Bracknell Urgent Care Centre

On this page

• 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

Safe – this means 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 to Good.

During our assessment of this key question, we found that the service provided care in a way that kept patients safe and protected them from avoidable harm. Staff were confident in responding to safeguarding concerns and had received training relevant to the role. Systems for the safe management of medicines, including emergency medicines were in place and regularly reviewed. People received co-ordinated and joined up care when transitioning between healthcare services through the management of referrals and regularly reviewed local care pathways. Recruitment checks were carried out in accordance with regulations and assurances were provided relating to the fit and proper persons employed. The practice ensured workforce planning arrangements were in place and staff were supported in their roles, including training, appraisal and relevant supervisions to provide safe care and treatment. Where relevant, there were effective handovers and shift changes to ensure staff could manage risks to people who use services. However, the service did not always have effective oversight to ensure required actions had been taken in relation to the legionnaires risk assessment and replacement of the emergency lighting within the fire risk assessment. After the assessment, the service provided evidence to demonstrate remedial actions to address the shortfalls were in place in relation to the premises.

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 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. We reviewed a sample of patient safety events and identified the service had investigated incidents appropriately. The service had started to work with local commissioners to apply the duty of candour for significant events that involved collaborative working with external stakeholders but at the time of inspection this was not yet fully embedded.

Staff were encouraged to raise concerns when things went wrong. They told us that significant events, complaints and examples of patient feedback were shared and discussed during regular all-staff meetings. Staff felt there was an open culture and understood their duty to raise concerns and report incidents. Leaders provided examples of how incidents were investigated and resolved.

There were policies and processes in place to record, investigate and take action from incidents and complaints. These were discussed in monthly governance meetings and minutes made available to staff who were unable to attend. 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 patients.

The service worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services. The service had processes to ensure referrals and test results were managed in a timely way. We saw examples of collaborative working such as with the local emergency departments to determine the effectiveness of onward referrals as well as with local Primary Care Networks (PCNs) to assess and raise concerns with patient’s own GP service following care and treatment. There were systems in place for monitoring local health pressures through the Operational pressure escalation Level (OPEL) framework. The service contributed to the overall oversight of capacity and demand at regional level.

There were safe systems to ensure patients were clinically assessed and treated in a timely way. The service developed systems and clinical pathways to ensure staff had clear protocols to treat patients and where required referred to external healthcare partners. The service had developed relationships with local organisations to ensure there was feedback on referrals and case reviews for learning. This included the introduction of patient advice information sheets as a safety mechanism following treatment.

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.

There were designated safeguarding children and adult leads at the service. There were monthly multi-disciplinary meetings where safeguarding issues were discussed and these were attended by members of the senior leadership team. External stakeholders were invited to safeguarding meetings where possible. Systems were in place to appropriately refer people to the local authorities and information was shared amongst community teams where required. Safeguarding and chaperoning policies were in place and accessible to staff.

A mixture of clinical and non-clinical staff members had chaperone responsibilities as part of their role. Those staff members had completed Disclosure and Barring Service (DBS) checks to ensure they would be appropriate to undertake this role.

We reviewed a sample of patient records as part of our remote clinical searches and found care plans noted how people were to be supported to remain safe. For example, raising vulnerable patient’s care and treatment concerns with their GP practice as part of a multi-disciplinary approach. There were safe systems and processes in place to ensure children had been appropriately followed up with when they failed to attend appointments.

The service worked with people to understand and manage risks of their care and treatment holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At this assessment, we found improvements had been made to oversight of staff supervision. Clinical audits and supervision had been carried out by service leaders on a routine basis to monitor performance. We identified examples such as prescribing audits of locum staff where trends of opioids and benzodiazepines prescribing (medicines used to treat symptoms of pain) had shown prescription amounts outside of national guidelines. The service demonstrated actions had been taken to address shortfall such as through staff engagement meetings, appraisals and regular bulletins. Staff competencies and clinical skills were kept up to date and there were systems and processes in place to manage clinical supervision.

Staff could recognise a deteriorating patient and knew what action to take. Patients were advised on risks related to their condition and actions to take if their condition worsened.

Bracknell Urgent Care Centre operated in a purpose built ‘Healthspace’ building, shared with other healthcare services. The provider did not always have effective oversight to ensure required actions had been taken in relation to premises risk assessments, which could pose a risk to the health and safety of service users and staff.

Actions had not always been taken to ensure the premises was compliant with the latest legionnaire risk assessment. However, we identified water temperatures were recorded within safe ranges.

The service recorded health and safety related risks on their risk register and improvement plan. At the time of inspection, we identified emergency lighting and alarms were not always functioning as required. The service was working to address the shortfalls with the premises estates and facilities team. After the assessment, the service provided evidence to demonstrate remedial actions to address the shortfalls relating to the legionnaires risk assessment. However, actions from the fire risk assessment including the emergency lighting remained outstanding were being addressed.

We found equipment specific to the service was regularly risk assessed, tested, calibrated, stored safely and well maintained such as fire extinguishers, oxygen cylinders and equipment requiring portable appliance testing.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us there were enough staff to manage workloads to prevent further backlogs of tasks and working excessive hours. Staff rotas were completed with oversight of cover where required, so that should a clinician be absent at short notice, their pre-booked appointments could be put into protected available same day slots with another clinician.

Staff told us that there were opportunities to ask for support, raise concerns and appraisals were carried out annually. Staff could discuss clinical queries in relation to their medicine prescribing or care and treatment planning with leaders who they said had an ‘open door’ policy. There were routine clinical supervision sessions to discuss performance, care and treatment. We found examples of supervision records which had demonstrated a strong focus on mentorship, continuous professional development and evaluation of records to ensure care was in line with evidence-based practice.

All recruitment and Human Resource (HR) records were kept in-line with practice policy and good national guidance. We carried out a review of the provider’s recruitment checks in relation to 3 members of staff and information was available, up to date in line with practice policy.

Staff received a formal induction relevant to their role and responsibilities and were supported through ongoing appraisals and supervisions, including prescribing checks for relevant clinical staff.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and were aware of how to share concerns with appropriate agencies where appropriate.

There was effective IPC leadership, with policies and checks carried out in relation to cleaning records and hand hygiene. Staff were aware of IPC procedures in place to ensure cleaning standards were adhered to, such as bodily fluid spillage kits, Control of Substances Hazardous to Health (COSSH) and Personal Protective Equipment (PPE). We saw evidence of records to ensure identified risks had been mitigated such as clinical waste arrangements. Where any infection prevention and control issues had been identified, there was a defect process to identify and allow for remedial actions to be taken.

The service ensured medicines and treatments involving medicines were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The service had risk assessed emergency medicines and equipment and these had been checked regularly to ensure they remained safe to use. We found there were suitable arrangements for the storage and ordering of oxygen cylinders and medical devices such as defibrillators had been maintained and calibrated. There were updated resuscitation guidelines for both adults and paediatric life support available for staff in the case of emergency. The service maintained appropriate fridge temperature records where vaccines were being stored and observation of variances of temperature had been addressed and logged.

The service ensured Patient Group Directions (PGD) and Patient Specific Directions (PSD) were authorised appropriately which relevant staff worked to in line with national guidelines.

There was an effective system to ensure safety alerts were acted upon in a safe way to protect patients from harm. We reviewed a sample of safety alerts appropriate to urgent care settings and found the service identified and recorded actions to demonstrate compliance in line with national guidelines.

Staff were aware of how the service managed information changes to a patient’s medicine, including how to identify changes made by other services, for example, the out of hours provider (OOH) and General Practice.