What is the Quality of Safety at The Practice St Albans

Positive

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

Positive

"• Staff treated patients with compassion kindness dignity and respect."

Positive

"• Staff were clear on their roles and accountabilities including in respect of safeguarding and infection prevention and control however the lead roles were not always known by staff."

Positive

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

Positive

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

Neutral

"• Where appropriate staff worked with other agencies to protect patients from abuse neglect discrimination and breaches of their dignity and respect."

Positive

"Kindness dignity respect and compassion We observed during the inspection that members of staff were polite friendly and helpful towards patients."

Positive

"We issued a requirement notice to the provider in respect of good governance safe care and treatment and the notification of appropriate incidents to the CQC."

Positive

"• Patients said they were treated with compassion and dignity and staff were supportive and respectful in providing care involving them in care and decisions about their treatment."

Positive

"Patients told us they were happy with the care provided by the practice and said their dignity and privacy was respected."

Positive

"• Patients said when they saw a clinician they were treated with compassion and respect and were involved in decisions about their care and treatment."

Positive

"Measures were in place within the practice to maintain the privacy and dignity of patients and to ensure they felt at ease."

Positive

"• We saw staff treated patients with kindness and respect and maintained patient and information confidentiality."

Positive

"The practice satisfaction scores were mixed in respect of consultations with nurses."

Positive

"These included: • Curtains were provided in consulting rooms to maintain dignity during examinations investigations and treatments."

Positive

"Kindness dignity respect and compassion We observed during the inspection that members of staff were polite friendly and helpful towards patients."

Positive

"• Patients said they were treated with compassion and dignity and staff were supportive and respectful in providing care involving them in care and decisions about their treatment."

Positive

"They told us they were happy with the care provided by the practice and said their dignity and privacy was respected."

Positive

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

Positive

"Patients also said they felt listened to by supportive staff and treated with dignity and respect."

Positive

"Measures were in place within the practice to maintain the privacy and dignity of patients and to ensure they felt at ease."

Positive

"• We saw staff treated patients with kindness and respect and maintained patient and information confidentiality."

Positive

"The practice satisfaction scores were mixed in respect of consultations with nurses."

Positive

"These included: • Curtains were provided in consulting rooms to maintain dignity during examinations investigations and treatments."

Positive

"Patients told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected."

Positive

"• The majority of patients said they were treated with compassion dignity and respect."

Positive

"They told us staff were caring and treated them with dignity and respect."

Positive

"• Consider the low patient satisfaction results in respect of GP consultations and identify improvement areas."

Positive

"Some of the stated aims included treating patients with dignity and respect; educating and developing staff; and multidisciplinary working with other professionals."

Positive

"Curtains were provided in consulting rooms so that patients’ privacy and dignity was maintained during examinations investigations and treatments."

Positive

"The also acknowledged the limited improvements that could be made in respect of telephone access as their current contract only allowed patient phone calls to be answered from two phone lines at the reception desk."

Positive

"• Clinical audit had a positive impact on quality of care and outcomes for patients."

Positive

"This recognises the significant improvements made to the quality of care provided by the service."

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

"This enabled the practice and wider provider group to identify any themes or trends Lessons learned from complaints and concerns and from trend analysis were used to improve the quality of care staff were informed of outcomes."

Positive

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

Positive

"Lessons learned from complaints and concerns and from trend analysis were used to improve the quality of care staff were informed of outcomes."

Positive

"Improvements were made to the quality of care as a result of complaints and concerns and learning from complaints was shared with staff and stakeholders."

Positive

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

Positive

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

Positive

"Patients told us they were happy with the care provided by the practice and said their dignity and privacy was respected."

Positive

"Measures were in place within the practice to maintain the privacy and dignity of patients and to ensure they felt at ease."

Positive

"They told us they were happy with the care provided by the practice and said their dignity and privacy was respected."

Positive

"Measures were in place within the practice to maintain the privacy and dignity of patients and to ensure they felt at ease."

Positive

"Patients told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected."

Positive

"Curtains were provided in consulting rooms so that patients’ privacy and dignity was maintained during examinations investigations and treatments."

Positive

"Track record on safety The practice had a good track record on safety."

Positive

"• The provider supported staff safety and wellbeing through schemes such as ‘bike to work’ and free eye tests."

Positive

"• The practice acted appropriately on patient and medicine safety alerts."

Positive

"This data when compared to others in the group helped it to understand risks and gave a clear accurate and current picture of performance and enabled corrective actions to be taken if required • The practice manager had oversight of safety alerts incidents and complaints."

Positive

"• The practice had collaborated with the local Fire and Rescue Service to link the flu clinic appointments with engagement about fire safety and smoke alarms."

Positive

"• Practice leaders had established the providers’ policies procedures and activities to ensure safety and assured themselves they were operating as intended."

Positive

"• There were risk assessments available in relation to safety issues."

Positive

"Overview of safety systems and processes Systems processes and practices were in place to help keep patients safe and safeguarded from abuse."

Positive

"The practice had other risk assessments in place to monitor safety of the premises such as legionella."

Positive

"• Staff received training that included safeguarding fire safety and information governance."

Neutral

"These covered areas such health and safety IT fire safety infection control and confidentiality."

Neutral

"In particular: • The provider had failed to ensure the safety of patients by maintaining infection control and prevention measures at the branch site."

Positive

"We saw evidence that lessons were shared and action was taken to improve safety in the practice."

Positive

"Our key findings across all the areas we inspected were as follows: • There was an open and transparent approach to safety within the practice."

Positive

"Overview of safety systems and processes Systems processes and practices were in place to help keep patients safe and safeguarded from abuse."

Positive

"The practice had other risk assessments in place to monitor safety of the premises such as legionella."

Positive

"• Staff received training that included: safeguarding fire safety and information governance."

Neutral

"These covered areas such health and safety IT fire safety infection control and confidentiality."

Positive

"Lessons were shared to ensure action was taken to improve safety within the practice."

Positive

"• The practice had other risk assessments in place to monitor the safety of the premises for example control of substances hazardous to health."

Positive

"Overview of safety systems and processes The practice had systems and processes in place to keep patients safe."

Positive

"Staff were also provided with a health and safety handbook which included information on fire safety manual handling and accidents."

Positive

"This included undertaking appropriate recruitment checks health and safety risk assessments and having procedures in place for dealing with medical emergencies."

Positive

"The practice had a system in place to receive and act on patient safety alerts and medicines and healthcare regulatory agency MHRA alerts."

Positive

"This included a health and safety policy and service agreements that allowed for periodic review of equipment."

Neutral

"• Where appropriate staff worked with other agencies to protect patients from abuse neglect discrimination and breaches of their dignity and respect."

Positive

"These included: • Arrangements were in place to safeguard children and vulnerable adults from abuse which reflected local requirements and relevant legislation."

Positive

"• The practice was a domestic violence aware practice with staff having had IRIS Identification & Referral to Improve Safety training a practice based domestic violence and abuse training support and referral programme."

Positive

"These included: • Effective arrangements were in place to safeguard children and vulnerable adults from abuse which reflected local requirements and relevant legislation."

Positive

"Records reviewed showed regular meetings were held with the health visiting team to review children and families at risk of abuse or living in vulnerable circumstances."

Positive

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

Positive

"Staff we spoke with knew how to recognise signs of abuse in children and vulnerable adults; as well as the lead GP for safeguarding."

Neutral

"For example: • Patients receiving end of life care carers those at risk of developing a longterm condition and those requiring advice on their diet smoking and alcohol cessation."

Neutral

"For example: • Patients receiving end of life care carers those at risk of developing a longterm condition and those requiring advice on their diet smoking and alcohol cessation."

Neutral

"For example: • Patients receiving end of life care those at risk of developing a longterm condition and those requiring advice on their diet smoking and alcohol cessation."

Positive

"• The practice promoted equality and diversity and had a policy to support this."

Neutral

"Staff had received equality and diversity training."

Positive

"This covered topics such as information governance safeguarding health safe and welfare equality and diversity."

Positive

"• Information about how to make a complaint or raise concerns was available."

Positive

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

Positive

"However the branch site was not adequate for example the baby changing facilities were a shelf in the toilet there was no information provided about translation services and guidance on how to make a complaint was difficult to find."

Positive

"For example: • The baby changing facilities were a shelf in the toilet • There was no information provided about translation services and guidance on how to make a complaint was difficult to find."

Positive

"We reviewed four complaints in detail and found the practice manager sent an acknowledgement letter on receipt of the complaint carried out an investigation and provided the complainants with explanations and apologies where appropriate."

Positive

"This was because; • The practice did not have an effective overarching governance framework in place to support the delivery of the strategy and good quality care."

Positive

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

Positive

"The provider values were trusted teamwork patients first performance governance and growth."

Positive

"• Evidence during the inspection led us to believe oversight of governance arrangements was not effective."

Positive

"• The managerial arrangements within the practice were aligned with those of the provider and there was support in key areas such as HR clinical governance and legal from a central team as needed."

Positive

"Governance arrangements • There were clear responsibilities roles and systems of accountability to support governance and management."

Positive

"• Staff told us there had been improved governance of the branch site since our last inspection and this had led to a refurbishment of the building to bring it in line with practice guidelines."

Positive

"Governance arrangements The practice did not have an effective overarching governance framework in place to support the delivery of the strategy and good quality care."

Positive

"We issued a requirement notice to the provider in respect of good governance safe care and treatment and the notification of appropriate incidents to the CQC."

Positive

"This allowed oversight of governance arrangements within the practice; however the issues found on the day of inspection showed this was not effective."

Positive

"• There was an overarching governance framework which supported the delivery of the strategy and good quality care."

Positive

"This included the arrangements for clinical governance and performance management which did not always operate effectively."

Positive

"Governance arrangements The practice had an overarching governance framework which supported the delivery of the strategy."

Positive

"This allowed oversight of governance arrangements within the practice however we found there was less oversight of the branch site which had caused lapses in temperature monitoring and stock management."

Positive

"Governance arrangements The overarching governance framework did not always support the delivery of good quality care."

Positive

"• The arrangements for clinical governance and performance did not always operate effectively and some incidents notifiable to the Care Quality Commission had not been reported as required by law."

Positive

"For example the arrangements for clinical governance and performance did not always operate effectively and some incidents notifiable to the Care Quality Commission had not been reported as required by law."

Positive

"The provider had a centralised support centre which offered strategic support in areas such as governance human resources and legal services."

Positive

"For example • the systems for clinical governance and performance did not always operate effectively and as a result some clinical outcomes were lower than the local and national averages."

Positive

"The practice manager would escalate the incidents to the provider’s governance team which had oversight responsibilities for reviewing the information and making any recommendations."

Positive

"This covered topics such as information governance safeguarding health safe and welfare equality and diversity."

Positive

"Monitoring care and treatment The practice provided evidence of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided."

Positive

"• The practice was involved in quality improvement activity."

Positive

"There was limited evidence of quality improvement including clinical audit."

Positive

"There was evidence of quality improvement including clinical audit."

Positive

"This included: • Procedures for the control of infection were not effective at the branch site due to the condition and management of the site."

Positive

"• Facilities at the branch site lacked appropriate levels of cleanliness in line with infection control guidance."

Positive

"Oversight of infection control and cleanliness was not as effective at the branch site; however an upgrade was planned to address this."

Neutral

"A nurse was the lead for infection control within the practice."

Neutral

"These covered areas such health and safety IT fire safety infection control and confidentiality."

Neutral

"In particular: • The provider had failed to ensure the safety of patients by maintaining infection control and prevention measures at the branch site."

Positive

"An advanced nurse practitioner was the lead for infection control within the practice."

Neutral

"These covered areas such health and safety IT fire safety infection control and confidentiality."

Positive

"The practice had appointed the advanced nurse practitioner ANP as the infection control lead."

Neutral

"• An infection control lead had recently been appointed and plans were in place to review the systems in place for infection control."

Neutral

"Policies and procedures related to infection control were in place and staff had received training."