Dartmouth Health & Wellbeing 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

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

At our last assessment in April 2016, we rated this key question as Good. At this assessment, the rating remains unchanged.

The service had a good learning culture and people felt able to raise concerns. Managers investigated incidents thoroughly and shared learning throughout the organisation. People were protected and kept safe. Staff took appropriate action to protect people and safeguard them from abuse. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes. The service had procedures to monitor patients prescribed medicines that required additional oversight. However, during our clinical searches, we identified some gaps in this monitoring. The service responded promptly, addressing the issues and implementing further systems to reduce the risk of recurrence.

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 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.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong.

During clinical meetings, the GPs, clinicians and practice manager discussed and learnt from clinical issues. Minutes of these meetings were shared with all staff.

Staff felt there was an open culture, and that safety was a priority. The provider had processes for staff to report incidents, near misses and safety events.

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.

There were systems for processing information relating to new patients.

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

Referrals were managed in a timely way. There were a system and process for monitoring and managing two week wait referrals, which all staff knew and understood (urgent requests for a hospital specialist to see a patient with symptoms thatmay indicate cancer, ensuring they are seen within 14 days).

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.

Staff were aware of safeguarding policies and were appropriately trained in safeguarding procedures. Staff members were able to give examples of where they had spoken to the Safeguarding Lead when they had concerns about a person.

There were safeguarding registers held for both adults and children which were regularly reviewed at meetings with other relevant organisations. Updates were recorded in meeting minutes.

A review of safeguarding records showed that alerts were appropriately placed on patient records and their household family members.

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. Staff could recognise a deteriorating patient and knew of action to take. We reviewed staff training records for sepsis awareness and evidenced all reception staff had received this training.

People were advised on risks related to their condition and actions to take if their condition deteriorated. GPs were available to support the receptionists with clinical advice where required.

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

There were contracts to ensure the premises were maintained. However, the service had difficulties obtaining information from Torbay and Devon NHS Foundation Trust (the premise owners) in relation to Health and safety risk assessments, audits and legionella (a serious type of pneumonia caused bylegionellabacteria found in water supplies). We evidenced that the provider had requested such documentation, and it had taken several months for the information to be provided.

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.

There was a range of clinical and non-clinical roles within the service. Safe recruitment practices were followed. We reviewed 5 recruitment files and evidenced that staff had appropriate recruitment checks, including references and a Disclosure and Barring Service (DBS) Checks. (Disclosure and Barring Service (DBS) is a check which enables employers to check the criminal records of current and potential employees to ascertain whether they are suitable to work).

Staff worked within their agreed areas of competence and were able to access appropriate learning and development opportunities. The service had a learning champion (an individual who supported and promoted learning and skill development within the service) to ensure staff’s learning needs were met.

Staff told us of how they were supported to achieve career progression. Clinicians had protected time for professional development They could use this time for completing mandatory training and build on and develop skills that benefited people’s care. Staff were encouraged to attend courses and share new skills and knowledge with the wider staff team.

There were processes were to ensure that staff were appropriately trained and had received an induction and ongoing training relevant for their role. Where there were gaps in staff training there was a plan to address these.

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 (IPC) lead, and all staff received relevant training. There were cleaning schedules which were followed. Risk assessments and audits were completed. The service undertook monthly IPC checks to ensure any issues identified from audits had been addressed.

The overall IPC audit included multiple audits such as handwashing and hand hygiene audits, environmental cleanliness and waste management. There were appropriate systems for waste and clinical specimen management. During the site visit, we evidenced the environment and equipment to be visually clean.

The service held records of staff immunisations, to ensure staff and people using the service were protected against infectious diseases.

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

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. This was accurately recorded in people’s consultation records. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. We found that people who were prescribed high-risk medicines were monitored appropriately in most cases.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

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. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

The service had systems to manage and respond to safety alerts and medicine recalls.

The service stored medical gases, such as oxygen, safely and completed required safety risk assessments.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics and prescribed certain medicines lower than average nationally. For example, the service monitored the prescribing of benzodiazepine hypnotic medicines (medicines to help when someone is unable to get to sleep or has disturbed sleep on a regular basis. They should be prescribed for the minimum amount of time due to being addictive).