencies and the servicing maintenance and calibration of medical equipment."

Positive

"There were leads for infection control safeguarding diabetes minor procedures health and safety and information governance."

Neutral

"We served warning notices in respect of the governance and safety at the practice."

Neutral

"Two warning notices were served one in respect of the safety and the other in relation to governance."

Positive

"• Staff were clear on their roles and accountabilities including in respect of safeguarding and infection prevention and control."

Positive

"Following that inspection the practice was served with two warning notices one in respect of the safety and another in respect of the governance at the practice."

Neutral

"Two warning notices were served one in respect of the safety and the other in relation to governance."

Positive

"Kindness respect and compassion Staff treated patients with kindness respect and compassion."

Positive

"Privacy and dignity The practice respected patients’ privacy and dignity."

Positive

"• Staff recognised the importance of patients’ dignity and respect."

Positive

"• Patient feedback in respect of telephone access and waiting times for appointments was variable."

Positive

"Other risks had not been identified in respect of health and safety and professional competence of clinical staff for example."

Neutral

"Audits had not been undertaken in respect of all areas of low QOF performance or high risk medicines."

Positive

"• Patients said they were treated with compassion dignity and respect and they were involved in their care and decisions about their treatment."

Positive

"Patients spoken with said they were treated with compassion dignity and respect and involved in decisions about their care and treatment."

Positive

"• The practice vision and values included working in partnership with their patients families and carers to ensure mutual respect and holistic care encouraging them to participate fully to express their needs and enabling them to maintain the maximum possible level of independence choice and control."

Positive

"We observed that staff treated patients with kindness and respect and maintained confidentiality."

Positive

"This respected their dignity and confidentiality."

Positive

"Staff acting as chaperones told us that consultations were undertaken with dignity in mind and privacy screens used when the examination was more intimate."

Positive

"The area where the provider must make improvements is: • 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 are: • Continue to monitor and improve patient feedback in relation to accessing the practice."

Neutral

"We served warning notices in respect of the governance and safety at the practice."

Positive

"Governance arrangements The partners and management team now had clear responsibilities roles and systems of accountability to support drive and improve good governance and management."

Positive

"• Structures processes and systems to support good governance and management were clearly set out understood and effective."

Positive

"The governance and management of partnerships joint working arrangements and shared services promoted coordinated personcentred care."

Positive

"Following that inspection the practice was served with two warning notices one in respect of the safety and another in respect of the governance at the practice."

Positive

"Governance arrangements Systems to support good governance and management were not always consistent or effective."

Positive

"• Systems to support good governance needed review and effective implementation."

Positive

"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."

Positive

"The practice had decided which training was mandatory; this included safeguarding basic life support information governance infection control and fire training."

Neutral

"The practice had a number of policies and procedures to govern activity and held regular governance meetings."

Neutral

"Staff had been allocated lead roles in relation to clinical and governance issues."

Neutral

"Governance arrangements The six partners at the practice met monthly with the practice manager where governance arrangements were discussed."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"We based our judgement of the quality of care at this service is 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."

Positive

"• Clinical and nonclinical audits completed since our previous inspection had a positive impact on quality of care and outcomes for patients."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"Inadequate As part of our inspection process we also look at the quality of care for specific population groups."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"Despite this staff that we spoke with knew what they would do if they suspected abuse and who the lead was."

Positive

"Staff knew how to recognise signs of abuse in vulnerable adults and children."

Positive

"We spoke with several members of staff on the day of our inspection and found that they had received safeguarding training and knew how to recognise signs of abuse in older people vulnerable adults and children."

Positive

"Staff had now been trained in safeguarding adults and children infection control and health and safety."

Positive

"Not all staff had received training and were unsure of the correct course of action in the event of an unexpected infection control risk."

Positive

"• The practice did not have effective systems to identify that staff had not received health and safety infection control or safeguarding vulnerable adults training."

Neutral

"• An infection control audit had been completed but this was not followed up by an action plan."

Positive

"This included infection control procedures the management of needlestick injuries and clinical waste management."

Positive

"Cleanliness and infection control The practice had a lead for infection control who had received appropriate training."

Positive

"An infection control policy was available to support staff."

Positive

"The practice had decided which training was mandatory; this included safeguarding basic life support information governance infection control and fire training."

Positive

"There were leads for infection control safeguarding diabetes minor procedures health and safety and information governance."

Neutral

"We viewed a sample of staff files and found that they contained details of infection control training."

Positive

"Nitrogen was now being stored safely and there was appropriate signage to alert people that nitrogen was being stored."

Positive

"Each GP received their own hard copy of the alert and were required to sign and return it to reflect that action had been taken."

Positive

"A chaperone sign was clearly displayed in the reception area for the information of patients and there was further information in the practice leaflet."

Positive

"A sign was clearly displayed in reception describing this and patients were advised that they could be seen alone if they preferred it."

Positive

"• The practice did not have a comprehensive programme of quality improvement activity."

Positive

"• The practice did not have a comprehensive programme of quality improvement activity although some audit activity had taken place."

Positive

"This includes monitoring patients on longterm medicines reviews of longterm health conditions and the lack of quality improvement activity."

Positive

"Monitoring care and treatment The practice did not have a comprehensive programme of quality improvement activity."

Positive

"This includes reviews of longterm health conditions and the lack of quality improvement activity."

Positive

"Privacy and dignity The practice respected patients’ privacy and dignity."

Positive

"Staff acting as chaperones told us that consultations were undertaken with dignity in mind and privacy screens used when the examination was more intimate."

Positive

"• Information about how to make a complaint or raise concerns was available at the reception desk although information about how to make a complaint could not be easily located on the practice website."

Positive

"• The complaint policy and procedures were in line with recognised guidance."

Positive

"The impact of service changes on the quality and sustainability of care is not understood."

Neutral

"Tackling inequity and promoting equality The practice had made reasonable adjustments to their premises so that disabled patients and those with limited mobility could access the service easily."