26/09/2018
During a routine inspection
This practice is rated as Good overall.
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
We carried out an announced comprehensive inspection at Balaam Street Surgery on 26 September 2018 as part of our inspection programme and following a change to the provider’s registration. The practice was previously registered as a partnership, and this inspection was of the new individual provider who registered with the CQC in March 2018.
At this inspection we found:
- There were no recent fire drills documented by the practice.
- The practice had appropriate systems to safeguard children and vulnerable adults from abuse. Staff had received up to date safeguarding training appropriate to their role.
- Staff had the skills, knowledge and experience to carry out their roles.
- The practice reviewed and monitored the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to relevant and current evidence based guidance and standards.
- The practice had an active patient participation group who were involved with the development of the practice.
- The practice had implemented a new online booking and triage system to improve access to appointments.
- There was a clear leadership structure, and staff told us that they felt able to raise concerns and were confident that these would be addressed.
- There was a focus on continuous learning and improvement.
The areas where the provider should make improvements are:
- Take action to ensure that fire evacuation drills are completed and documented appropriately.
- Review where documents relating to staff checks and training are saved on the computer system.
- Develop a system for ensuring that electrical and medical equipment in the doctor’s bag is in good working order.
- Take action to ensure there is a functioning hearing loop which staff know how to use.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence t ables for further information.