2 August 2023
During an inspection looking at part of the service
We carried out an announced focused inspection at Woodford Medical Limited on 2 August 2023, to follow up on breaches of regulations identified at our inspection in November 2022, when we rated the service as Requires improvement overall.
This inspection focused on issues relating to the key questions of Safe and Well-led.
This service is now rated as Good overall.
The two key questions are rated as:
Are services safe? Good
Are services well-led? Good
Are services effective? Previously rated good
Are services caring? Previously rated good
Are services responsive? Previously rated good
At our inspection in November 2022, we identified issues relating to the key questions Safe and Well-led:
- The provider could not demonstrate that a risk assessment had been carried out to ensure that an appropriate range of emergency medical equipment and emergency medicines were available on site.
- The provider had not ensured infection prevention and control audits were carried out regularly.
- The provider had failed to assure themselves the issues identified by the legionella risk assessment were addressed by the premises landlord.
- The provider could not demonstrate that clinicians’ required training had adequately covered their responsibilities in relation to the Mental Capacity Act 2005 and information governance.
These constituted a breach of Regulation 12 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and we served a notice on the provider requiring it to take action to comply with the regulation. The provider sent us a plan of the actions it intended to take, and we carried out this inspection to check on what had been implemented.
Our key findings were:
- A risk assessment had been conducted relating to emergency equipment and medicines; suitable stocks were being maintained and monitored.
- Regular infection prevention and control audits had been implemented, with the findings actioned, including in relation to legionella risk management.
- There was evidence that clinicians had undertaken training covering the Mental Capacity Act and information governance.
We found the provider had taken appropriate action to comply with the requirements of Regulation 12 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have revised the ratings accordingly.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Health Care