What is the Quality of Safety at The Vineyard Surgery

Positive

"• Curtains were provided in consulting rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Positive

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

Positive

"Staff told us if they had any concerns or observed any instances of discriminatory behaviour or where patients’ privacy and dignity was not being respected they would raise these with the practice manager however they were confident that all patients would be treated the same."

Positive

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

Neutral

"We observed that consultations and treatments were carried out in the privacy of a consulting room."

Neutral

"The waiting room for patients was small and unavoidably provided little privacy for patients when talking with receptionists."

Positive

"Safe track record and learning There was a system in place for reporting and recording significant events; however we saw evidence that the threshold for recording an incident as a significant event was set too high to appropriately capture safety incidents and therefore opportunities for learning could be missed."

Positive

"The practice had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and infection control and legionella Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"Requires improvement ––– People with long term conditions The provider was rated as inadequate for safety and requires improvement for caring and wellled."

Positive

"Requires improvement ––– Working age people including those recently retired and students The provider was rated as inadequate for safety and requires improvement for caring and wellled."

Positive

"Overview of safety systems and processes The practice had clearly defined and embedded systems processes and practices in place to keep patients safe and safeguarded from abuse which included: • Arrangements were in place to safeguard children and vulnerable adults from abuse."

Positive

"• During the initial inspection we found that the practice had failed to ensure that risks to patient safety were well managed; specifically we found that they had failed to conduct regular infection control audits."

Positive

"The areas where the provider must make improvement are: • Ensure that all staff are aware of their responsibilities with regards to reporting safety incidents including their obligations under the duty of candour and that they are familiar with the processes to be followed."

Positive

"However we found further breaches of regulation in relation to the safety of staffing arrangements the understanding of performance and the oversight of risk."

Positive

"The provider had failed to assess monitor and mitigate the risks relating to the health safety and welfare of service users; specifically they had: • Failed to ensure that all staff were aware of their role in reporting incidents."

Positive

"We identified breaches of regulations relating to staffing and the monitoring of safety and we issued requirement notices in relation to these breaches."

Positive

"Older people The provider was rated as inadequate for safety and requires improvement for caring and wellled."

Positive

"Requires improvement ––– People experiencing poor mental health including people with dementia The provider was rated as inadequate for safety and requires improvement for caring and wellled."

Positive

"• Ensure that processes are in place to monitor the safety and performance of the practice including gathering and acting on feedback from patients including analysing and acting on the results of the NHS patient survey and developing a patient participation group."

Positive

"We also found that staff recruitment procedures were not sufficiently thorough to ensure patient safety and an infection control audit had not been completed."

Positive

"There was a health and safety policy available with a poster which identified local health and safety representatives."

Positive

"• Staff received training that included: safeguarding fire safety awareness basic life support and information governance."

Neutral

"This covered such topics as safeguarding infection prevention and control fire safety health and safety and confidentiality."

Positive

"All staff were fully trained on the system and commented positively about the system’s safety and ease of use."

Positive

"Staff told us they knew how to use the spillage kit but that they had not for example been shown how to use the fire extinguishers and could not recall having received fire safety training records provided post the inspection indicated most of the staff had received fire safety training."

Positive

"Staff stated they had not received fire safety training however records provide subsequent to the inspection indicated most staff had received some fire safety training."

Positive

"National patient safety alerts were circulated to staff but there was no cohesive system in place to use them as a basis for risk assessment or quality improvement."

Positive

"We reviewed safety records and significant events and these showed that in that time the partners had managed these consistently."

Positive

"For example reported incidents national patient safety alerts as well as comments and complaints received from patients."

Positive

"National patient safety alerts were disseminated to practice staff by the deputy practice manager."

Positive

"Reliable safety systems and processes including safeguarding The practice had systems to manage and review risks to vulnerable children young people and adults."

Positive

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

Positive

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

Positive

"Overview of safety systems and processes The practice had clearly defined and embedded systems processes and practices in place to keep patients safe and safeguarded from abuse which included: • Arrangements were in place to safeguard children and vulnerable adults from abuse."

Positive

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

Positive

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

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."

Positive

"For example for all minor surgical procedures patients were asked to sign a consent form."

Positive

"Patients said they felt the practice offered an excellent service and staff were helpful caring and treated them with dignity and respect."

Positive

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

Positive

"• The majority of patients said they were treated with compassion dignity and respect and they were involved in decisions about their care and treatment."

Positive

"Results from the national GP patient survey showed patients felt they were treated with compassion dignity and respect by GPs."

Positive

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

Positive

"• Curtains were provided in consulting rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Positive

"The provider had failed to keep an accurate complete and contemporaneous record in respect of each service user; specifically they had failed to ensure that a record was made in patients’ notes of their consent to receive treatment."

Positive

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

Positive

"Patientcarer support to cope emotionally with care and treatment Patients were positive about the emotional support provided by the practice."

Positive

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

Positive

"We also saw that staff treated patients with kindness and respect ensuring confidentiality was maintained."

Positive

"Patients said they were treated with respect dignity and they felt safe."

Positive

"We saw from our own observations and heard from patients they were treated with dignity and respect."

Positive

"Staff told us if they had any concerns or observed any instances of discriminatory behaviour or where patients’ privacy and dignity was not being respected they would raise these with the practice manager however they were confident that all patients would be treated the same."

Positive

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

Positive

"For example the practice had received a complaint from a patient who felt that they were asked sensitive questions in the waiting area."

Positive

"The practice had responded to two of the comments however we saw that in one instance they had responded by saying that as the complaint had not been made directly to the practice in line with their complaints procedure it was not possible to investigate this matter."

Positive

"None of the patients spoken with had ever needed to make a complaint about the practice."

Positive

"Continuous improvement The partnership and management team responsible for the group of practices were in the process of standardising governance and staffing arrangements across the group."

Positive

"Governance arrangements The practice had an overarching governance framework which supported the delivery of the strategy; however there were areas where the practice’s performance was not well understood."

Neutral

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

Neutral

"• There was an overarching governance framework which was in the process of being updated and standardised across all practices in the group."

Positive

"However improvements are needed with regard to staff recruitment and support; monitoring infection control; the processes for dealing with test results and the overall governance framework all of which can impact on the quality of patient care."

Positive

"However improvements were needed with regard to staff recruitment and support; monitoring infection control; the processes for dealing with test results and the overall governance framework all of which can impact on the quality of patient care."

Positive

"and there was no governance framework to support the delivery of good care."

Neutral

"We were told they also used complaints as a quality improvement tool however staff were unable to provide us with examples of where improvements had been made to the services as a result of this."

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

"The practice had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and infection control and legionella Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"• During the initial inspection we found that the practice had failed to ensure that risks to patient safety were well managed; specifically we found that they had failed to conduct regular infection control audits."

Positive

"During the followup inspection we found that risks at the practice were still not always well managed specifically those relating to infection control security and medicines management."

Positive

"We also found that staff recruitment procedures were not sufficiently thorough to ensure patient safety and an infection control audit had not been completed."

Positive

"• The practice had completed an infection control audit and most staff had received infection control training; however the practice infection control clinical lead had not received infection control refresher training within the recommended timeframe."

Positive

"• Ensure that adequate processes are in place to manage the risks of infection including putting processes in place to monitor cleaning in the practice and ensuring that staff with specific infection control responsibilities are qualified to undertake their role."

Positive

"There was an infection control protocol Are services safe?"

Neutral

"One of the nurse practitioners was the infection control clinical lead; however she was not up to date with infection control training."

Neutral

"Annual infection control audits were undertaken and we saw evidence that action was taken to address any improvements identified as a result."

Positive

"Management lead through learning & improvement We looked at staff training records and saw that staff were offered regular training in areas such as safeguarding infection control and basic life support."

Positive

"An infection control policy and supporting procedures were available for staff to refer to which enabled them to plan and implement control of infection measures."

Positive

"The infection control lead had undergone training on waste management."

Neutral

"An infection control audit had been started but not completed."

Neutral

"The practice had a lead for infection control who was able to illustrate the various areas she monitored."

Neutral

"For example personal protective equipment including disposable gloves aprons and coverings were available for staff to use and staff were able to describe how they would use these in order to comply with the practice’s infection control policy."

Positive

"Tackle inequity and promote equality The practice had recognised the needs of different groups in the planning of its services and recognised people whose circumstances may make them vulnerable."