Hightown Village Surgery

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

This service scored 63 (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 listened to concerns about safety and investigated appropriately. Processes were in place for staff to report near misses and safety events. Staff felt there was an open culture, and that safety was a priority. The provider held a log of significant events and a log of complaints which they used to show themes and trends. A Local Resolution Group (LRG) and a Learning Discourse Group (LDG) were set up to improve incident closures, cross organisational learning and ensure reporters received consistent feedback. When things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes being implemented to improve care for others. Protected learning time was provided for staff to undertake training, learning and professional development.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed. Some partners reported safety concerns due to medication-related errors including prescribing errors.

Staff showed a clear understanding of their responsibilities to ensure referrals were made in line with relevant policies and procedures. Multi-disciplinary meetings were held where patients with more complex needs or those approaching the end of life could be discussed. Triage systems were in place for staff to follow. Patients referred under the two-week wait rule for suspected cancer were followed up appropriately. Urgent referrals were checked to ensure patients attended appointments and clinicians followed up their own referrals to ensure patients were contacted by the hospital.

People could request a chaperone for intimate examinations if they wished and there was information to alert them to this in the waiting room and in clinical rooms.

The service worked to safeguard people from the risk of abuse. There were systems and processes to respond when it was suspected that people may be subject to abuse or neglect. The service maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. Safeguarding policies were in place, and accessible. Contact information for raising safeguarding concerns to appropriate staff within practice and Local Authority Safeguarding Teams was easily accessible, and all staff had been provided with a lanyard containing this information.

Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities and had a clear understanding of safeguarding. The service had a designated lead for safeguarding adults and children at risk and staff were aware of this. They knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns. Alerts were added to the patient record system when a patient was subject to a safeguarding concern so that all relevant members of the staff team could readily identify this.

The service worked with people to understand and manage risks. They provided care and treatment to meet people’s needs that was safe, supportive and encouraged people to remain healthy. Friends and Family feedback from people who used the service indicated that 81% of patients felt that the healthcare professional they saw or spoke to was good at listening to them during their last appointment which was below local (88%) and national (87%) averages. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff worked proactively to support patients with the prevention of ill health, for example, recalling patients who were at risk of developing diabetes or referring patients for dietary advice. Patients were called in for regular checks on their health when they were living with a long-term condition. Our review of the patient clinical record system showed that overall patients who were prescribed high risk medicines were being monitored effectively.

The service was in a building that provided the required facilities such as safe access for people with physical disabilities. Ramped access was available to the side of the building and CCTV was in operation. Parking was limited and there was 1 disabled space on site.

The provider detected and controlled potential risks in the environment; however, they did not always make sure equipment and facilities supported the delivery of safe care. The clinical waste bin was visible and accessible to people on the street passing by. This was discussed during our assessment, The provider was aware of the issue and was receptive to our feedback. We received assurance that action had been taken to mitigate risk including securing the bin to the wall and moving CCTV cameras to cover the surrounding area. The practice had raised the issue with the landlord and discussions about relocating the bin were ongoing at the time of the assessment.

Regular checks were conducted on the premises, facilities and equipment provided and contracts were in place to ensure the premises were clean and well maintained.

Health and safety assessments and procedures were in place. Staff had been provided with health and safety related training including fire safety, infection control and manual handling.

There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

We looked at recruitment records for a sample of staff. These showed recruitment practices were conducted in line with legal requirements. All new staff undertook an induction programme and were required to complete mandatory training, including specific training to support autistic people and people with a learning disability. There were arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff was minimal. Staff told us they had protected learning time for them to undertake training, learning and professional development.

Feedback from patients who used the service that was shared directly with CQC showed that people frequently reported long wait times to obtain a face-to-face appointment and there were higher than expected levels of dissatisfaction regarding access to clinicians. The provider told us they were reviewing capacity, demand and the use of the digital/on-line provision.

Infection prevention and control audits were conducted and reviewed, and actions taken were necessary and appropriate. During our assessment we observed cleaning mops were not stored appropriately and there had been evidence of recent pest activity in one of the clinical rooms. Appropriate actions had been taken to mitigate risks relating to pest control and the storage of mops prior to our assessment. Risk assessments had been updated and were appropriate to the risk identified.

Personal protective equipment was in good supply and located appropriately around the premises. Cleaning schedules were in place, and regular infection control and cleaning audits were conducted to maintain standards.

Key staff had responsibilities around infection prevention and control, and they linked in with other infection control leads in the area. Staff vaccination was maintained in line with current guidance, if relevant to their role.

The provider made sure that medicines and treatments were safe and met people’s needs. Staff managed prescription stationery appropriately and securely. Our review showed that medicines were managed and stored safely. The approach to medicines reflected current and relevant best practice and staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Overall, there was appropriate monitoring and reviews for people with long-term conditions. Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Vaccines were stored appropriately, and regular checks were conducted to ensure safe storage and stock.