The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Michael Florin Also known as Norris Road Surgery

Overall: Inadequate read more about inspection ratings

356 Norris Road, Sale, Cheshire, M33 2RL (0161) 962 5464

Provided and run by:
Dr Michael Florin

Important: Dr Michael Florin was placed into special measures in January 2015. You can find out more about special measures here.

All Inspections

29/07/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a follow up inspection on 29th July 2015 at the GP practice of Dr Michael Florin as a result of the practice currently being in special measure due to continued non-compliance with the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the practice to be inadequate in three of the five domains inspected. However the practice was good at caring for patients but required improvement in the responsive domains. The practice has failed to meet any of the regulatory requirements prescribed after the last inspection in October 2014 and no improvement in meeting the fundamental standards has been made.

Our key findings were as follows:

  • The practice had no clear leadership structure, insufficient leadership capacity and no formal governance arrangements in place to support staff to deliver high quality evidence based care to patients accessing the service.
  • All areas of the practice were seen to be clean, tidy and well-maintained.
  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment, actions identified to address concerns with infection control practice had not been taken and some staff had not received appropriate training for their role.
  • Management of medicines within the practice did not follow practice policy, local or national guidelines for the management of vaccines.
  • Appointments with both the GP and nurse were available at short notice, with the waiting time for non-urgent appointments generally around 24 hours. All urgent requests were usually addressed within the day either with a telephone consultation or a face to face appointment offered to the patient.
  • We received positive comments from patients who requested to speak with us during the visit.
  • There were some policies and guidance in place to support the management of the practice but these had not been shared with staff at the time of the inspection.

Importantly, the provider must:

  • The provider must ensure that staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice. They must ensure staff are appropriately trained to take on the roles delegated or expected of them This must include training to allow staff to carry out effective scanning, summarising of patient records and clinical coding.
  • The provider must ensure there are systems in place to review and monitor patients who may be at risk or vulnerable within the practice population.
  • The provider must take action to address infection prevention and control to ensure that they comply with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’. The practice must ensure there is an appropriate policy and staff training in place.
  • The provider must take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff.
  • The provider must review its systems for assessing and monitoring the quality of the service provision and take steps to ensure risks are managed appropriately.
  • The provider must ensure there are formal governance arrangements in place and staff are aware how to implement these to ensure the practice functions in a safe and effective manner.
  • The provider must ensure there is a clear strategy for the future of the practice.
  • The provider must ensure that all policies and procedures are followed for the safe management and use of medicines which includes ensuring there is an auditable system for reviewing and monitoring the recording of serial numbers on all blank electronic and hand written prescriptions pads held in storage and once allocated to the GP.

This service was placed in special measures in January 2015; this followed five previous CQC inspections where the service was found to be not meeting regulations. Insufficient improvements have been made such that there remains a rating of Inadequate overall for this practice. The domains of Well led, effective and Safe are inadequate and the Responsive domain still requiring improvement. Caring is the only domain which has a rating of Good. As a result of this overall rating of inadequate all population groups remain inadequate. Therefore we are taking action in line with our enforcement procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

08/10/2014

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice.

We carried out a responsive inspection on 8 October 2014 at the GP practice of Dr Michael Florin as a result of continued non-compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We had visited this practice on four previous occasions within the last 18 months.

We found the practice to be inadequate in two of the five key questions inspected (safe and well-led). The practice was good at caring for patients but required improvement for the responsive and effective key questions. Unfortunately the GP did not fully engage with the inspection team during the visit and therefore it was extremely difficult to gather enough information about the quality of care provided in the six population groups.

Our key findings were as follows:

  • All areas of the practice were clean, tidy and well-maintained.
  • Appointments with both the GP and the nurse were available at short notice, with the waiting time for non-urgent appointments generally around 24 hours. All urgent requests were usually addressed on the day either with a telephone consultation or a face-to-face appointment.
  • We received positive comments from the patients we spoke to during the visit. They were complimentary about all their interactions with staff and felt they dealt with them with compassion, dignity and empathy.
  • The GP did not fully engage with us at this inspection so we were unable to discuss his awareness of monitoring safety or the latest best practice guidelines, and if these were incorporated into day-to-day practice.
  • There were no appropriate policies or guidance in place to support staff and ensure that risks to patients were identified, monitored and reviewed.
  • There were no appropriate quality assurance and governance processes in place to support staff to deliver high quality evidence-based care to patients accessing the service.

Importantly, the provider must:

  • Ensure that staff have appropriate policies and guidance, which are reflective of the requirements of the practice, in order to carry out their roles in a safe and effective manner. The provider is failing to meet Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Ensure there are systems in place to review and monitor patients who may be at risk or vulnerable within the practice population. The provider is failing to meet Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Take action to address infection prevention and control to ensure that the practice complies with the Health and Social Care Act 2008: Code of Practice for health and social care on the prevention and control of infections and related guidance. The provider is failing to meet Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and necessary employment checks are in place for all staff. The provider is failing to meet Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Review its systems for assessing and monitoring the quality of service provision and take steps to ensure risks are managed appropriately. The provider is failing to meet Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Ensure there are formal governance arrangements in place and staff are aware of how to implement these to ensure the practice functions in a safe and effective manner. The provider is failing to meet Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • Ensure there is a clear strategy for the future of the practice. The provider is failing to meet Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

On the basis of the ratings given to this practice at this inspection, and the concerns identified at four previous inspections, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with Care Quality Commission (CQC).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

17 March 2014

During an inspection looking at part of the service

We found the practice manager had developed some policies to assist staff to carry out their roles and responsibilities in a safe manner.

We found staff training had been implemented and recorded fully on training needs analysis forms within personal files. The GP had completed his safeguarding training for both adult and children.

We saw the new patient leaflet was comprehensive, informative and contained relevant information for patients joining the practice including the new practice website details.

The consent policy had been amended and now included details regarding recording decisions made by young adults regarding their care.

The patient participation group had yet to be started but interest from patients within the practice had been sought.

We found adequate policies and processes for the management of medicines, sharing information, safeguarding, infection prevention and control and recruitment had been implemented by the practice manager.

We found staff personal files were updated with relevant information for the staff member.

Whilst we found improvements within the practice were evident, there was still a significant shortfall in the overall quality monitoring and risk management within the practice. These areas had been raised with the GP on numerous occassions during the inspections carried out at the practice. Despite the GP submitting action plans to CQC and declaring compliance with all areas we found this not to be accurate.

We did not speak to any patients during this inspection but did speak to members of staff, representatives from the Local area team, Local management committee, lead medical practitioner who was supporting Dr Florin and a practice manager from a local practice who was offering support to this practice.

21 November 2013

During an inspection looking at part of the service

We inspected this practice to follow up actions taken in respect of the warning notices and compliance actions issued, following concerns at our last inspection in June 2013.

We found the practice had made attempts to develop policies but these were not robust and would not support staff to carry out their roles and responsibilities in a safe manner.

We found some basic staff training had been implemented but there was still key training outstanding for the GP in his role as lead for adult and child safeguarding within the practice.

We saw a new patient leaflet had been designed but there were still some gaps in the information that should be provided for patients.

We found the new consent policy lacked detail regarding recording decisions relating to young adults giving informed consent.

The practice had not yet started to develop a patient participation group. There was no process to gather feedback from patients regarding the service provided.

There were still no suitable arrangements to monitor the quality of the service provided by the practice.

Information sharing protocols were not robust and it was still unclear how the practice would share information with other health or social care professionals, to ensure patient received care appropriate to their needs.

There was still no evidence of effective systems in place to reduce the risk and spread of infection.

The practice did not have an appropriate medicines management process in place.

There was not a robust safeguarding process and policy in place within the practice. However staff had received training in safeguarding at the appropriate level.

The practice had implemented an appropriate management of records process and had up current data management policies for staff.

We found the practice had appropriate management of equipment used in the practice.

Although the practice had a recruitment policy, a recent recruitment demonstrated that the practice had not followed their own process.

We did not speak to any patients during this visit; however, we spoke with four members of staff.

28 June 2013

During a routine inspection

We spoke with four patients on the day of our visit. They spoke positively about the practice and commented that they were happy with the care they received. Patients we spoke with told us 'I've been here for about 30 years I am satisfied with my service. I like the continuity in my care with only one GP'. 'You do tend to wait as appointments always run over. I find there is good communication between the GP and the hospital as I attend both frequently'.

The practice had electronic records in place to accurately describe the contact patients had with the service and the actions taken to provide appropriate care and treatment.

We found the practice did not have any policies and procedures in place to assist and support staff working within the practice.

We found staff had no training in both adult and child safeguarding and therefore staff were not aware of the local authority contact numbers to report concerns.

The provider did not have an up to date recruitment policy in place and did not maintain personnel files for staff. We found the practice had not completed criminal records bureau (CRB) checks for staff.

The practice did not have a patient participation group or practice leaflet for patients to be involved the decisions made regarding the practice. The practice did not carry out any patient surveys to gather feedback on the care patients received.

The practice did not have a consent policy or procedure available to staff or patients in the practice. There was no guidance for staff in respect of treatment for minors.

There were no suitable arrangements in place to monitor the quality of the service within the practice. We found the practice did not have a complaints policy or procedure available for patients.

We found no information sharing protocols in place. There found no evidence that information is shared with relevant health professionals or other agencies to ensure patients receive care that is appropriate to their needs.

The practice had no up to date training, policy or guidance for staff on infection prevention and control, waste management and environmental cleaning. We found the consulting rooms to be dusty and cluttered with inadequate hand washing facilities.

The GP did not have adequate record management policies available to staff which would give guidance on the safe management of records. We found confidential records left unattended or not securely stored in a number of areas of the practice.

The practice did not have appropriate medicine management policies and procedures in place. We found a number of medicines used to treat patients in emergency situations were past their expiry date and also found some vaccines stored in the fridge that were six months out of date.

We found no evidence to demonstrate that equipment was serviced, calibrated and maintained as required.