What is the Quality of Facilities at The Orchard Surgery

Positive

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

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."

Positive

"• The practice had increased the number of online appointments and there was a dedicated member of staff who was monitoring appointment booking system."

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."

Positive

"Management monitoring and improving outcomes for people The practice used the information collected for the Quality Outcomes Framework QOF and performance against national screening programmes to monitor outcomes for patients."

Positive

"• There were procedures in place for monitoring and managing risks to patient and staff safety."

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."

Positive

"There was no evidence of any follow up or monitoring to assess if any of these changes were impacting the patients positively and if access had been improved for patients."

Positive

"We found concerns in safeguarding infection control training medicine management access and quality and monitoring systems."

Positive

"The monitoring of outcomes for patients with long term conditions was not always audited effectively to identify improvements."

Positive

"We found the practice had ineffective systems for checking and monitoring refrigerator temperatures."

Positive

"The nurse told us they were responsible for monitoring the fridge temperature on the days they worked and confirmed they only worked two days of the week."

Positive

"For example there was no evidence of regular monitoring and review of the access medicines management infection control and the clinical waste arrangements."

Positive

"Management monitoring and improving outcomes for people The practice showed us some examples of clinical audits that had been undertaken in the last two years."

Positive

"The practice was not routinely monitoring safety and risk consistently overtime and therefore was unable to demonstrate a safe track record."

Positive

"• There were inadequate systems for checking and monitoring refrigerator temperatures."

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 looked at documentation including relevant monitoring tools for training recruitment maintenance and cleaning of the premises."

Positive

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

Positive

"A practice nurse was the infection control lead who liaised with the local infection prevention teams to keep up to date with best practice."

Positive

"The practice had arranged a training session for the locum nurse to ensure that vaccines were given to patients safely and in line with current guidelines."

Positive

"For example we saw a nurse had completed training courses in wound care and cytology."

Neutral

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

Neutral

"The practice employs one senior practice nurse and one practice nurse."

Neutral

"The practice nurse had already started shadowing senior nurse in the practice during diabetic clinics."

Neutral

"A senior nurse was due to attend coil insertion training course."

Positive

"The nurse told us they were responsible for monitoring the fridge temperature on the days they worked and confirmed they only worked two days of the week."

Positive

"The emergency medicines were checked by the practice nurse who kept a record with volumes and expiry date."

Positive

"For example one nurse confirmed to us that they required a sharps bin for cytotoxic waste in their treatment room but did not have one in place."

Positive

"The information was kept in three folders and contained information such as referral forms basic information about the practice hours and contact numbers for the district nurse and the counsellor who no longer worked for the practice."

Positive

"For example the practice nurse told on the day urgent appointments were not set aside for the nursing team."

Positive

"• The practice was in the process of installing two additional telephone lines recruited four administration staff a health care assistant and a clinical pharmacist to take the lead role in carrying out medicine reviews which would increase GP capacity and allow the practice to offer additional GP appointments."

Positive

"• The practice was in the process of installing two additional telephone lines recruited four administration staff a health care assistant and a clinical pharmacist to take the lead role in carrying out medicine reviews which would increase GP capacity allowing the practice to offer additional GP appointments."

Positive

"The practice informed us that a clinical pharmacist would take the lead role in carrying out medicine reviews which would reduce the burden on GPs and so they could offer additional GP appointments."

Positive

"Regular medicine audits were carried out to ensure the practice was prescribing in line with best practice guidelines for safe prescribing."

Positive

"The aim of the audit was to ensure all patients prescribed this medicine had regular blood tests carried out to monitor serious side effects."

Positive

"Areas for improvement Action the service MUST take to improve • Ensure medicine management systems are reviewed and reflect national guidelines."

Positive

"Action the provider MUST take to improve: • Ensure medicine management systems are reviewed and reflect national guidelines."

Positive

"We found concerns in safeguarding infection control training medicine management access and quality and monitoring systems."

Neutral

"We did not see any notice in the reception area but receptionist showed us contact details for external interpreter service."

Neutral

"The practice is a purpose built premises with car parking for patients and staff."

Neutral

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

Positive

"• The practice had undertaken a risk assessment to mitigate the risks to patients with limited mobility wheelchair users and patients with prams with regards to access."

Positive

"We noted the automatic front door was not in working order and as a result we saw that patients with limited mobility wheelchair users and patients with prams had difficulty with accessing the service."

Positive

"At the time of the visit we saw the automatic front door was not in working order and as a result we saw that patients with limited mobility wheelchair users and patients with prams had difficulty with accessing the service."

Positive

"• There was a register to manage end of life care and unplanned admissions."

Neutral

"• These included 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

"The practice took part in multidisciplinary team meetings on ad hoc basis to discuss the needs of patients with complex medical needs for example those with end of life care needs."

Positive

"For example we saw a nurse had completed training courses in wound care and cytology."

Neutral

"Develop a regular completed clinical audit process and implement actions."

Neutral

"• Develop a regular completed clinical audit process and implement actions."

Positive

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

Positive

"There was a health and safety policy available."

Neutral

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

Neutral

"Including those relating to health and safety and risks to patient safety."

Positive

"• There was a lack of risk assessments such as for fire safety and control of substances hazardous to health COSHH and there was no health and safety risk assessment in place."

Positive

"For example risk assessments for fire safety and control of substances hazardous to health COSHH and there was no health and safety risk assessment in place."

Positive

"Health and safety information was displayed for staff to see and there was an identified health and safety representative."

Positive

"The practice had a health and safety policy."

Neutral

"This included child protection information governance health and safety fire safety manual handling and equality and diversity."

Positive

"The GP partner told us these meetings were attended by district nurses and palliative care nurses and decisions about care planning were shared and discussed."

Positive

"Data from the QOF showed how the practice had performed well in areas including maternity services and palliative care."

Positive

"The practice arranged transport for the elderly patients to ensure they were able to attend their appointment at the practice or in the hospital."

Positive

"Patients with mental health care needs were registered at the practice."

Positive

"There was no clarity about the responsibility for cleaning specific areas and items and it was not clear who was responsible for which area between the practice staff and the contractor."

Positive

"The cleaner and practice staff also used the communication book for any particular areas that required cleaning on that day."

Positive

"Later on the inspection day we were provided with another cleaning schedule which was had a less detailed specification than the first schedule and had been emailed by the cleaner who confirmed they were using this schedule."

Positive

"• The system operated was inconsistent for cleaning of the practice premises clinical waste was not always secured properly and there was lack of hand gel and soap on the practice premises."

Neutral

"We looked at documentation including relevant monitoring tools for training recruitment maintenance and cleaning of the premises."

Neutral

"Cleanliness and infection control We found the cleaning of the premises was inconsistent."

Neutral

"However the infection control audit and the spot checks did not identify the inconsistency in cleaning of the practice premises the lack of hand gel and soap and that staff did not always have appropriate equipment."

Neutral

"We noted all cleaning equipment was stored in a cleaning cupboard."

Neutral

"In the cleaning cupboard we found mop heads for cleaning different areas of the practice had been placed together in one bucket."

Neutral

"They worked in accordance with the cleaning schedules provided by the practice."

Neutral

"At the time of the inspection different cleaning schedules were made available to us."

Positive

"The practice arranged transport for the elderly patients to ensure they were able to attend their appointment at the practice or in the hospital."

Neutral

"The practice had systems in place to communicate information about these clinics to patients with young children and elderly patients which included correspondence via letter or contact by telephone."

Neutral

"Home visits were arranged for frail and elderly patients."