What is the Quality of Facilities at Morland House Surgery

Positive

"The practice sent us evidence of improvement in their monitoring systems which included more frequent monitoring by appropriate staff and regular contact with the cleaners."

Positive

"• Carrying out robust monitoring of cleaning standards • Monitoring clinical audit via weekly clinical review meetings."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"We reviewed information sent to us by the practice including examples of medicines monitoring their revised chaperone policy cleaning monitoring process and prescription security system."

Positive

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

Positive

"Management monitoring and improving outcomes for people Staff across the practice had key roles in monitoring and improving outcomes for patients."

Positive

"There was a system in place for the management of high risk medicines which included regular monitoring in line with national guidance."

Positive

"However the practice must improve further aspects of managing medicines to ensure high risk medicines are not dispensed before patients have received relevant monitoring of their condition and blank prescriptions are tracked when issued to GPs."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"The record of any patient who had not received the required monitoring was passed to the GPs for review."

Neutral

"This showed the practice carried out monitoring of cleaning and reported any areas which required attention by the cleaners."

Neutral

"Staff told us about the arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"Learning and improvement from safety incidents The Practice has a system in place for reporting recording and monitoring significant events."

Positive

"Management monitoring and improving outcomes for people The practice GPs told us they all had responsibility for keeping up to date with recent guidance."

Positive

"The GPs all felt they had a collective responsibility for making decisions and monitoring the effectiveness of clinical practice through audits or specialist training."

Positive

"The practice had an effective system of monitoring and following up referrals."

Positive

"The practice manager was responsible for the day to day running of the service and assessing monitoring and developing nonclinical staff whose roles were in reception or administration."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"• Guidance for staff in relation to monitoring the storage temperatures of vaccines was out of date and did not follow national guidance."

Positive

"• Ensuring all staff that undertook chaperone duties had completed a disclosure and barring service DBS check."

Positive

"• Carrying out robust monitoring of cleaning standards • Monitoring clinical audit via weekly clinical review meetings."

Positive

"Following each clinical audit changes to treatment or care were made where needed and the audit repeated to ensure outcomes for patients had improved."

Neutral

"However the practice could enhance the number of completed clinical audit cycles undertaken."

Neutral

"The Practice has a system in place for completing clinical audit cycles."

Positive

"• Carrying out robust monitoring of cleaning standards • Monitoring clinical audit via weekly clinical review meetings."

Neutral

"We reviewed information sent to us by the practice including examples of medicines monitoring their revised chaperone policy cleaning monitoring process and prescription security system."

Positive

"Action the service SHOULD take to improve • Ensure cleaning of high level surfaces is carried out effectively in consulting rooms."

Positive

"In addition the provider should: • Ensure cleaning of high level surfaces is carried out effectively in consulting rooms."

Neutral

"There was a cleaning schedule for staff outlining the cleaning tasks that should be completed on a daily weekly and quarterly basis."

Neutral

"There was a communication log in place which contained messages for and from the cleaning staff."

Neutral

"This showed the practice carried out monitoring of cleaning and reported any areas which required attention by the cleaners."

Neutral

"There was a cleaning schedule for staff outlining the cleaning tasks that should be completed on a daily weekly and quarterly basis."

Positive

"• The medicines held for use in emergencies had been risk assessed and a medicine to counteract the effects of an overdose of prescribed opium substitutes had been added."

Positive

"A medicine to counter the effects of an overdose had been added to the emergency medicine stock."

Positive

"We noted a good skill mix among the doctors with GPs holding additional diplomas in sexual and reproductive medicine and obstetrics."

Positive

"One patient had been recently issued their medicine when they had not received their blood test to check that further prescribing was appropriate."

Neutral

"During our visit we spoke with a range of staff including GPs practice nursing staff medicine dispensing staff the practice manager and reception and administrative staff."

Neutral

"For example obstetric medicine and guidelines relating to prescribing the contraceptive pill were discussed at a clinical meeting on the day of our inspection."

Positive

"It had a palliative care register and had regular internal as well as multidisciplinary meetings to discuss the care and support needs of patients and their families."

Positive

"The meetings were attended by district nurses and palliative care nurses and decisions about care planning were documented and circulated to all who attended."

Positive

"• The practice worked closely with the community nursing team and palliative care team to ensure good provision of end of life care."

Positive

"The practice worked closely with the community nursing team and palliative care team to ensure the provision of end of life care."

Positive

"For example carrying out a home visit to provide palliative care and family support."

Positive

"One GP had a specialist interest in palliative care and told us that the practice supported patients as far as possible if their wish was to die in their own home."

Positive

"Other GPs had areas of specialist interest such as palliative care."

Positive

"The provision of palliative care and support for bereaved families was a priority for all staff."

Positive

"It was responsive to the needs of older patients and offered home visits and services on site such as a visiting nurse specialising in care of the elderly."

Positive

"The practice had one nurse specifically trained to provide care and support to patients with diabetes."

Positive

"We heard that the practice nurse with specialist responsibility for supporting patients with diabetes added additional checks into their programme of supporting patients who had recently commenced taking insulin."

Positive

"Patients with diabetes who commenced insulin therapy received a daily call from the diabetes nurse to support them in taking their new medicine."

Positive

"During our inspection we spoke with a range of staff including GPs a practice nurse the practice manager a health care assistant HCA and reception and administration staff."

Positive

"Cleanliness and infection control A lead nurse was responsible for infection control procedures at the practice."

Positive

"These included; physiotherapy the memory clinic a nurse specialising in care of the elderly dietician counselling and the drugs and alcohol specialist team."

Neutral

"Where patients encountered difficulty in adapting to this treatment the nurse would carry out a home visit if the patient could not attend the practice."

Neutral

"The practice ran regular nurse specialist clinics for longterm conditions."

Neutral

"For example there was a lead nurse for infection control a named GP was the lead for safeguarding."

Positive

"We were told that the emergency equipment and emergency medicines were checked monthly by a practice nurse to ensure the equipment was working and the medicines were in date so that they would be safe to use should an emergency arise."

Positive

"The practice had one nurse specifically to provide care and support to patients with diabetes."

Positive

"Cleanliness & Infection Control A lead nurse was responsible for infection control procedures at the practice."

Positive

"The practice had one nurse specifically to provide care and support to patients with diabetes Identification & Management of Risk There was evidence that the practice continually learnt from incidents and feedback."

Neutral

"One patient told us the nurse they visited always checked that they knew how to use equipment and medication."

Positive

"The notes of the practice’s significant event meetings showed that staff had discussed a medical emergency concerning a patient and that the practice had learned from this appropriately."

Positive

"All staff had received training in basic life support and we saw that there was a supply of emergency medicines and equipment such as oxygen and a defibrillator which may be needed should a patient experience a medical emergency while attending the practice."

Neutral

"Consulting rooms were located on the ground and first floor with lift access to the first floor."

Neutral

"There was a patient lift giving access to first floor consulting rooms."

Neutral

"There was a patient lift to the first floor where some of the consulting rooms were located."

Neutral

"The practice had wide corridors on the ground floor that provided sufficient space for both wheelchair and mobility scooter access."

Positive

"This included those identified as requiring end of life care as part of a national programme called the gold standards framework."

Positive

"The practice also had a health and safety policy."

Positive

"The health and safety policy was supported by a range of risk assessments."

Positive

"These included; physiotherapy the memory clinic a nurse specialising in care of the elderly dietician counselling and the drugs and alcohol specialist team."

Positive

"Nurses had taken part in a range of training courses to improve patient care such as nursing elderly people family planning and diabetic nursing."

Positive

"The practice carried out regular home visits for patients in this population group as access to transport in the semirural area was often difficult."