Farrow Medical Centre

We carried out an announced comprehensive inspection at Farrow Medical Practice on 5 December 2018. The overall rating for the practice was inadequate.

Three warning notices were issued by the Care Quality Commission after the December 2018 inspection for breaches of Regulations 12, safe care and treatment, Regulation 18, staffing and Regulation 17, good governance of the Health and Social Care Act 2008, Staffing (regulated activities) Regulations 2014.

A further focused inspection was undertaken on 28 May to review compliance with the warning notices issued for the breaches of Regulations 12 and 17 and any actions taken by the provider. We found that some improvements had been made. However, following the inspection we issued a requirement notice for Regulation 17, good governance for continuing non-compliance regarding the management of complaints, significant events and safety alerts.

This inspection carried out on 7 August 2019, was an announced comprehensive inspection of the service which also reviewed in detail the breach of Regulation 18 (staffing) from the December 2018 inspection.

We have rated this practice at this inspection as requires improvement overall.

The report for the 28 May 2019 inspection and previous inspection reports can be found by selecting the ‘all reports’ link for Farrow Medical Practice on our website at www.farrowmc.co.uk .

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.

We rated the practice as requires improvement for providing safe services because:

• The provider did not have appropriate systems in place for the safe management of vaccines and the cold chain.
• The provider had not taken steps to ensure that all actions related to the management of infection prevention and control were completed.
• The provider did not always learn and make improvements when things went wrong.

We rated the practice as requires improvement for providing responsive services because:

• The provider had not sufficiently improved their response to patient complaints. The response and management of complaints did not follow NHS guidance or the provider’s own policy. On the day of inspection, we found that it was difficult to track and follow a complaint through to completion or see how learning was shared.

We rated the practice as requires improvement for providing effective services because:

• We found an overall reduction in the number of children being brought for vaccinations in 2018/2019.
• Data showed that outcomes for some patients with long term conditions were below CCG and national averages with high exception reporting, for example respiratory issues.

We rated the practice as inadequate for providing well-led services because:

• While the practice had made some improvements since our inspections on 5 December 2018 and 28 May 2019 it had not adequately addressed the Warning Notice and subsequent Requirement Notice in relation to Regulation 17, good governance of the Health and Social Care Act 2008, Staffing (regulated activities) Regulations 2014.
• The provider could not demonstrate that all the systems and processes in place at the practice kept people safe. The provider had reviewed the system for the documentation, discussion, review and management of complaints and significant events. However, we found that overall governance at the practice remained ineffective.

We rated the practice as good for providing caring because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Patient feedback was positive and the results of the National GP patient survey 2019 showed that the practice had scored higher than their CCG average in every question. Results were also better than or comparable to national averages.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Complete all of the required improvements and actions identified relating to the management of infection prevention and control.
• Improve meeting notes to reflect the discussions held and allow all members of the team the opportunity to be involved in the continual evaluation and improvement of services for patients.

This service was placed in special measures on 27 February 2019. Insufficient improvements have been made such that there remains a rating of inadequate for at least one population group, key question or overall. Therefore, we are taking action in line with our enforcement procedures to vary the terms of their registration with CQC. The service will remain in special measures for a further period of six months, be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months, and if there is not enough improvement we may take action to begin the process of preventing the provider from operating the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated care

We carried out an announced comprehensive inspection at Farrow Medical Centre on 5 December 2018. The overall rating for the practice was inadequate. The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Farrow Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection, carried out on 28 May 2019. The purpose of this inspection was to review actions taken by the provider in response to warning notices for non-compliance with Regulations 12, safe care and treatment and Regulation 17, good governance issued by the Care Quality Commission in January 2019.

At the inspection on 5 December 2018 the provider was rated as inadequate and told they must improve. This inspection on 28 May 2019 was not rated.

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.

We found that:

• The provider had complied with the warning notice for regulation 12 of the Health and Social care Act 2008, safe care and treatment. Improvements had been made in the management and oversight of infection prevention and control (IPC), health and safety, fire and the appropriate and safe storage of vaccines and prescriptions.

• The practice had not fully complied with the warning notice for regulation 17,of the Health and Social Care Act 2008, good governance and there were issues remaining with the systems and processes that were in place to manage complaints, significant events and safety alerts.

• We saw that a Disclosure and Barring Service Check (DBS check) or a risk assessment was in place for all staff members.

• The practice had improved their identification of carers to 1.2% of the practice population.

• The practice could not assure themselves that everyone who had direct contact with patients, including reception staff, was up to date with routine immunisations.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to review the outcomes of the environmental audits that have been undertaken and ensure that they continue to implement the actions required from the fire risk assessment, the health and safety risk assessment and the infection prevention and control audit.

• Continue with the work to review the immunisation status of the staff team in line with the requirements of Immunisation against infectious disease (The Green Book).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Farrow Medical Centre on 5 December 2018 as part of our inspection programme.

Farrow Medical Centre was last inspected on 4 November 2014 and was rated as good.

Our judgement of the quality of care at this service is based 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.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The provider could not demonstrate that suitable arrangements were in place to prevent the spread of infection at the practice.
• The provider had failed to assess the risks to the health and safety of staff and patients at the practice.
• Systems and processes were not in place to keep patients safe and protected from abuse.

We rated the practice as inadequate for providing effective services because:

• The practice was unable to demonstrate that staff were suitably trained or had the skills, knowledge and experience necessary to carry out their roles.

This issue affected all areas of the service. Therefore, we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance. For example; we saw that the processes in place to manage complaints, significant events, safety alerts and patient group directions were ineffective.
• The practice could not demonstrate that the relevant policies and procedures were in place to support the good governance of a GP practice. A small number of policies were available but the majority did not contain up to date or relevant information and the practice could not assure themselves that they would direct staff to the best course of action.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure that persons employed by the service are suitably trained as is necessary to enable them to carry out the duties they are required to perform.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve the identification of carers to ensure that they are able to meet the needs of this vulnerable group.
• Continue to review the immunisation status of the staff team in line with the requirements of Immunisation against infectious disease (The Green Book).
• Ensure that DBS checks are undertaken in line with practice policy.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice