The Care Quality Commission
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  • GP practice

Archived: Stanley Medical Centre

Overall: Inadequate read more about inspection ratings

60 Stanley Road, Kirkdale, Liverpool, Merseyside, L5 2QA (0151) 207 0126

Provided and run by:
Dr Don Jude Chaminda Mahadanaarachchi

All Inspections

9 and 16 December 2021

During a routine inspection

We carried out an inspection Stanley Medical Centre on 9 and 16 December 2021. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective – Requires Improvement

Caring – Good

Responsive - Requires Improvement

Well-led - Inadequate

We carried out a remote assessment of Stanley Medical Practice in November 2020 following information of concern raised with us. At this time, we issued the provider with two warning notices for Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and Regulation 17 HSCA (RA) Regulations 2014 Good governance.

A follow up inspection was carried out in June 2021 during which time improvements had been made. However, we issued a requirement notice in respect of a breach of Regulation 18 (staffing) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

These inspections were remote inspections therefore the previous rating of Good did not change.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Stanley Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection as a result of information of concern being shared with us.

How we carried out the inspection

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.

How we carried out the inspection

This included:

  • Conducting staff interviews
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A practice site visit

Our findings

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.
  • Staff did not have the information they needed to deliver safe care and treatment. There was no documented approach to managing test results. We identified a large backlog of patient correspondence and tasks, resulting in delays to treatments for patients.
  • Staff were unclear about reporting processes and there was insufficient evidence that appropriate actions and learning took place.
  • The provider did not have a systematic programme of clinical audits which should be used to monitor quality.
  • Structures, processes and systems for accountability were not clearly set out or understood by staff. There was a lack of management and leadership oversight and monitoring of these systems to ensure their effectiveness.
  • Patient views were not acted on to improve services and culture.
  • Previous improvements had not been sustained in relation to previous breaches of regulations.

We have rated this practice as Inadequate overall.

We rated the provider as Inadequate for providing safe services. This was because:

  • Recruitment checks were only partially carried out in accordance with regulations.
  • Partners and staff were not trained in safeguarding matters to appropriate levels for their role.
  • Health and safety risk assessments, including fire risk assessments were out of date at the time of inspection.
  • Systems and processes to monitor significant events were ineffective. There was limited evidence of learning and dissemination of information for the management of significant events.
  • Risk assessments for infection prevention and control measures were incomplete and risks to patients and staff were observed.
  • The systems in place for monitoring patients’ health in relation to the use of medicines including high risk medicines, such as lithium required improvements.
  • Safety alerts were not being acted upon consistently.

We rated the provider as Requires Improvement for providing effective services because:

  • Patients’ care and treatment was not regularly reviewed and updated.
  • The practice did not have an effective system for following up on blood test results and tasks that required immediate action. This led to increased risks that patients presenting with symptoms which could indicate serious illness not being followed up in a timely and appropriate way.
  • Children’s immunisation rates were below the 90% minimum national target.
  • The uptake of cervical screening for women was below the 70% uptake for national targets.
  • There was limited monitoring of the outcomes of care and treatment.
  • Information to show that staff had the skills, knowledge and experience to deliver effective care, support and treatment was not in place for all staff working at the practice.
  • Regular appraisals, one to ones and clinical supervision had not taken place for staff.
  • Do not attempt cardiopulmonary resuscitation (DNACPR) orders were not adequately recorded.

We rated the provider as Requires Improvement for providing responsive services. Concerns included:

  • Patients were not able to make appointments in a way which met their needs and telephone access to the practice was poor.
  • The complaints policy and procedure was not followed, verbal complaints were not recorded.
  • Complaints were not responded to in a timely way and not all aspects appropriately investigated.
  • There was insufficient evidence that complaints were used to drive continuous improvement.

We rated the provider as Inadequate for providing well-led services. This was because:

  • We identified arrangements were not in place for identifying, recording and managing risks, issues and mitigating actions.
  • Staff were unclear about reporting processes and there was insufficient evidence that appropriate actions and learning took place.
  • The provider did not have a systematic programme of clinical audits which should be used to monitor quality.
  • Structures, processes and systems for accountability were not clearly set out or understood by staff. There was a lack of management and leadership oversight and monitoring of these systems to ensure their effectiveness.
  • Patient views were not acted on to improve services and culture.
  • We identified several examples to show that robust arrangements were not in place for identifying, recording and managing risks, issues and mitigating actions.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 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.

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

28 29 June 2021

During an inspection looking at part of the service

We carried out an announced remote assessment at Stanley Medical Centre on 28 and 29 June 2021. This review focused on the regulatory breaches previously found.

This review did not result in the provider being awarded a rating as a site visit was not undertaken.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for GP Stanley Medical Centre on our website at www.cqc.org.uk

Why we carried out this review.

This review was a focused follow-up remote review of information without undertaking a site visit to follow up on 28 and 29 June 2021.

We looked at the following key questions:-

Safe

Effective

Responsive

Well-led

This review was a focused follow-up review of information without undertaking a site visit, to follow up on two breaches of regulation. These were identified at the previous review we carried out between 9 and 12 November 2020. At that time, we identified improvements were need to the governance of the service and to ensure medicines were managed safely. We issued warning notices for breaches of:

  • Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
  • Regulation 17 HSCA (RA) Regulations 2014 Good governance

The full reports for previous inspections can be found by selecting the ‘all reports’ link for GP Practice at Riverside on our website at www.cqc.org.uk

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out in a way which enabled us to not spend any time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider

Our findings

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 a number of improvements had been made since the last remote assessment, including:

  • The provider had undertaken a recruitment drive and new systems and induction programmes were developed to support new and temporary staff.
  • The processes for monitoring patients’ health in relation to the use of medicines including high risk medicines, had significantly improved.
  • There had been improvements to policies and procedures to ensure there was clear guidance for staff.
  • The arrangements for identifying, recording and managing risks, issues and mitigating actions had improved. This included the management of significant events and complaints monitoring.
  • The practice had systems and processes to keep clinicians up to date with current evidence-based practice.
  • The practice had an improved programme of quality improvement and used information about care and treatment to make improvements.
  • We found that improvements had been made to the governance systems to ensure better oversight, monitoring and review.
  • There was improved clinical leadership from a lead GP and nurse and regular monthly clinical meetings with practice staff.
  • Staff reported that they felt able to raise concerns without fear of retribution.
  • Staff reported that there had been improvements to communication and their involvement in the operation of the service.

We found areas where improvements needed to be made: -

  • Since the last inspection the provider had developed a training plan. However, there were gaps identified in the required mandatory training for a number of clinical staff.
  • A systematic approach to determine the number of staff and range of skills required in order to meet the needs of patients and keep them safe was not in place.
  • There was insufficient support or monitoring of clinical staff. Appraisals and formal supervision had not taken place.
  • Some staff told us there was not always enough clinical staff for the volume of work and there was a lack of continuity of staff. Staff told us there was not enough practice nurses and not enough long-term GPs.
  • The provider used a high number of locum staff to maintain clinical staffing levels without effective oversight.

We found a breach of regulations. The provider must:

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

The areas where the provider should make improvements:

  • Review and improve significant event reporting and analysis forms to fully document learning and action taken.
  • Review and improve processes to seek feedback from patients about access to the services provided.
  • Review and improve the procedures for offering patients a service at another location operated by the provider.
  • Review and improve the policy for staff development and retention.
  • Review and improve the record keeping of checks to ensure the receptionists are allocating patients to the correct area of the triage system.
  • A programme for audits should be put in place which reflects local, national and service priorities.
  • The provider should ensure that a written agreement or contract is in place for GP locums working at the practice. Formal procedures and monitoring processes should be put into place to ensure safe treatment and care is carried out.

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

9-12 November 2020

During an inspection looking at part of the service

This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic and reducing the burden placed on practices by minimising the time inspection teams spend on site.

This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider. The assessment did not include on-site inspection and therefore the practice has not been rated or ratings from our previous inspection have not been reviewed.

Background:

We undertook a remote regulatory assessment between 9 and 12 November 2020 following information of concern being brought to our attention. The practice had previously not been inspected under this provider’s registration.

The service is registered with CQC under the Health and Social Care Act 2008 to provide the regulated activities of: Diagnostic and screening procedures and Treatment of disease, disorder or injury.

The registered provider is the responsible individual and is the ‘registered person’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the assessment we reviewed Stanley Medical Centre clinical record system which included the practice’s task management system and a sample of electronic patient records.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we carried out the assessment.
  • information from our ongoing monitoring of data about services and
  • information from the provider, staff, patients, the public and other organisations.

We found that:

  • Staff felt patients had their needs met and that overall care was prioritised depending on need. However, the workload was high, sometimes excessive and sometimes there were insufficient staff to meet patient demand.
  • The provider did not have a system in place to effectively assess and manage staffing needs to ensure patient safety.
  • Overall responsibility for risk management was not clear. There were gaps in systems to assess, monitor and manage risks to patients, for example, the management of patients’ medicine reviews.
  • The monitoring of patients’ medication, including high risk medication, was not robust. Medication reviews and monitoring was not done in a timely manner, lacked oversight and was not always managed safely.
  • There were no assurance processes that patients test results were processed and acted upon in a timely manner.
  • The systems to report, analyse, learn and make improvements when things went wrong were not robust. The significant event and complaint procedures and processes needed improvement.
  • Good governance systems and processes required improvements. The governance framework was not clearly defined or identified. There was insufficient review, analysis and a lack of action planning and review.
  • There was a senior management team and structure in place, they had a vision and supporting strategies in place.
  • The organisation and the practice were supported by a culture strategy and staff reported that they felt able to raise concerns without fear of retribution. Staff generally felt well supported by colleagues and managers and they felt the culture of the practice was one of openness and honesty.
  • There were a number of communication methods in place, however improvements were needed. Structured, formally recorded meetings that looked specifically at operational or clinical issues were not taking place at practice level.
  • Some of the policies and procedures that we looked at required review and improvements as they lacked significant detail such as the checks to be undertaken during the staff recruitment process.
  • The system in place for monitoring and auditing the practice required improvement. The audit plan did not demonstrate that it was based on local, national or service priorities.
  • Improvements were needed to the support provided to clinical staff. There were informal arrangements to review the consultations, referrals and prescribing of clinicians and no formal induction for locum staff. Locum staff were not always included in the appraisal process, audits or involved in the significant event process.

The areas where the provider must make improvements:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

4 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stanley Medical Centre on 4 April 2017. Overall the practice is 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded 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 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. 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 named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a leadership structure and staff said they felt supported by 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.

There were areas where the provider should make improvement. The provider should:

  • Monitor the new cleaning contract in place and ensure regular cleaning audits are undertaken.

  • Ensure that procedures are followed monitored and reviewed for the management and maintenance of the premises.

  • Review the staffing levels of reception staff across the week to ensure adequate arrangements are in place at all times.

  • Review the management and leadership structure of the practice.

  • Monitor the new system put into place to ensure all nurses working at the practice are covered with appropriate medical indemnity insurance.

  • This should include a risk assessment and needs analysis as the basis for deciding sufficient management and leadership roles are in place at all times.

  • Monitor the new system put into place to ensure all

  • Ensure that appropriate action plans are drawn up and monitored when risks, such as a fire risks, are identified for the practice.

  • Consider the inclusion of reception staff to regular practice meetings so that communications can improve.

  • Review the arrangements and meetings held with the Patient Participation Group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice