The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Paul Unyolo Also known as Talke Pits Clinic

Overall: Requires improvement read more about inspection ratings

High Street, Talke Pits, Stoke On Trent, Staffordshire, ST7 1QQ (01782) 783565

Provided and run by:
Dr Paul Unyolo

Important: The provider of this service changed. See new profile

All Inspections

18/05/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Paul Unyolo on 30 September 2015. A total of four breaches of legal requirements were found. After the comprehensive inspection, the practice was rated as inadequate overall and placed into special measures.

We issued three warning notices in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.

  • Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safeguarding service users from abuse and improper treatment.

  • Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Receiving and acting on complaints.

We also issued a requirement notice in relation to:

  • Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Fit and proper persons employed.

We undertook an announced comprehensive inspection on 18 May 2016 to check that the practice now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Paul Unyolo on our website at www.cqc.org.uk .

Our key findings were as follows:

  • The practice had made improvements to the way it reported and recorded significant events and strengthened systems to keep vulnerable patients safe.

  • While the practice had made some improvements to their process for handling complaints, these were not sufficient to meet recognised guidance and contractual obligations for GPs in England. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Responsibility for some safety issues had been classed as the responsibility of others without understanding or knowledge of the level of risk involved.

  • We saw examples of when care was not delivered in line with current evidence based guidance.

  • The capability and appropriate knowledge of the leadership team within the practice was not clearly evident.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

There are areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Implement and operate a consistent and effective system for receiving and acting on medicines alerts affecting patient safety.

  • Assess, monitor and mitigate the risks to patients and others at risk from actions detailed in the practice legionella risk assessment.

  • Assess, monitor and improve the quality of services provided in relation to the care and treatment reflecting nationally recognised guidance.

  • Operate an effective system for receiving, handling and responding to complaints.

  • Implement and operate an effective system for receiving and issuing blank prescriptions.

  • Display Care Quality Commission (CQC) inspection ratings conspicuously within the practice premises.

In addition the provider should:

  • Implement a consistent system for checking that monitoring for patients, who take long term medicines on a shared care basis, has been provided before the medicines are issued.

  • Review the capability of leadership within the practice.

  • Improve the identification of patients who may be carers.

  • Ensure relevant staff have completed recognised training in safeguarding vulnerable adults.

  • Mitigate outstanding actions in the practice infection control audit.

This service was placed in special measures on 17 December 2015. Insufficient improvements have been made such that there remains a rating of inadequate for well-led services.

The levels of concern identified at this inspection met the threshold for us to escalate our previous enforcement action in line with our enforcement and decision making policies. We have not issued a notice of proposal to cancel the provider’s registration as they submitted an application to cancel their individual registration with CQC.

We have received a new partnership provider application to provide services at the practice. This application will be assessed in line with legal requirements.

The practice will remain in special measures and will be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months or sooner if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 September 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Paul Unyolo (Talke Clinic) on 30 September 2015. This inspection was undertaken to check the practice was meeting regulations and to consider whether sufficient improvements had been made since our last inspection in February 2015.

Our inspection in February found breaches of regulations relating to the safe, effective and well-led delivery of services. As a result of these the practice was rated as inadequate for providing well-led services and requires improvement for providing safe and effective services.

Following the publication of the report in June 2015, we received an action plan which detailed the actions to be taken to achieve compliance. At our inspection in September 2015 we found that the practice had made improvements in some areas and was meeting regulations that had previously been breached. However, further breaches were identified.

Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • Staff generally understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. However, information about safety was not always properly recorded, monitored, appropriately reviewed and addressed. There was limited evidence of learning from significant events and complaints. Discussions with staff were not always documented.
  • There was no system to ensure all clinicians were kept up to date with national guidance and guidelines.
  • Safeguarding arrangements to protect children and vulnerable adults within the practice were not robust. Children considered by the practice to be at risk of abuse had not been reviewed or followed up appropriately.
  • Patients and staff were at risk of harm because systems and processes were not in place to keep them safe.
  • Data showed patient outcomes were in line with the average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Urgent appointments were usually available on the day they were requested and most patients we spoke with were happy with access to the practice.
  • The practice had a number of policies and procedures to govern activity, but there was no clear system in place to review and update these.
  • Whilst the practice had a leadership structure, we found there was insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

  • Put systems in place to ensure that children and vulnerable adults are protected from harm.
  • Ensure Disclosure and Barring Service (DBS) checks are undertaken for all staff or where these are not undertaken, a risk assessment is in place.
  • Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
  • Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
  • Take action to address identified concerns with infection prevention and control practice.

In addition the provider should:

  • Strengthen their programme of clinical audit to ensure audits are sufficiently detailed, reference national guidelines and drive improvement within the practice.
  • Consider whether there is leadership capacity to deliver all improvements
  • Ensure all staff have appropriate policies, procedures and guidance to carry out their role.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

09/02/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Paul Unyolo (Talke Pits Clinic) on 9 February 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be inadequate for providing well-led services, requiring improvement for providing safe and effective services. It also required improvement for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was good for providing a caring and responsive service.

Our key findings across all the areas we inspected were as follows

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients were not always kept safe as the arrangements in place for recording, investigating and learning from risks to safety were not robust. The practice was not recording and reviewing significant events effectively which could result in a lack of learning from significant events, and compromise safety.
  • The practice was not always managing communications relating to the care and treatment of patients effectively.
  • Data showed patient outcomes were at or below average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

The areas where the provider must make improvements are:

  • Ensure that the recording, investigation and dissemination of significant events is robust.
  • Ensure that risks that may affect patient safety are acted upon to minimise the risk of harm to patients.
  • Ensure that the processing of communications relating to the care and treatment of patients is robust.
  • Ensure that risks to patients and staff from infection are minimised by completing, recording and acting upon findings from regular infection control audits.
  • Ensure that records relating to the management and coordination of patient care and treatment are accurately kept.
  • Support all staff at the practice with a mechanism to provide individual feedback such as an appraisal and the opportunity to explore individual training needs.

In addition the provider should:

  • Expand the process of audit to demonstrate improvement in delivering patient care and treatment; this should also include minor surgery undertaken at the practice.
  • Ensure that patients, visitors and staff are protected from the risk of water borne infection by means of completing a legionella risk assessment.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than four months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a check to make sure that the improvements required had been made

We carried out this review to follow up on two areas of non-compliance from our previous inspection on 15 July 2013. At our last visit we saw that improvements were needed to the recruitment and selection processes used at the practice. We also found that the provider did not have systems in place to regularly monitor the quality of its service.

We asked the provider to send information to us to show that improvements had been made in both areas of non-compliance. We checked the information we received.

The information showed that an effective recruitment and selection process had been put in place that ensured patients were kept safe from the risk of harm. The provider confirmed that appropriate systems had been put in place to regularly monitor the quality of their service.

15 July 2013

During a routine inspection

On the day of our inspection we spoke with 10 patients, five members of staff and one visiting professional. One patient told us, 'All the staff are very, very friendly and efficient'. Another patient told us, 'If you've got a good surgery like this and poor health, you are very lucky. I would be in such a state without it'.

We saw that patient's views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. We saw that patients experienced care and treatment that met their needs. They were kept safe from the risk of abuse because the practice had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We saw that effective recruitment and selection processes were not in place. This was because the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service.