All inspections: Lakeside Healthcare at Stamford

We carried out an announced focused inspection at Lakeside Healthcare at Stamford on 31 January 2024. The inspection was undertaken in response to concerns raised with CQC. This inspection was focused and did not look at sufficient of any of the key questions to alter any existing ratings.

Therefore the ratings from the previous inspection in November 2022 are unchanged and the practice is still rated overall as requires improvement.

The previous ratings for each key question remain as:

Safe – Requires improvement.

Effective – Good

Caring - Requires improvement.

Responsive - Requires improvement.

Well-led – Good.

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

Why we carried out this inspection

We carried out this inspection to address specific concerns raised with CQC. The areas focused on, as part of the inspection, related to elements of the key questions: effective and well led.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

Conducting staff interviews.
Completing reviews of patient records on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
A short 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.
information from the provider, patients, the public and other organisations.

We found that:

Staff who carried out the removal of intrauterine devices (IUDs) had undertaken appropriate training and competency checks.
The staff files we reviewed showed that appropriate training had been completed for the role.
The clinical supervision processes in place did not always ensure appropriate oversight of the work of all clinical staff. The practice were in the process of reviewing and strengthening their clinical supervision policy and framework.

The provider should:

Continue to implement then embed their updated clinical supervision policy and framework.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

We carried out an announced inspection at Lakeside Healthcare at Stamford on 23 November 2022. Overall, the practice is rated as requires improvement.

The ratings for each key question:

Safe – Requires improvement.

Effective – Good

Caring - Requires improvement.

Responsive - Requires improvement.

Well-led – Good.

Following our previous inspection in June 2021, the practice was rated as inadequate and was placed in special measures. Following the inspection, the practice was issued with conditions on their registration, in respect of Regulation 12 (Safe Care and Treatment) and two warning notices in relation to Regulation 17 (Good Governance) and Regulation 18 (Staffing).

We carried out a follow-up inspection in September 2021 to check if the provider had complied with the conditions of registration and the two warning notices. We found that although some improvements had been made further work was required. The practice had met the conditions placed on their registration but had still not ensured that care and treatment was provided in a safe way. Following the inspection, the practice was issued with a further warning notice in relation to Regulation 17 (Good Governance) and a requirement notice for Regulation 18 (staffing).

We carried out a follow up inspection in March 2022 to review compliance in relation to being in special measures and to review the compliance with the warning notice for Regulation 17 and requirement notice for Regulation 18. The practice had made improvements and had met the requirement notice for Regulation 18, but further work was required, and a requirement notice for Regulation 17 was issued.

This comprehensive inspection was carried out in November 2022 to review compliance in relation to being in special measures and to review the compliance with the requirement notice for Regulation 17.

How we carried out the inspection

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 inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

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 short 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.

We have rated this practice as requires improvement overall.

The practice had carried out a significant amount of work to improve the service since the last inspection.
Patients mainly received effective care and treatment that met their needs.
The practice had effective systems in place for the appropriate and safe use of medicines, including medicines optimisation.
There were sufficient systems and oversight in place to ensure the dispensaries

were adequately and safely managed.

Appropriate standards of cleanliness and hygiene were met.

However:

Overall, the process in place for medicine reviews and the monitoring of long-term conditions was effective but continued work was required on consistency for checking contraindications of medicines.
There were effective systems to assess, monitor and manage risks to patient safety.
The practice organised and delivered services to meet patients’ needs, with continued work needed to improve patient access to the service.
There was poor patient feedback relating to access and care in the GP National Survey, directly to CQC and to Healthwatch Lincolnshire.
Leaders demonstrated that they had the required capacity and skills, but further work was required to embed systems and processes in order for them to deliver high quality sustainable care.
Most governance arrangements were now in place, but further work was required to embed these systems and to ensure they were managed effectively.

In response to these findings the provider should:

Ensure the capture all of the learning and outcomes from errors, incidents and significant events to enable sharing of good practice and to reduce the risk of recurrence. This includes incidents in the practice’s dispensaries.
Continue action to improve the uptake of childhood immunisations and cervical screening.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced comprehensive inspection on 2nd March 2022 at Lakeside Healthcare at Stamford.

Overall, the practice is rated as Requires Improvement.

The ratings for each key question are:

Safe - Inadequate

Effective – Requires Improvement

Caring - Requires Improvement

Responsive - Requires Improvement

Well-led – Requires Improvement

Following our previous inspection in June 2021 the practice was rated as inadequate and was placed in special measures. Following the inspection, the practice was issued with conditions on their registration, in respect of Regulation 12 (Safe Care and Treatment) and two warning notices in relation to Regulation 17 (Good Governance) and Regulation 18 (Staffing).

We carried out a follow-up inspection in September 2021 to check if the provider had complied with the conditions of registration and the two warning notices. We found that although some improvements had been made further work was required. The practice had met the conditions placed on their registration but had still not ensured that care and treatment was provided in a safe way. They had not organised and delivered services to meet patients’ needs or ensured patients were able to access care and treatment in a timely way. They had improved but still did not have established effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care or ensured that persons employed in the provision of the regulated activities received the appropriate support, training, supervision and appraisal necessary to enable them to carry out the duties. Following the inspection, the practice was issued with a further warning notice in relation to Regulation 17 (Good Governance) and a requirement notice for Regulation 18 (staffing).

This comprehensive inspection carried out in March 2022 and covered all key questions was to review compliance in relation to being in special measures and to review the compliance for the warning notice for Regulation 17 and a requirement notice for Regulation 18.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lakeside Healthcare at Stamford on our website at www.cqc.org.uk/

Why we carried out this inspection

This inspection was a comprehensive inspection of information with a short onsite visit inspection to follow up on:

Outline focus of inspection to include:

Key questions inspected
Areas followed up including any breaches of regulations or ‘shoulds’ identified in previous inspection
Any other areas reviewed

How we carried out the inspection

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 inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of 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 remote clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
Requesting evidence to be submitted to us electronically from the provider.
To ensure we gathered staff feedback we used a questionnaire which was given to staff electronically via email.
To ensure we gathered patient feedback we worked with Healthwatch Lincolnshire who carried out a patient survey on our behalf.
A short 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.

We have rated this practice as Requires Improvement overall.

We found that:

The practice had carried out a significant amount of work to improve the service since the last inspection.
The practice still did not have all the effective systems in place for the appropriate and safe use of medicines, including medicines optimisation.
We were not provided with assurance that sufficient systems and oversight were in place to ensure the dispensaries were adequately and safely managed.
The process in place for medication reviews and the monitoring of long term conditions was still not effective.
Appropriate standards of cleanliness and hygiene were not always met.
There were still gaps in systems to assess, monitor and manage risks to patient safety.
The practice organised and delivered services to meet patients’ needs, although work continued to improve patient experience.
Leaders demonstrated that they had the capacity and skills, but further work was required to embed systems and processes in order for them to deliver high quality sustainable care.
Most governance arrangements were now in place, but further work was required to embed these systems and to ensure they were managed effectively.

We found two breaches of regulations. The provider must:

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

The practice was put in special measures in August 2021 (following our inspection June 2021). Whilst improvements were seen at this inspection, there was still processes that needed embedding and strengthening so the practice will remain in special measures for a further six months.

If, after re-inspection, the service fails to continue to make sufficient improvement, and is still rated as 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 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 further 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

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 follow-up inspection at Lakeside Healthcare at Stamford on 1 September 2021 to review compliance with the conditions imposed on their registration under Section 31 of the Health and Social Care Act and two warning notices which were served at our previous inspection on 7th and 8th June 2021.

In June 2021, the practice was rated as inadequate overall and also in the key questions of safe, effective, responsive, well-led and all the six population groups. Caring was rated as requires improvement.

This follow-up inspection on 1st September 2021 was to review compliance with the conditions and two warning notices which had to be met by 31 July 2021 but the inspection was not rated. The ratings from June 2021 therefore still apply and will be reviewed at a further inspection to take place within six months of the original inspection date.

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

Why we carried out this inspection

This inspection was a review of information undertaking a site visit inspection to follow up on:

Compliance with conditions issued in respect of breaches of regulation 12 (safe care and treatment) and two warning notices for regulation 17 (good governance); and regulation 18 (staffing).

How we carried out the inspection

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 inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting interviews using video conferencing.
Undertaking remote access to the practice’s patient records system to identify issues and clarify actions taken by the provider and to discuss findings.
Requesting evidence from the provider to be submitted electronically
A 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.

We have not rated this practice as the rating remains unchanged until we have completed a further inspection incorporating all relevant key questions.

However, we found that:

Actions had been taken to address the areas of concern set out in the conditions for Regulation 12, safe care and treatment.

Actions had been taken to address some of the areas of the breaches identified in the warning notices and it was evident that a significant amount of work had taken place and improvements had been made. However, some issues were still found and some required actions were ongoing and were not yet fully completed or embedded. These related to the warning notices for regulation 17(good governance) and regulation 18(staffing).

We found two continued breaches of regulations. The provider must:

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, supervision and appraisal necessary to enable them to carry out the duties.

In addition, the provider should:

Develop the practice website to include more information on local services and practice updates.
Improve visibility and communication between the central support function personnel in Corby Northamptonshire and the practice team.
Review local management arrangements to ensure appropriate roles are in place.
Continue to develop staff engagement processes, and improve responses to patient feedback to enhance service user experience.

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 inspection at Lakeside Healthcare at Stamford on 7 and 8 June 2021. Overall, the practice is rated as inadequate.

The ratings for each key question are:

Safe - Inadequate

Effective – Inadequate

Caring – Requires improvement

Responsive - Inadequate

Well-led - Inadequate

Following our previous focused follow-up inspection on 22 August 2019 the practice was rated as good for providing safe services. This inspection was completed as a desktop review, carried out to assess where the practice had improved in the key question of ‘safe’ and to ensure that they had made the recommended improvements identified during our comprehensive inspection in November 2018. Following the desktop review, the practice was rated as good overall and for all key questions and population groups.

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

Why we carried out this inspection

This inspection was a comprehensive review of information undertaking a site visit inspection to follow up on:

Key questions inspected.
Areas followed up including ‘shoulds’ identified in previous inspection.
Any other areas reviewed.

How we carried out the inspection

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 inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of 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 remote clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
Requesting evidence to be submitted to us electronically from the provider.
To ensure we gathered staff feedback we used a questionnaire which was given to staff electronically via email. To ensure we gathered patient feedback we worked with Healthwatch Lincolnshire who carried out a patient survey on our behalf.
A short 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.

We have rated this practice as inadequate overall and inadequate for all population groups.

We found that:

The practice was not providing care in a way that kept patients safe and protected them from avoidable harm.
Patients were not always receiving effective care and treatment that met their needs.
Staff mostly dealt with patients with kindness and respect and involved them in decisions about their care. However patients commented that their care had been impacted upon by poor access to appointments.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. However, patients were unable to access care and treatment in a timely way.
The way the practice was being led and managed did not promote the delivery of high-quality, person-centred care.

We found three 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.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, supervision and appraisal necessary to enable them to carry out the duties.

In addition the provider should:

Implement the new telephone system with adequate staff resourcing to improve telephone access for patients.
Develop the practice website to include more information on local services and practice updates.
Improve visibility and communication between the central support function personnel in Corby Northamptonshire and the practice team.
Provide stronger local management by recruiting an appropriately skilled practice or business manager.
Develop staff engagement processes, and improve responses to patient feedback to enhance service user experience.

Following our inspection in June 2021, the CQC took urgent action to impose conditions on the provider’s registration to keep patients safe.

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.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Lakeside Healthcare in Stamford on 28 November 2018.

The overall rating was Good. Safe was rated as Requires Improvement. Effective, Caring, Responsive and Well-led as rated as Good. Population Groups were rated as Good.

The full comprehensive report for the November 2018 inspection can be found by selecting the ‘all reports’ link for Lakeside Healthcare at Stamford on the CQC website – .

This inspection was a focussed follow-up inspection which was completed as a desktop review carried out on 22 August 2019. It was undertaken to assess where the practice had improved in the key question of ‘Safe’ and made the recommended improvements identified during our previous inspection in November 2018. The report covers our findings to those requirements and additional improvements made since the last inspection.

The practice overall rating remains as Good. The practice is now rated as Good for providing Safe Services.

Our key findings were as follows:

Care and Treatment was provided in a safe way for service users.
Appropriate recruitments systems and processes were in place
The practice now had a clinical oversight model in place to ensure staff had the appropriate qualifications and skills to provide safe patient care.
Improvements to the security of the dispensary had been put in place.

The areas where the provider should make improvements are:

Have oversight of legionella water temperature monitoring carried out by external contractors at both sites and ensure actions are taken when required.

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 Lakeside Healthcare Stamford on 28 November 2018 as part of our inspection programme. We inspected both sites at Sheepmarket Surgery and St Mary’s Medical Centre. Both sites had been inspected previously and had been rated good overall. We inspected St Marys Medical Centre as part of our inspection programme in June 2017. Sheepmarket Surgery was inspected in February 2015 and rated requires improvement overall. We carried out follow up inspections in April and September 2017 to check improvements had been made and as a result, the practice was rated as good overall.

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
information from the provider, patients, the public and other organisations and
patient interviews with Healthwatch.

We have rated this practice as good overall and for all population groups.

We found that:

There was an effective system for high risk drug monitoring.
Performance data was in line with local and national averages.
We saw evidence of systems and processes for learning, continuous improvement and innovation.
Although the practice had clear processes for managing risks, these were not always followed through and actioned.
The practice provided care in a way that kept patients safe and protected them from avoidable harm.
Patients received effective care and treatment that met their needs and patients we spoke with told us they were treated with kindness and compassion.
We saw staff dealt with patients respectfully and involved them in decisions about their care.
The practice organised and delivered services to meet patients’ needs.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

Audit nurse prescribing and implement a system to provide oversight of nurses working in the same day clinics.

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

Lakeside Healthcare at Stamford

All Inspections

31 January 2024

During an inspection looking at part of the service

23 November 2022

During a routine inspection

2 March 2022

During a routine inspection

1st and 6th September 2021

During an inspection looking at part of the service

8 June 2021

During a routine inspection

During an inspection looking at part of the service

28 November to 28 November 2018

During a routine inspection