Little Lever Health Centre & Little Lever Library

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• Overview
• Learning culture
• Safe and effective staffing
• Medicines optimisation

We assessed all quality statements in this key question. The service did not have a good learning culture. Incidents were not always investigated thoroughly. Feedback was that there were not enough staff to provide a safe service. Not all the required staff checks took place. We found issues with the management of medicines. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. Managers made sure staff received appropriate training. This is the first inspection for this service since its registration with CQC at the current location. This key question has been rated as inadequate. We identified breaches of regulation in relation to safe care and treatment and fit and proper persons employed.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. The practice had a significant events policy, giving the procedure to follow for the recording and the analysis of significant events. This stated that examples of significant events included new cancer diagnoses, and events which resulted in a complaint. The policy was not followed. New cancer diagnoses were not recorded as significant events and we saw complaints, such as clinics running late, had not been recorded as significant events. The policy also stated significant events should be discussed at the following practice meeting. We saw discussions about some significant events had not taken place. There had been 3 prescribing errors by the same GP since 27 October 2024. One of these had not been included in the practice’s significant events log. ‘No harm’ was recorded for all of them, but the potential harm had not been considered. One of the forms did not state how the error had been identified and who identified it. There was another prescribing error by the same GP earlier in October 2024. The significant event form, and the discussion held, did not focus on how to prevent the clinician making similar errors. The person, who had capacity to consent and was over the age of 16, was excluded from relevant the discussion and decision making process, even though family members were included. There being 4 prescribing errors by the same GP in 5 weeks had not been considered, so safeguards had not been put in place.

The recruitment policy stated all new staff must have a Disclosure and Barring Service (DBS) check. It said checks would be processed in house. We examined the personnel files of all staff. One staff member provided a DBS check from a job they were in 2 years previously, and another DBS check was carried out 6 months prior to the staff member starting work. Evidence that photographic identification had been verified was not held for all staff. Following the assessment the practice manager told us they had now obtained this. Not all staff had provided a full employment history. The managers told us a staff member had been previously employed by a GP Federation prior to joining their practice so they did not carry out all the usual pre-employment checks. The policy stated all staff must have 2 satisfactory references. No references had been sought for the 2 most recently employed staff members. A check of professional registration had been carried out for the practice nurse and locum GPs when they started work, but they had not been repeated. The General Medical Council registration checks had not been repeated for the 2 locum GPs since February 2023 and January 2021, and the Nursing and Midwifery Council check for the practice nurse had not been repeated since 2015. The practice manager repeated the check while we were on the premises. The appraisal policy stated staff would have an annual appraisal. Appraisals had been carried out recently, but they had not been conducted annually. Competence and performance of clinical duties was not mentioned in the appraisals for the nurse or phlebotomist.

The provider had systems to manage and respond to safety alerts and medicine recalls, but these were not always effective. People prescribed medicines with specific risks did not always receive appropriate monitoring. The practice nurse was not correctly authorised to administer some medicines; the provider had authorised Patient Group Directions (PGDs) prior to the nurse being named.