We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Harmoni - Hanley Health Centre Tel: Date of Inspection: 30 May 2013 Date of Publication: June 2013 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Staffing Supporting workers Assessing and monitoring the quality of service provision Records Inspection Report Harmoni - Hanley Health Centre June

2 Details about this location Registered Provider Registered Managers Overview of the service Harmoni HS Ltd Mrs. Jennifer Ann Bourne Mrs. Lisa Anne Smith This is a GP practice and walk in centre, also offering treatment and services to patients not registered with the practice. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. Type of services Regulated activities Doctors consultation service Doctors treatment service Diagnostic and screening procedures Family planning Maternity and midwifery services Surgical procedures Treatment of disease, disorder or injury Inspection Report Harmoni - Hanley Health Centre June

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Care and welfare of people who use services 6 Staffing 8 Supporting workers 9 Assessing and monitoring the quality of service provision 10 Records 12 About CQC Inspections 13 How we define our judgements 14 Glossary of terms we use in this report 16 Contact us 18 Inspection Report Harmoni - Hanley Health Centre June

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 30 May 2013, observed how people were being cared for and talked with people who use the service. We talked with staff and reviewed information given to us by the provider. What people told us and what we found The clinic provided a one stop place for patients to access a GP and a range of other services for both their short term and long term health needs. Access to services at the clinic was flexible and provided patients with choices on who they saw, and when, for their care and treatment. One patient we spoke with told us, "The clinic works with you to get an appointment that fits." Patients' notes were updated in a timely manner to ensure that every GP or nurse had access to as much information as possible about a patient. One person told us, "Any GP I see has a good understanding of my last appointment and my health needs. They must keep good notes." The planning of staff ensured that patients received the right advice and care, at the right time. The staffing arrangements in place ensured that there was always a minimum of one GP on site at all times when the clinic was open. There were systems in place to ensure that staff were appropriately trained and skilled to deliver services. The quality of care provided by staff was reviewed through appraisal and supervision processes. There were systems in place to support learning from patients' experiences and to ensure actions were taken to improve the quality of care. There were policies and procedures in place for all staff to follow, setting out the agreed ways of working in the clinic. There were checks in place to manage risks and identify and assess things that could go wrong. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent Inspection Report Harmoni - Hanley Health Centre June

5 judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Harmoni - Hanley Health Centre June

6 Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement We found that the access to services at the clinic was flexible and provided patients with choices on who they saw, and when, for their care and treatment. The clinic was open 8am to 8pm every day of the year, providing patients with access to more appointments and greater choice and flexibilities in when they came to the clinic. Appointments could be booked in advance or a patient could walk in at the time for a consultation with either a GP or a nurse. The clinic offered home visits to patients who were genuinely unable to attend the clinic. A doctor could also call to discuss any health concerns over the phone. When the clinic was closed, there were arrangements in place for the local out of hours service to meet patients' needs. One patient we spoke with told us, "The clinic works with you to get an appointment that fits." We found that the clinic was meeting patients' ongoing health and medical needs through the assessment and planning of care as part of every consultation. The service could be accessed by patients who were not registered with the clinic. This meant that a GP or nurse seeing a patient would not always have access to their medical history or other relevant information. The assessment completed as part of patients' consultations included a discussion on their medical history and any current medication. This ensured that their needs were fully understood before agreeing any treatment required. One patent we spoke with had recently transferred to the clinic from another GP practice. They told us that they had a health check and a review of their medication as part of their registration at the clinic. They told us, "This practice is really good. I cannot fault them, they are all so kind and caring." Patients were supported to access other services to meet and review known and unknown health needs. Referrals were made to other professionals as identified and agreed with the patient. The clinic used information to identify where patient education and information could help patients' access the right service for their needs first time. For example, all emergency admissions of patients to hospital and attendance at accident and emergency were reviewed to check for any avoidable admissions and attendances. Where unnecessary Inspection Report Harmoni - Hanley Health Centre June

7 admissions were identified, alternative plans for any future need for care and treatment were agreed. There were systems in place to ensure that where the transfer of care from the clinic to other services took place, relevant information was shared to provide continuity of care. When patients not registered with the clinic saw a GP or a nurse at the clinic, the reason and outcome of the consultation was immediately shared with the patients' own GP. Where consent to share information was withheld, staff confirmed that this would be respected unless there was an overriding medical reason why the information should be shared. The clinic provided a one stop place to access a range of additional services linked to promoting healthier living and disease prevention. Patients were encouraged to make decisions about healthy living choices. The clinic identified patients at risk and vulnerable to long term health conditions, to provide early advice and intervention to prevent any deterioration in their health needs. The clinic had good links with local sexual health services and provided access for young people to sexual health advice and contraception. There were appropriate systems in place to ensure the continuity and effectiveness of care for patients. There was a process in place for the reporting and review of patients' test results to ensure that any follow on appointments and treatment took place. There were regular checks to ensure that prescribing decisions continued to meet with clinical best practice and were cost effective. During our inspection, we spoke with six patients. For three of the patents, it was the first time they had been to the clinic. They all told us that the staff were friendly and welcoming and that they had been told how long to expect to wait. The three patients who had used the clinic before all told us that they found the doctors and nurses involved them in their care and that they had opportunities to talk and ask questions. There were arrangements in place to respond to medical emergencies in the clinic. All the staff had received basic life support training and regular emergency response drills were completed to ensure staff knew how to respond. There was suitable equipment and emergency drugs available, and at least one GP was always on duty during clinic opening hours. There were guidelines in place to support reception staff, who had the first contact with patients coming into the clinic, to recognise patients who required immediate attention. Inspection Report Harmoni - Hanley Health Centre June

8 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There was enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement The planning of staff ensured that patients received the right advice and care, at the right time. The staff numbers and skill mix were kept under review to ensure that the right staff to meet patients' needs and provide continuity of care was available during opening hours. There were agreed nurse and GP numbers agreed for each shift. The staffing arrangements in place ensured that there was always a minimum of one GP on site at all times when the clinic was open. One patient told us that they could not always see the same GP but that they always got the appointment time they wanted, whether they booked in advance or just walked in. The staff numbers and skill mix were based on the actual pattern of demand coming through the clinic and a minimum ten minute appointment per patient. The length of time a patient would be waiting from arriving at the clinic to seeing the GP or nurse varied, depending on how busy the clinic was and whether they had a booked appointment with a GP. We found that doctors were rotated to work in patient clinics as well as deliver phone triage, prescription reviews and to conduct home visits. This ensured that key decisions and review tasks were completed to provide timely care and treatment. The staffing plans were put in place in advance so that any known staff shortages could be planned for through overtime or the use of locum and agency cover. Where there were unexpected staff absences, locum and agency staff would also be used to provide cover. In exceptional circumstances, patients' needs would be reviewed and where safe to, appointments rearranged to ensure that patients requiring urgent attention would be seen. The training provided ensured staff had the right skills to meet the needs of patients and protect their safety and welfare. Staff told us that they completed regular training in basic life support and this was reflected in the training plan for the clinic. Chaperone training was provided to both clinical and non clinical staff to ensure that a trained member of staff was always available to support any intimate examination that needed to be carried out. The provider may wish to note that a number of the clinical staff were recorded in the clinic training plan to be overdue in completing their annual BSL update at the time of our inspection. Inspection Report Harmoni - Hanley Health Centre June

9 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement During our inspection, we asked patients on how professional and helpful staff at the clinic were. One patient who had not used the clinic before told us, "I would use the clinic again. The staff are just brilliant. I had all the information I needed and I feel better already." There were systems in place to ensure that staff were appropriately trained and skilled to deliver services. We found that there was a service led approach to training to support both the delivery of core medical services and the range of extended services offered. For example, nursing staff had been trained to support the delivery of a small range of sexual health services. Staff were also supported to obtain additional qualifications to develop their skills and knowledge, and their scope of practice within the clinic. The quality of care provided by staff was reviewed through appraisal and supervision processes. We found that all staff had received an appraisal within in the last twelve months. New staff were supported with regular reviews during their 12 week probation period. Clinical supervision was provided to all clinical staff to support reflection and discussion on individual practice. The staff we spoke with told us this gave them an opportunity to discuss any issues they had. We found a safe and supportive working environment for staff at the clinic. The clinic had a policy of zero tolerance to violence and aggression against staff. We talked with five staff working at the clinic. They all confirmed that they felt safe at work and that the clinic was a good place to work, with a supportive management team. Inspection Report Harmoni - Hanley Health Centre June

10 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. There were systems in place for monitoring the safety and quality of care provided. Reasons for our judgement There were systems in place to learn from patients' experiences and ensure actions were taken to improve the quality of care. The feedback from both informal and formal complaints was used to identify changes required to improve the service. One patient told us that they had previously had a little issue with the reception staff but told us, "I raised it and it was sorted straight away." Patients were requested to complete a survey on their experience of the care and treatment provided at the clinic. The responses received were reviewed and areas for improvement identified and responded to. The most recent surveys reflected a high level of satisfaction with nurses and doctors at the clinic and being able to get an appointment but a general dissatisfaction with waiting times. The clinic had made changes to the appointments process and the availability of same day appointments and the number of appointments that there made and then missed in response to concerns about waiting times. There were systems and checks in place to manage risks and identify and assess things that could go wrong. There were policies and procedures in place for all staff to follow, setting out the agreed ways of working in the clinic. The reporting of incidents was promoted. There was an incident reporting system in place, to help staff to easily report incidents for review and investigation where necessary. A number of regular safety and environmental checks were completed to ensure equipment and medicines remained suitable to be used and the premises provided an appropriate place to receive treatment. The provider may wish to note that the daily fridge temperature checks were taking place but readings outside the agreed temperature ranges were not always being reported for further review. There was a leadership and governance structure in place to monitor the safe delivery of patient care and treatment. Senior management were visible within the clinic. The lead nurse clinician was responsible for the day to day management of the clinic. The clinic had a local medical director, who was responsible for the delivery of safe services at the clinic. The medical director was present at the clinic at least once a week and was involved in the local management meetings held, which encouraged discussions around patient safety and brought together all the information related to risks to the safety of care. Learning from incidents and complaints was used and shared to identify where changes in practice and Inspection Report Harmoni - Hanley Health Centre June

11 procedures were required to keep patients safe and reduce the risk of harm. Staff performance was monitored to ensure people using the clinic were not harmed as a result of unsafe care or treatment. The provider completed regular audits of the quality of assessment, decision making and recording by GPs and nurses working at the clinic. Information from audits was shared generally and discussed on an individual basis in one to one meetings to support learning and improvements in the delivery of the service. Inspection Report Harmoni - Hanley Health Centre June

12 Records People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was meeting this standard. The quality and accuracy of records protected people from the risk of unsafe or inappropriate care. Reasons for our judgement We found that the clinic had systems to ensure that patient records were managed appropriately and in accordance with the law. All patient records were stored electronically and securely in one place to provide a complete record of patients' medical history and ongoing needs in one place. There were systems in place to maintain the security and integrity of information held. The clinic had backup processes and recovery plans in place to ensure information could be restored and accessed as soon as possible. The systems to record patients' care and health needs ensured that every GP or nurse had access to as much information as possible about the patient to enable well informed clinical decisions to be made. Patients' notes were updated in a timely manner to ensure accurate records were in place. There was reference to a patient's clinical record as part of every consultation and the records were usually updated during the consultation. One patient told us that they could not always see the same GP in the clinic but told us, "Any GP I see has a good understanding of my last appointment and my health needs. They must keep good notes." There were processes to ensure that where a domiciliary visit took place that records were updated immediately following the appointment to maintain the continuity of care. Staff were supported to comply with the law and maintain accurate records through training, and policies and procedures. The clinic completed ongoing audits to monitor the standard of recording and identify any issues or inconsistencies. Inspection Report Harmoni - Hanley Health Centre June

13 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Harmoni - Hanley Health Centre June

14 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Harmoni - Hanley Health Centre June

15 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Harmoni - Hanley Health Centre June

16 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Harmoni - Hanley Health Centre June

17 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Harmoni - Hanley Health Centre June

18 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Harmoni - Hanley Health Centre June

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