rtwskin

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

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

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 69 (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. They listened to concerns about safety and risks and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Managers encouraged staff to raise concerns when things went wrong. We were told by staff that the team discussed and learnt from any clinical issues, complaints and feedback or staff concerns.

There was a system for staff to report incidents, near misses and safety events. We reviewed one incident which had been clearly documented. The service had involved the person in the investigation. When things went wrong, staff apologised and gave people support.

The service worked with people to establish and maintain safe systems of care, in which safety was managed or monitored.

The service liaised with people’s general practitioners (GPs) and other health professionals when appropriate. Test results (for example, skin biopsies) were reviewed and acted on promptly. The service always shared appropriate clinical information with the person’s NHS GP if they consented to this.

The service worked with people and other organisations to safeguard people from the risk of abuse or neglect. However not all staff were up to date with required training.

The service had failed to ensure that all senior clinical staff had completed current safeguarding training for children at ‘level 3’. Level 3 training is considered essential for clinicians who contribute to assessing, planning and reviewing cases concerning children or young people.The service provided evidence that this training module had been completed by the relevant staff member the day after our inspection visit.

The service had safeguarding policies in place and processes to report any safeguarding concerns with the designated lead. The service checked that adults bringing children to the service had parental authority to do so.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe and supportive.

We saw that people were provided with information about relevant treatments and what these might involve before and after their consultations. People were advised on risks related to their condition and actions to take if their condition deteriorated. The service was generally used by people who were not acutely ill. The service carried emergency equipment and medicines for use in the event of an emergency including anaphylaxis which were regularly checked.

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 and equipment were maintained. Health and safety risk assessments were undertaken when due and any risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed. The service had recently experienced a serious environmental incident (flooding) and could demonstrate the immediate and follow-up actions they had taken to ensure the premises and equipment were made safe. This included engagement with external advisors with relevant expertise.

The service had enough qualified, skilled and experienced staff. Staff received effective support, supervision and development. However, the service was not always able to demonstrate that appropriately registered clinicians were carrying out surgical procedures.

We found that the service could not always demonstrate that only clinicians who are appropriately qualified and registered with an appropriate UK professional body, were undertaking certain procedures without direct supervision (for example, excision with a laser for medical reasons). In response, the service told us that for the cases we identified, people had already undergone a medical assessment before being referred to the service, and this treatment was therefore appropriately carried out by a non-registered practitioner. However, the clinical records we reviewed did not include sufficient detail to corroborate this approach. The service told us that more detailed documentation would be included in the records going forward.

There were a range of clinical and non-clinical roles within the service. We found that required training was up to date aside from one clinician who was not up to date with safeguarding children training to the expected level at the time of the inspection.

The service assessed staff members’ learning needs and supported professional development. The service was able to demonstrate how staff had been able to develop in their roles, for example, a member of staff had recently undertaken training to become an independent prescriber. There was a process to observe practice and competencies for staff who were developing additional clinical skills. The service followed safe recruitment practices.

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 including hand washing audits. Cleaning schedules were in place and 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. They involved people in planning, including when changes happened.

At the time of the inspection, the clinicians were prescribing a narrow range of medicines. They did not prescribe medicines that required ongoing monitoring or controlled drugs. The service monitored national patient safety alerts to ensure any relevant guidance was implemented.

Clinicians and practitioners advised people on how to manage any medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

However, clinical records did not always include notes about medicines which had been dispensed to people and this information might potentially be missed in future. The service kept a small stock of prescription-only skin creams which it dispensed at the time of the inspection. Following the inspection, the service told us that it had decided to stop dispensing medicines and it would provide all medicines via private prescription from now on.

Staff received training and were confident managing the storage and recording of medicines. Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates.