Practice Plus Group - South West London OOH/CAS

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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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff told us that they were encouraged to report concerns, and we saw from minutes of meetings that learning from clinical issues was shared.

The provider had processes for staff to report incidents, near misses and safety events. Incident reporting was a standard agenda item on their monthly governance meetings. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The service 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, such as ensuring that people’s own GPs were made aware of any consultations with the service.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service utilised a centralised safeguarding “hub”. When safeguarding referrals were required, clinicians provided information to the hub, where staff completed referrals as needed. Staff told us that senior clinicians were always available to provide safeguarding advice, including overnight and at weekends.

Safeguarding policies were in place and known to staff.

The service worked with people to understand and manage risks by thinking holistically. They 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. This included medical oxygen, a defibrillator and emergency medicines which were available at both the OOH hubs, and in the home visiting vehicles. The vehicles used for the home visiting service were well maintained and drivers had access to a recovery service in the event of a vehicle breakdown. Staff could recognise a deteriorating service user and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service had procedures in place at the CAS service to ensure that, if it was not possible for a clinician contact the person inside the timelines required by its commissioners, a “comfort” call back would be provided by a care co-ordinator. This ensured oversight in the event that their condition had deteriorated, and also provided them with an update.

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

Contracts were in place to ensure the premises were maintained. For example, there were contracts for maintenance and annual servicing of gas and electrical appliances and equipment. Risk assessments for fire and legionella were completed in a timely manner.

In the 3 OOH hubs which were not managed by the provider, they had taken steps to ensure that they were safe for use. For example, at one of the 3 hubs, the reception area did not overlook the waiting area. The service had risk assessed this and arranged for the receptionist to regularly check the waiting area.

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 service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, the service did not consistently ensure that specific staff groups received training in line with best practice guidance. For example, some staff who acted as chaperones had not been trained to the safeguarding level specified in the most recent intercollegiate guidelines. We spoke to members of staff in this role who confirmed that they did chaperone. However, the staff to whom we spoke were aware of their safeguarding responsibilities. Following the inspection the service provided details of changes that had been made to address this. Staff worked together well to provide safe care that met people’s individual needs.

There were a range of clinical and non-clinical roles within the service. We found that other training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

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

The service had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place at the clinical premises used by the service, and were followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines. Staff managed prescription stationery appropriately and securely, including dispensing prescriptions where medicines were provided directly. Staff followed protocols to ensure they prescribed all medicines safely.

Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. The home visiting service and out-of-hours hubs held medicines that could be dispensed directly to people in the event that the need was urgent and local pharmacies were closed. Stock was monitored such that sufficient medicines were always in place. Waste medicines were recorded and disposed of. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. There were suitable processes for staff to follow when dispensing medicines. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.