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Archived: Albion Place Medical Practice

Overall: Requires improvement read more about inspection ratings

23-29 Albion Place, Maidstone, Kent, ME14 5DY (01622) 235613

Provided and run by:
Dr Peter Szwedziuk and Doctor Annmarie Keeley

Important: The provider of this service changed. See new profile

All Inspections

24/04/2018

During a routine inspection

This practice is rated as inadequate overall. (Previous inspection July 2017 – inadequate)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Albion Place Medical Practice on 24 April 2018, to follow up on breaches of regulations identified at our inspection in August 2017. At a previous inspection, July 2017, we rated the practice inadequate for providing safe and well-led services, requires improvement for providing effective and responsive services, and good for caring.

We issued warning notices in respect of these issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 29 November 2017. The details of these can be found by selecting the ‘all reports’ link for Albion Place Medical Practice on our website at www.cqc.org.uk/

At this inspection we found:

  • The systems to manage risk so that safety incidents were less likely to happen were not always effective. When incidents did happen, the practice learned from them and improved their processes.
  • The practice was unable to demonstrate that; patients on high risk medicines were being reviewed appropriately, patient group directions (PGDs) had been revised and updated accordingly and the appropriate two week referral form was in use.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • The practice was unable to demonstrate that; all clinicians had received training in the Mental Capacity Act 2005, staff had the skills and knowledge to deliver effective care and treatment. The learning needs of all staff had not been identified through a system of appraisals and that all staff were up to date with relevant training. They had continued to improve the staff appraisal systems, in order to help ensure that nurse appraisals included more detailed evidence of clinical matters discussed.
  • The practice was unable to demonstrate that staff files had further been improved since our focused inspection visit on 29 November 2017, where we noted that 15 out of 30 files had been completed. We reviewed personnel files and found that whilst training records had been updated, no further action had been taken to address the updating of staff files with proof of identity.
  • Clinicians had access to appropriate information to deliver safe care and treatment.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients did not always find the appointment system easy to use and reported that they were not always able to access care when they needed it.
  • Patient feedback on the care and treatment delivered by all staff was overwhelmingly positive.
  • The practice was unable to demonstrate that; their governance arrangements always followed national guidance on infection prevention and control, all appropriate recruitment checks had been undertaken for existing staff, the system for managing patients on high risk medicines was not always effectively managed and implemented and the system and process for managing personnel files had been improved.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The registered providers of the service as a partnership have applied to voluntary cancel their registration as a registered partnership. An application has been submitted and CQC has accepted the application for Dr Annmarie Keeley to register as an individual. The change in registration will have no impact on the current patient list and services will continue to be provided from Albion Place Medical Practice.

The partnership were still registered at the time of our inspection visit. There were areas where breaches of regulations were identified and the practice must make improvements:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure that staff employed receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
  • Ensure effective systems and processes to ensure good governance in accordance with the fundamental standards.
  • Ensure recruitment procedures are further embedded and improved to ensure only fit and proper persons are employed.

There were areas where the practice should make improvements:

  • Continue with their plan to conduct clinical audits, in order to improve the quality of services provided.
  • Continue with their plan to improve telephone access.
  • Ensure that staff understood the practice vision, values and strategy and their role in achieving them.
  • Continue with their plan to improve how carers are identified and offered support.

This service was placed in special measures in October 2017. Although improvements have been made these are insufficient such that there remains a rating of inadequate for safe. I am placing the service into special measures for a further six months.

Services placed into special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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 six months, and if there is not enough improvement we will move to close the service.

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

29 November 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Albion Place Medical Practice on 26 July 2017. Overall the practice was rated as inadequate and was placed into special measures. Practices placed in special measures are inspected again within six months of publication of the last inspection report.

Additionally, a breach of the legal requirements was found because systems and processes had not been established and operated effectively and recruitment processes were not always safe. As a result, the provider was not assessing, monitoring and improving the quality and safety of the services provided and mitigating the risks related to the health, safety and welfare of service users and others. Therefore, Warning Notices were served in relation to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

  • Regulation 17 Good Governance.

  • Regulation 19

Following the comprehensive inspection, we discussed with the practice what they would do to meet the legal requirements in relation to the breach and how they would comply with the legal requirements, as set out in the Warning Notices.

We undertook this announced focused inspection on the 29 November 2017, to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 July 2017. The practice was not rated as a consequence of this inspection, as the practice is in special measures. It will be inspected again, with a view to assessing the practice’s rating when the timescale for being placed into special measures has passed.

This report only covers our findings in relation to those requirements. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Albion Place Medical Practice on our website at www.cqc.org.uk.

Our key findings were as follows:

  • The practice was able to demonstrate there was now a consistent process for all significant events recording.

  • The system to process The Medicines and Healthcare Products Regulatory Agency (MHRA) and National Patient Safety (NPS) alerts had improved. However, there were two historic alerts which had not been processed.

  • The practice’s systems, processes and practices to help keep patients safe and safeguarded from abuse had improved.

  • All staff who acted as chaperones were trained for the role and had received a Disclosure and Barring Service (DBS) check.
  • Systems and process to monitor effective infection prevention and control (IPC) had been significantly improved.
  • The arrangements for managing medicines in the practice kept patients safe.
  • All appropriate recruitment checks had been undertaken prior to the employment of newly appointed staff but further improvements were required for the files of long standing staff of the practice.
  • The practice group indemnity insurance now covered the practice of the advanced nurse practitioners and paramedic practitioners.

  • The procedures for assessing, monitoring and managing risks to patient and staff safety had been improved.

  • The practice had a comprehensive business continuity plan for major incidents and all staff were now aware of this.

  • The practice could demonstrate that staff had the skills and knowledge to deliver effective care and treatment. The learning and training needs of staff had improved.

  • The practice was able to demonstrate a more consistent approach when managing complaints. However, improvements were still required in order to help ensure complaint procedures were further enhanced.

  • Governance arrangements had been improved in order to ensure they were effectively implemented.

  • The practice was able to demonstrate they had an action plan to address performance issues and patient satisfaction results.

  • Practice specific policies were implemented and were available to all staff.

  • The systems and processes to underpin the services provided had been improved. For example; significant events, national patient safety alerts, complaints, nfection prevention and control.

The practice had also taken appropriate action to address areas where they should make improvements:

  • Action had been taken to ensure they identified and kept a record of patients who are carers to help ensure they are offered appropriate support.

  • Accurate records were maintained in respect of how staff feedback is acted upon.

  • The patient participation group were active in supporting improvement.

Importantly, the provider must:

  • Ensure that systems and processes are further embedded and improved, to ensure good governance in accordance with the fundamental standards of care.

  • Ensure recruitment procedures are further embedded and improved to ensure only fit and proper persons are employed.

  • Ensure that systems and processes are further embedded and improved, to ensure an effective and accessible system for responding to complaints by service users and other persons.

In addition the provider should:

  • Continue to improve the staff appraisal systems to help ensure that nurse appraisals include more detailed evidence of clinical matters discussed.

  • Continue with their plan to ensure all staff have access to the online staff portal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

26 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Albion Place Medical Practice on 26 July 2017. Overall the practice is rated as inadequate.

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

  • The practice’s system for reporting and recording significant events was not always effectively managed and implemented.

  • Patients were at risk of harm because the systems and processes to help keep them safe and safeguarded from abuse were not always implemented effectively.

  • The practice was unable to demonstrate they always followed national guidance on infection prevention and control.

  • The arrangements for managing medicines in the practice did not always keep patients safe.

  • The practice was unable to demonstrate that all appropriate recruitment checks had been undertaken prior to employment.

  • Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

  • Staff were aware of current evidence based guidance. However, not all staff had received an annual appraisal and the practice was unable to demonstrate all relevant staff were up to date with safeguarding children and vulnerable adults training, chaperone training as well as infection prevention and control training.

  • The practice was unable to demonstrate they had a reliable system that ensured records were kept of all samples sent for the cervical screening programme.

  • 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.

  • The practice was responsive to the needs of specific groups of patients. For example, older patients and those patients that were deaf or hearing impaired. Online consultations via a website were also available to patients.

  • Results from the national GP Patient Surveys in July 2017 indicated that patients scored the practice lower than average in relation to accessing services, appointment availability and seeing a GP of their choice.

  • Patients we spoke with said they did not always find it easy to make an appointment with a named GP but urgent appointments were always available the same day usually with other practitioners.

  • Information about services and how to complain was available. However, improvements were required to help ensure all complaint investigation outcomes were recorded appropriately and shared with staff.

  • Governance arrangements were not always sufficient or effectively implemented.

  • The provider was aware of the requirements of the duty of candour. However, the practice was unable to demonstrate the systems to help ensure compliance with the duty of candour, which included support training for all staff on communicating with patients about notifiable safety incidents, were effective.

The areas where the provider must make improvements are:

  • 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.

  • 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.

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition the provider should:

  • Continue to ensure they identify and keep a record of patients who are carers to help ensure they are offered appropriate support.

  • Maintain an accurate record in respect of how staff feedback is acted upon.

  • Continue to ensure the patient participation group is embedded and made sustainable.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

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