The Beggarwood Surgery Quality Report Broadmere Road Basingstoke Hampshire RG22 4AQ Date of inspection visit: 14 November 2017 Tel: 01256 396500 Date of publication: This is auto-populated when the Website: www.beggarwoodsurgery.co.uk report is published This report describes our judgement of the quality of care at this service. It is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information given to us from the provider, patients, the public and other organisations. Ratings Overall rating for this service Requires improvement ––– Are services safe? Requires improvement ––– Are services effective? Requires improvement ––– Are services caring? Good ––– Are services responsive to people’s needs? Requires improvement ––– Are services well-led? Inadequate ––– 1 The Beggarwood Surgery Quality Report This is auto-populated when the report is published Summary of findings Contents Summary of this inspection Page Overall summary 2 Detailed findings from this inspection Our inspection team 4 Background to The Beggarwood Surgery 4 Detailed findings 5 Action we have told the provider to take 22 Overall summary Letter from the Chief Inspector of General • People whose circumstances may make them Practice vulnerable – Requires improvement At our previous inspection in February 2017 we • People experiencing poor mental health (including found the practice to be inadequate overall. people with dementia) - Requires improvement Following this inspection on 14 November 2017 we Previously we undertook a follow up comprehensive rated the practice as requires improvement overall. inspection of The Beggarwood Surgery on 28 February The key questions are rated as: 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was • Are services safe? – Requires improvement rated as inadequate and placed into special measures. • Are services effective? – Requires improvement Warning notices were also served. We then undertook a follow up, focused inspection on 21 June 2017 to look • Are services caring? – Good specifically at the shortfalls identified in the warning • Are services responsive? – Requires improvement notices. We found that there were some improvements at that time. • Are services well-led? -Inadequate On this occasion we carried out an announced As part of our inspection process, we also look at the comprehensive inspection at The Beggarwood Surgery quality of care for specific population groups. Due to the on 17 November 2017, to follow up on breaches of overall rating being Requires Improvement the regulations found at our comprehensive inspection in population groups are rated as: February 2017 as well as progress since the inspection in • Older People – Requires improvement June 2017. • People with long-term conditions – Requires At this inspection we found: improvement • The practice had recently introduced new systems to • Families, children and young people – Requires manage risk so that safety incidents were less likely improvement to happen. When incidents were identified, the practice learned from them and improved their • Working age people (including those retired and processes. students) – Requires improvement 2 The Beggarwood Surgery Quality Report This is auto-populated when the report is published Summary of findings • The practice had recently commenced routine This service was placed in special measures in June 2017. reviews of the effectiveness and appropriateness of Insufficient improvements have been made such that the care it provided. there remains a rating of inadequate for Well Led services. Therefore we are taking action in line with our • Staff involved and treated patients with compassion, enforcement procedures to begin the process of kindness, dignity and respect. preventing the provider from operating the service. This • The practice had recently employed a clinical lead will lead to cancelling their registration or to varying the GP to improve local clinical oversight. terms of their registration within six months if they do not improve. The service will be kept under review and if • There was an increasing availability of both urgent needed could be escalated to urgent enforcement action. and routine appointments. Where necessary, another inspection will be conducted • The practice had a vision of improvement, although within six months, and if there is not enough there was no yet a sustained track record for delivery improvement we will move to close the service by of the vision. adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s Areas where the provider must make improvements as registration. they are in breach of regulations : Professor Steve Field (CBE FRCP FFPH FRCGP) • Establish effective systems and processes to ensure Chief Inspector of General Practice good governance in accordance with the fundamental standards of care. 3 The Beggarwood Surgery Quality Report This is auto-populated when the report is published The Beggarwood Surgery Detailed findings number of families with younger children and is situated in Our inspection team an ethnically diverse area with a relatively high population of Polish, Asian and African population groups. It is situated Our inspection team was led by: in an area where there is least deprivation. Our inspection team was led by a CQC lead inspector. The practice is registered with the Care Quality Commission The team included a GP specialist adviser, and a second to provide the following regulated activities: CQC inspector. • Surgical procedures; • Treatment of disease, disorder or injury; Background to The • Family planning; Beggarwood Surgery • Maternity and midwifery services; The Beggarwood Surgery is part of the Cedar Medical • Diagnostic and screening procedures. Group Limited. There are two locations for this provider, the There are two locations for the provider Cedar Medical other is registered as Rooksdown Surgery which since our Limited. We inspected this location only: last comprehensive inspection now holds the clinical commissioning group contract and The Beggarwood The Beggarwood Surgery Surgery is due to become a branch of that practice. Broadmere Road Support for the business management is provided by Integral Medical Holdings (IMH). Basingstoke The Beggarwood Surgery has approximately 7,500 patients Hampshire registered. The Beggarwood Surgery practice has a high RG22 4AG Practice website: www.beggarwoodsurgery.co.uk 4 The Beggarwood Surgery Quality Report This is auto-populated when the report is published Requires improvement ––– Are services safe? • There were some improvements in staff numbers and Our findings planning within the practice. At our previous inspection of February 2017 we rated • Some staff were still unsure of the exact location of the the practice as inadequate for safe services as the emergency equipment in the practice. arrangements in respect of the following were not • Safety processes were not yet embedded and there adequate: were some omissions, for example ensuring sharps • Significant events were not always being discussed and boxes were correctly disposed of and that the Legionella acted upon for future learning. risk assessment was adhered to. • Not all national safety alerts were being shared and Safety systems and processes discussed with clinical staff. The practice had systems to keep patients safe and • Not all staff were up to date with their safeguarding safeguarded from abuse. training. • The practice conducted safety risk assessments. It had • Some care plans were not entered on the patients’ recently implemented new computer software that electronic records. contained the safety policies which were reviewed and communicated to staff. Staff received safety information • Staff were unaware of the chaperone policy for the for the practice as part of their induction and refresher practice. training. • It was unclear if patients were being safely monitored • The practice had systems to safeguard children and who were receiving repeat prescriptions for a high risk vulnerable adults from abuse. drug. • The management company undertook the recruitment • There were not enough qualified staff to meet patient for practice staff.All recruitment files were stored and needs. updated centrally by this company and therefore were • Some staff were unaware of where to locate the not viewed on the day of inspection.However we saw emergency equipment. evidence that they carried out (DBS record or is on an official list of people barred from working in roles where The arrangements had improved when we undertook they may have contact with children or adults who may the follow up inspection 14 November 2017. The be vulnerable). practice is now as requires improvement for safe services. • All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to • The practice was improving on past shortfalls, but had identify and report concerns. Staff who acted as not demonstrated a sustained safety record with chaperones were trained for the role and had received a regards to acting on incidents or safety alerts. DBS check. There was a policy that outlined the • All staff were now up to date with their safeguarding protocol for chaperoning available on the new software training. system. • Care plans were now entered onto patient notes, but • There was a system to manage infection prevention and there were still