What is the Quality of Safety at The Orchard Surgery

Positive

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

Positive

"All staff we spoke with had a comprehensive understanding of the governance arrangements and performance of the practice."

Neutral

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

Positive

"Good governance The registered person must assess monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity."

Positive

"For example policy documents did not always identify the correct lead within the practice which caused some confusion for staff and governance systems were not effective."

Neutral

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

Positive

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

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."

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

Positive

"The areas where the provider must make improvements: • Assess monitor and improve the quality and safety of the services provided Details of our findings and the evidence supporting our ratings are set out in the evidence tables."

Positive

"The practice also 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 a bacterium which can contaminate water systems in buildings."

Positive

"The practice had an up to date fire risk assessment in place and they carried out fire safety checks."

Positive

"• Lessons were shared to make sure action was taken to improve safety in the practice."

Positive

"• When there were safety incidents patients received reasonable support truthful information a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again."

Positive

"• We reviewed safety records incident reports national patient safety alerts and minutes of meetings where these were discussed."

Positive

"The weak leadership of the practice was not always consistent which impacted on the quality and safety of the service to patients."

Positive

"The majority of information about safety was recorded monitored and reviewed."

Positive

"The practice had systems in place for knowing about notifiable safety incidents • The practice proactively sought feedback from staff and patients which it acted on."

Positive

"There was not an effective operation of systems designed to regularly assess and monitor the quality of the services to identify assess and manage risks relating to the health welfare and safety of patients and others who may be at risk."

Positive

"There was a health and safety policy available."

Positive

"The practice had systems in place for knowing about notifiable safety incidents."

Positive

"When there were safety incidents: • The practice gave affected patients reasonable support truthful information and a verbal and written apology."

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."

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

"Good governance The registered person must assess monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity."

Positive

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

Positive

"The provider was rated as inadequate for safety and for wellled and requires improvement for effective and responsive domains."

Positive

"Reliable safety systems and processes including safeguarding The practice had comprehensive adult and children safeguarding policies in place."

Positive

"Leadership openness and transparency The leadership of the practice was not always consistent which impacted on the quality and safety of the service to patients."

Positive

"The leadership of the practice was not always consistent which impacted on the quality and safety of the service to patients."

Positive

"Inadequate ––– People with long term conditions The provider was rated as inadequate for safety and for wellled and requires improvement for effective and responsive domains."

Positive

"Learning and improvement from safety incidents."

Positive

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

Positive

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

Positive

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

Positive

"Monitoring safety and responding to risk The practice did not have appropriate systems in place to manage and monitor risks to patients staff and visitors to the practice."

Positive

"The practice had a health and safety policy."

Positive

"The practice had also fire safety procedures and medical emergencies protocols and staff were familiar with these."

Neutral

"• Ensure there are processes in place to identify assess and manage risks relating to health welfare and safety of patients."

Neutral

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

Neutral

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

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

"• Governance systems were operated including quality improvement initiatives."

Positive

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

Positive

"They said staff treated them with dignity and their privacy was respected."

Positive

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

Neutral

"The practice had redesigned the reception area to enhance patients privacy and maintain confidentiality."

Positive

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

Positive

"All 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 and treatment rooms so that patients’ privacy and dignity was maintained during examinations investigations and treatments."

Positive

"We saw this system in operation during our inspection and noted that it was difficult to maintain confidentiality during busy times because the reception area was crowded and little privacy could be afforded to patients."

Neutral

"Staff and patients told us that all consultations and treatments were carried out in the privacy of a consulting room."

Positive

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

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 patients vulnerable adults and children."

Positive

"Safeguarding service users from abuse and improper treatment."

Positive

"The registered person failed to ensure systems were established and operated effectively to prevent the abuse of service users."

Positive

"The practice also 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 a bacterium which can contaminate water systems in buildings."

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

"Requirement notices were set for the regulations relating to the unsafe use and management of medicines infection control and safeguarding training."

Positive

"For example some actions relating to infection control and medicines management did not reflect national guidelines in relation to safe practice."

Neutral

"• There was an infection control protocol in place and infection control audits were undertaken regularly."

Neutral

"There was an infection control protocol in place and all staff had received up to date 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

"• Ensure appropriate infection control systems are in place in line with national guidelines."

Positive

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

Positive

"The practice did not have appropriate infection control systems in place in line with national guidelines."

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

"For example the policy stated a specific named GP was the infection control Are services safe?"

Positive

"We found no evidence that confirmed the infection control lead had completed appropriate training to perform the role."

Positive

"The practice manager also carried regular spot checks to ensure infection control protocols were being met."

Positive

"These included policies for children and adult safeguarding infection control confidentiality chaperone whistleblowing complaints and health and safety."

Neutral

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

Neutral

"The practice had infection control policy in place."

Neutral

"The audit had identified staff required infection control training and hand washing training."

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

"Cleaning equipment was not used or stored in line with current infection control guidance."

Neutral

"However the practice had not provided training for infection control or safeguarding training to all staff."

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

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

Positive

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

Positive

"This also included treating patients with dignity and respect and delivering high quality services to meet the specific needs of patients."

Positive

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

Positive

"• We also saw that staff treated patients with kindness and respect."

Positive

"They said staff treated them with dignity and their privacy was respected."

Positive

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

Positive

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

Positive

"The evidence from both sources showed patients were satisfied with how they were treated and that this was with compassion dignity and respect."

Positive

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

Positive

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

Positive

"• Patients were positive about their interactions with staff and said they were treated with compassion and dignity."

Positive

"We observed that staff treated patients with kindness and respect and maintained confidentiality."

Positive

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

Positive

"Tackling inequity and promoting equality The practice had recognised the needs of different groups in the planning of its services."

Neutral

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

Neutral

"Staff had received equality and diversity training."

Positive

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

Positive

"The practice did not have robust systems for checking fridge temperatures disseminating learning that had occurred from significant events and complaint outcomes to practice staff."

Positive

"The complaints procedure provided further information on how to make complaint on someone’s behalf and who at the practice would deal with the complaint."

Positive

"There was no system in place to disseminate learning that had occurred from significant events and complaint outcomes to practice staff."

Positive

"Information on how to make a complaint was provided on the practice website and leaflet."

Neutral

"The patients we spoke with told us they would be comfortable making a complaint if required."