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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed and the provider is now rated good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty.

Concerns about safety were proactively identified, investigated and reported as safety events or near misses. Lessons were learnt to continually identify and embed good practice. The provider took concerns seriously and proactively made improvements to the services.

The services of an independent governance consultant were utilised to provide support and oversight with any incidents or concerns. This enabled the provider to discuss clinical issues with an independent party.

There was a system in place to report incidents, near misses and safety events. We reviewed a recent near miss that had been identified by the provider and saw evidence that appropriate action had been taken in response to this.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked with other providers to deliver shared care and when patients moved between services.

We noted at the time of our assessment, that patients were provided with electronic notes which they could choose to share with their own NHS GP. We highlighted this as an area for improvement during our site visit.

Following our site visit we received confirmation from the provider that the process had been reviewed and updated. They advised that people were now asked to provide details of their registered GP and to confirm whether they consented to relevant information being shared with them at the point of registration. The person's decision, including where consent was declined, was recorded within the practice management system. Information displayed within the service explained how information may be shared with a person's registered GP. The service's procedures supported the proportionate and secure sharing of clinically significant information, including findings, prescriptions and referrals, where consent had been provided.

The provider had designed a computerised application to support management of referrals and test results. The application allowed referrals to be easily monitored from date of referral until and outcome was received. We saw that test results were managed daily, at the time of our site visit the results to be reviewed had been received that day.

The registered provider worked with people and healthcare partners to understand what safeguarding meant and staff knew how to share concerns quickly and appropriately.

There was a dedicated safeguarding lead who was external to the service. This enabled the provider to have access to support and an impartial view as and when any concerns arose.

Any safeguarding concerns were discussed at a monthly governance meeting with the provider and the governance lead.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider leased the premises and worked with the landlord to ensure adequate assurance regarding premises safety. Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

The provider was a trained and competent paramedic with the experience and skills to support any emergency alongside the community services offered. The provider sourced external supervision, and we saw documented evidence of supervision of injections, blood drawing, ECGs and clinical observations.

At the time of our assessment, there were no employed staff members working for the service. This was due to occupational health services making up the majority of workload at the present time. GPs and specialist occupational health nurses and doctors were contracted as demand required.

We found the training was up to date. A new system for monitoring training requirements had been implemented following our last inspection. Information was stored within the newly designed computerised application with prompts for when training was due to expire.

The provider had a recruitment policy in place, this outlined safe recruitment practices which would be followed as and when the service expanded.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had undertaken relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The provider kept detailed records of medicines in people’s clinical records and for stock or audit purposes. They regularly checked stock levels and expiry dates for all medicines, including emergency medicines and vaccines.

As part of this assessment a CQC GP specialist advisor undertook a review of patient records. We reviewed 8 patient records and found that where patients had required medication, this had been prescribed appropriately. We also saw evidence of prescribing being refused when not clinically appropriate.