What is the Quality of Facilities at St Ann's Medical Centre

Positive

"There are three nurse practitioners four practice nurses three health care assistants and two phlebotomists who all work across the three sites."

Neutral

"These records identified the practice manager had reviewed these and the senior nurse had checked the records weekly."

Positive

"There is one nurse practitioner five practice nurses and four health care assistants who all work across the three sites."

Positive

"They had recruited two locum advanced nurse practitioners to support this and were in the process of recruitment of a permanent advanced nurse practitioner."

Positive

"The practice manager told us this task was the responsibility of the nurse or health care assistant who was working at the branch surgery each day."

Positive

"Although a GP and nurse now had lead roles in IPC there was some confusion within the management team as to who was responsible for monitoring IPC standards were maintained and ensuring the action plan relating to the risk assessment and audit was implemented."

Positive

"Since the last inspection the practice had increased nurse led minor illnesses clinics to support the GPs and release GP appointments."

Positive

"We saw that patients requesting an urgent appointment or advice were put onto a list for the triage nurse to call them back."

Positive

"Where a patient’s mental capacity to consent to care or treatment was unclear the GP or nurse assessed the patient’s capacity and where appropriate recorded the outcome of the assessment."

Positive

"This was to be delivered by the advanced nurse practitioner and nurse prescriber to support the GPs and release some GP appointments."

Positive

"There is one nurse practitioner five practice nurses and four health care assistants who all work across the three sites."

Positive

"• A schedule of meetings were held which included daily informal clinical meetings for case review and support weekly formal clinicalbusiness meetings monthly practice meetings and reception team and nurse team meetings."

Positive

"During our visit we spoke with a range of staff including two GPs advanced nurse practitioner practice nurse deputy practice manager administration manager and eight administration staff."

Positive

"In addition to prebookable appointments that could be booked up to six weeks in advance urgent appointments were also available for people that needed them via the nurse triage system."

Positive

"We saw that patients requesting an urgent appointment or advice were put onto a list for the triage nurse to call them back."

Neutral

"The team included a second CQC inspector GP specialist advisor a practice manager specialist advisor nurse specialist advisor and an expert by experience."

Neutral

"We were told alerts would normally be sent to staff by the practice manager or the deputy if action was required but there had been a change in practice and alerts should now be going directly to the lead nurse to be actioned where necessary."

Neutral

"However the lead nurse said she would be undertaking this role in future."

Neutral

"We saw DBS checks had been obtained for a nurse from their previous employer and for a locum GP."

Neutral

"The practice was in the process of implementing nurse led minor illnesses clinics to support the GPs and release GP appointments and they were in the process of recruitment for an additional nurse."

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

"New systems for maintaining fridge temperature monitoring records had been implemented which included electronic records available to all staff for all sites."

Positive

"However the practice is still rated as requires improvement for providing well led services due to a lack of monitoring in one area which may cause a risk for patients."

Positive

"However the practice is still rated as requires improvement for being wellled due to a lack of monitoring in one area which may cause a risk for patients."

Positive

"The provider must ensure all those involved in administering vaccines and monitoring the temperatures of vaccine storage understand what to do in the event of a failure in the cold chain."

Positive

"However we saw some areas which still required improvement s: • Cold chain monitoring arrangements were not effective to ensure to maintain the cold chain for vaccine storage."

Positive

"We found there were still some areas where tasks had not been completed due to this confusion andor lack of monitoring such as implementing the infection prevention and control action plan and the recruitment policy and procedure and ensuring vaccine fridge temperaturemonitoring was completed consistently at the branch surgery."

Positive

"However although this task had been delegated to nursing or reception staff there was no evidence of management monitoring of the effectiveness of these arrangements and staff competence in this area had not been assessed."

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

"• Staff competence to undertake the task of monitoring fridge temperatures used for vaccine storage had not been assessed."

Positive

"However we found there was a lack of oversight and monitoring by the provider and practice manager to ensure that everyone undertaking their roles and responsibilities and procedures and systems were fully implemented."

Positive

"We found there were still some areas where tasks had not been completed due to this confusion andor lack of monitoring such as implementing the infection prevention and control action plan and the recruitment policy and procedure."

Positive

"This was because: • There was a lack of monitoring and oversight to ensure governance systems were fully implemented."

Positive

"• There was a still a lack of management monitoring to ensure all policies and procedures were being implemented and appropriate records were maintained and stored securely."

Positive

"However there was a still a lack of management monitoring to ensure all policies and procedures were implemented and appropriate records were maintained."

Positive

"Although a GP and nurse now had lead roles in IPC there was some confusion within the management team as to who was responsible for monitoring IPC standards were maintained and ensuring the action plan relating to the risk assessment and audit was implemented."

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 checked this fridge and processes for monitoring stock at this inspection and found all vaccines to be in date and a monitoring record of expiry dates to be in place."

Neutral

"For example the recruitment procedure infection prevention and control action plan and monitoring arrangements for vaccine fridge temperatures at a branch surgery had not been fully implemented."

Positive

"Management monitoring and improving outcomes for people The practice participated in the Quality and Outcomes Framework QOF."

Positive

"• There were procedures in place for monitoring and managing risks to patient and staff safety and a site manager was responsible for health and safety matters at the main site and Kimberworth branch surgery."

Positive

"For example monitoring systems were not in place to ensure that policies and procedures for recruitment health and safety and infection control were implemented and standards maintained."

Positive

"However there was a lack of monitoring in areas such as recruitment and infection prevention and control."

Positive

"However there was a lack of monitoring in nonclinical areas to ensure all policies and procedures were being implemented and appropriate records maintained."

Positive

"There was also a lack of overall monitoring to ensure that everyone was undertaking their roles and responsibilities."

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

"• Arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs."

Positive

"We found there were still some areas where tasks had not been completed due to this confusion andor lack of monitoring such as implementing the infection prevention and control action plan and the recruitment policy and procedure and ensuring vaccine fridge temperaturemonitoring was completed consistently at the branch surgery."

Neutral

"We found the provider had reviewed and updated the practice infection prevention and control IPC policy and procedure and this now clarified staff roles and responsibilities."

Positive

"Cleanliness and infection control We saw there were improved processes in place for the management of infection prevention and control IPC."

Positive

"We found there were still some areas where tasks had not been completed due to this confusion andor lack of monitoring such as implementing the infection prevention and control action plan and the recruitment policy and procedure."

Neutral

"Our key findings across all the areas we inspected were as follows: The provider had implemented a number of improvements recommended at the last inspection for example they had; • Implemented systems to identify risks relating to infection prevention and control and to monitor and maintain standards."

Neutral

"The provider had implemented a number of improvements recommended at the last inspection for example they had; • Implemented systems to identify risks relating to infection prevention and control and to monitor and maintain standards."

Neutral

"For example the recruitment procedure infection prevention and control action plan and monitoring arrangements for vaccine fridge temperatures at a branch surgery had not been fully implemented."

Positive

"Systems to risk assess and monitor infection prevention and control standards across all three sites were not in place."

Positive

"Importantly the provider must: • Implement systems to ensure risks relating to infection prevention and control are identified and standards are monitored and maintained across all three sites."

Positive

"For example we were told infection prevention and control IPC was everyone’s responsibility however we found shortfalls in this areas."

Neutral

"There was an infection prevention and control IPCprotocol in place and IPC training was provided."

Neutral

"The practice did not have an infection prevention and control IPC clinical lead at the time of the inspection due to changes in the staff team."

Positive

"We saw audits had been implemented for staff to check cleaning standards although the practice manager was not clear about some of the recording in the records which indicated these had not been checked by the manager."

Positive

"There was no schedule of cleaning for the curtains and no log of when these were last changed or cleaned."

Neutral

"The most recently employed member of clinical staff and a receptionist had the required number of references."

Positive

"The practice also provided evidence of some areas highlighted for improvement at the last inspection For example health and safety signage relating to storage of oxygen had been reviewed and oxygen storage areas were now identified by consistent signage."

Positive

"• There were procedures in place for monitoring and managing risks to patient and staff safety and a site manager was responsible for health and safety matters at the main site and Kimberworth branch surgery."

Positive

"For example monitoring systems were not in place to ensure that policies and procedures for recruitment health and safety and infection control were implemented and standards maintained."

Neutral

"• The practice had an induction programme for newly appointed nonclinical members of staff that covered such topics as safeguarding fire safety health and safety and confidentiality."

Neutral

"Medicines management At the last inspection although regular stock checks of medicines were undertaken by the nurses we found one medicine out of date in the vaccine fridge at a branch surgery."

Neutral

"Regular stock checks of medicines were undertaken by the nurses but we found one medicine out of date in the vaccine fridge at Kimberworth."

Neutral

"We observed alerts were used on patient notes to identify when medicine reviews were due."

Neutral

"One partner was the chair of local CCG another was the chair of the members committee."

Positive

"However we observed a bar of soap was in place in one GPs room which may create a risk of cross contamination."

Positive

"There was evidence of completed clinical audit cycles and evidence these were driving improvement in performance to improve patient outcomes."

Positive

"• There was understanding of the performance of the practice • A programme of continuous clinical audit which was used to monitor quality of the care and treatment and to make improvements."

Positive

"This included ongoing support during sessions onetoone meetings appraisals coaching and mentoring clinical supervision and facilitation and support for the revalidation of doctors."