The Care Quality Commission
  • Doctor
  • GP practice

Waterhouses Medical Practice

Overall: Good read more about inspection ratings

Waterfall Lane, Waterfall, Waterhouses, Stoke On Trent, Staffordshire, ST10 3HY (01538) 308207

Provided and run by:
Drs V & U Tiguti

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Waterhouses Medical Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Waterhouses Medical Practice, you can give feedback on this service.

13 March 2020

During an annual regulatory review

We reviewed the information available to us about Waterhouses Medical Practice on 13 March 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

4 October 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services. We carried out a focused inspection in respect of safe care on 5 October 2016 to check that urgent action had been taken to comply with legal requirements. We undertook a further announced comprehensive inspection at Waterhouses Medical Practice on 19 April 2017. The overall rating for the practice was good with requires improvement in providing safe services. The reports for the three inspections can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017. It was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in the regulation that we identified in our previous inspection on 19 April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • Joint injections were carried out in clinical rooms with appropriate flooring to prevent and control the risk of infection.

  • Syringes, dressings and dressing packs were in date and a system for checking them had been put in place.

  • Medicines used in the treatment of joint injections were stored securely.

  • Prescription stationary used in printers was stored securely.

  • Satisfactory evidence of conduct in previous employment was documented for locum staff who worked at the practice.

  • The safeguarding policy for vulnerable adults had been updated to reflect categories or definitions of the types of abuse for example, modern slavery.

  • Systems to follow up children who failed to attend for hospital appointments had been implemented.

  • Alerts had been added to the records of the parents of children with a child protection plan in place.

  • A formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice had been implemented. The practice had reviewed their processes for supporting nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. The practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led services.

We carried out a focused inspection in respect of safe care and treatment on 5 October 2016 to check that action had been taken to comply with legal requirements. The two inspection reports can be found by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

We undertook a further announced comprehensive inspection of Waterhouses Medical Practice on 19 April 2017 to check that action had been taken to comply with legal requirements relating to providing effective and well led services. The two GP partners were not available on the day of the inspection but we spoke with a locum GP who will become a partner at the practice in November 2017. Overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and there had been significant improvements in reporting and recording significant events.
  • The practice had clearly defined systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey published in July 2016 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. There had been a significant improvement in the recording and analysis of trends in complaints. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day especially for children, frail older patients and patients identified with complex health issues.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had significantly reduced the annual number of patients that attended A&E during GP opening hours from 115 patients per 1000 to 71 per 1000.
  • There was a clear leadership structure and most staff felt supported by the management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

  • Carry out joint injections in a clinical room with appropriate flooring to prevent and control the risk of infection.

  • Implement systems to ensure items such as syringes, dressings and dressing packs are in date.

  • Ensure that medicines used in the treatment of joint injections and prescriptions used in printers are stored securely.

  • Ensure satisfactory evidence of conduct in previous employment is documented for all locum staff who work at the practice.

The areas where the provider should make improvement are:

  • Update the safeguarding policy for vulnerable adults to reflect updated categories or definitions of the types of abuse for example, modern slavery.

  • Implement systems to follow up children who failed to attend for hospital appointments.

  • Add alerts to the records of the parents of children with a child protection plan in place.

  • Implement a formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice. Continue to explore and implement ways in which practice nurses are supported to carry out their role.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

5 October 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Waterhouses Medical Practice on 21 June 2016. Three breaches of legal requirement were found. A warning notice was served for:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment.

Requirement notices were served for :

  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.

  • Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staffing.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Waterhouses Medical Practice on our website at www.cqc.org.uk.

We undertook a focused follow up inspection on 5 October 2016 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. This report only covers our findings in relation to the warning notice. A follow up inspection will be carried out within six months to check that the practice had followed their action plan for the two requirement notices and to confirm they meet legal requirements.

Our key findings were as follows:

  • There was a formal system in place to log, review, discuss and act on alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts, received into the practice.
  • Opportunities to raise significant events were identified. There was an effective system in place for reporting and recording significant events.
  • Effective systems had been put in place to mitigate risks to patients who took high risk medicines.
  • There was a system in place to track prescriptions throughout the practice.
  • An infection control audit had been completed and an action plan had been put in place to mitigate risks identified.
  • Risks identified in the practice’s legionella risk assessment and fire risk assessment had been mitigated.
  • Hepatitis B immunisation records were available for most staff. Risk assessments were in place for two locum GPs whilst their hepatitis B status was confirmed.
  • Emergency medicines were stored securely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

21 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterhouses Medical Practice on 21 June 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • Staff did not always demonstrate an understanding of their responsibilities to raise concerns, and to report incidents and near misses. There was little evidence that learning from significant events had been communicated to all staff and annual reviews to identify trends had not been carried out.
  • Risks to patients were assessed but not always well managed. Risks identified in the legionella risk assessment and fire assessment had not all been addressed. There was no formal system in place to log, review, discuss and act on alerts received that may affect patient safety.
  • Robust systems were not in place for assessing the risk of, preventing, detecting and controlling the spread of infections, including those that are health care associated.
  • Not all staff had received training in safeguarding children and vulnerable adults or understood their responsibilities in protecting them from the risk of abuse. One person who chaperoned told us they had not received chaperone training. Two members of staff had not received an appraisal since 2013.
  • National guidance for the monitoring of patients receiving high risk medicines was not always followed. There was no system in place to track prescriptions issued throughout the practice.
  • Data showed patient outcomes were low compared to the national average in three areas.
  • Patients said they were treated with compassion, dignity and respect and they felt cared for, supported and listened to.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Urgent appointments were available the same day. Patients said they found it easy to make an appointment but had to wait two to three weeks to see their GP of choice.
  • Governance arrangements were not sufficiently robust enough to ensure effective governance. The practice had a number of policies and procedures to govern activity, but not all staff were aware of where to locate these. Information about how to complain was available and easy to understand but not all complaints were documented to ensure learning and identification of trends.

The areas where the provider must make improvements are:

  • Ensure that staff are aware of when to raise significant events and that learning from significant events is communicated to all staff. Ensure there is a system in place to annually review significant events to identify patterns or trends.
  • Ensure all members of staff receive training in safeguarding children and vulnerable adults and staff who chaperone receive chaperone training. Ensure all staff receive regular appraisals.
  • Ensure there are adequate systems in place for assessing the risk of, preventing, detecting and controlling the spread of infections, including those that are health care associated.
  • Ensure robust systems are in place that comply with national guidance for the monitoring of patients receiving high risk medicines.
  • Implement robust governance arrangements including systems for assessing, monitoring and mitigating risks and the quality of the service provision. Implement a formal system to log, review, discuss and act on alerts received that may affect patient safety.

In addition the provider should:

  • Ensure there is a system for tracking prescriptions through the practice and that emergency medicines are stored securely and safely.
  • Ensure all complaints are documented to ensure learning and identification of trends.
  • Ensure that all staff are provided with the mandatory training identified by the practice.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by the Care Quality Commission (CQC) that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice