Stirling Road Medical 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, we rated this key question as requires improvement. At this assessment, the rating has changed to good.
 

This service scored 66 (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.
The service had improved its systems for reporting and reviewing events and demonstrated that learning had led to changes in practice.

Now, staff understood how to raise concerns and were able to report incidents, near misses and safety events through a formal incident reporting process supported by a significant event and incident policy. The service demonstrated oversight of these events and undertook analysis which fed into a centralised assurance framework. Learning and actions arising from incidents were recorded and monitored through this framework, supporting wider learning, identification of themes and oversight of changes of practice.
We reviewed significant event records and saw evidence that learning from safety events resulted in changes of practice. This included improvements to prescribing and medication review documentation processes and the introduction of a lead GP role following an error in patient record management. Staff reviewed safety events during meetings; however, some staff told us that outcomes and wider learning were not always shared consistently across the organisation. In response, leaders planned to introduce a monthly learning bulletin for all staff groups and make learning a standing agenda item at every team meeting.
 

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, including when people moved between different services.
The service had systems to manage referrals and transitions between services. Urgent and suspected cancer referrals were monitored through the electronic referral system, and a daily discrepancy report was reviewed to identify and address any issues. People received information explaining how to contact services regarding their referral and appointment arrangements.
There were systems for processing information relating to new people. The service had established processes for the management of test results and clinical correspondence. Governance records demonstrated that leaders regularly reviewed risks relating to test management through clinical review and governance meetings.
 

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 had made improvements to its safeguarding systems and processes since the last inspection.

Now, staff had completed safeguarding training appropriate to their roles. Staff demonstrated a good understanding of safeguarding responsibilities and were able to describe how they would identify, escalate and report concerns. The service had safeguarding leads for both adults and children, and a current safeguarding policy which was regularly reviewed and supported staff to respond consistently to concerns.
The service worked collaboratively with other services, including regular review of vulnerable people through meetings. Staff used systems to identify and monitor vulnerable people, including the use of digital flags and alerts within peoples records to ensure relevant information was visible 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.
The service had systems to support people to understand and manage risks associated with their health and care. We found evidence that people were contacted, reminded and followed up where monitoring, investigations or reviews were overdue. This included follow up for medicines monitoring and long-term condition management, such as diabetes.
Staff could recognise a deteriorating patient and knew of action to take. The service had implemented a care navigation system, and this supported staff to ensure people received the right support at the right time.
The service used a digital support tool support people to self-manage risks. This provided safety-netting advice, self-care information and guidance about symptoms that may require further medical attention. It helped people understand when to seek advice from a GP, pharmacist or other healthcare professional.
 

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
We identified environmental concerns at several branch sites and we could not be assured systems were consistently effective across the service.
The service’s fire risk assessment for the main site contained 13 recommendations that were outstanding at the time of the inspection.
At the Mannamead branch site the fire emergency fire exit was located behind a keypad secured door which could delay evacuation in the event of a fire. Additionally, a scaffold support pole (associated with temporary fire precaution works) restricted the fire exit, This had been risk assessed by the service demonstrating that this did not cause restriction.
At the main site, we found there was no warning signage where hot water temperatures presented a potential scalding risk. Also, there was no lighting in the mop cupboard which reduced visibility when accessing cleaning equipment and materials.
Following the inspection, leaders of the service submitted an action plan to address the outstanding fire safety recommendations and evidence to demonstrate that environmental concerns had been addressed.
The service had systems to oversee the management of premises and equipment across its sites supported by health and safety and business continuity policies. Building and estates matters were monitored through a central planner, which included oversight of fire safety, legionella (a bacteria which can cause breathing problems) management, water temperature testing, portable appliance testing, equipment calibration, emergency lighting and waste management. Records showed that routine checks and maintenance activities were undertaken. Staff told us they had the equipment required to carry out their roles and were satisfied with the service’s health and safety arrangements.
 

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 were a range of clinical and non-clinical roles within the service including nurses, paramedics and a social prescribing link worker.
The service had made improvements in its staffing systems and processes since the last inspection.
The service had recruitment and clinical supervision policies which supported safe recruitment, induction, competency assessment, supervision and staff development. Workforce governance was monitored through human resource compliance dashboards covering recruitment, Disclosure and Barring Service checks (DBS), professional registration, appraisals and training. Induction included competency assessments during probation and role-specific frameworks for reception staff, advanced clinical practitioners, paramedics and GPs. Leaders used standard operating procedures and competency frameworks to ensure staff worked within their level of competence. Staff said they had access to training and development appropriate to their roles and received supervision and support, including regular one-to-one meetings, appraisals and access to senior clinical and managerial decision-makers. Occupational health support was also available to staff.
Leaders monitored staffing levels, skill mix, workload and capacity through the monthly operational management meeting and a weekly audit tracker reviewed by senior operational leaders. Staff described rota monitoring, restrictions on simultaneous leave, overtime, locum cover, cross-site telephone arrangements and advance planning for peak periods.
 

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.
During the site visit we identified environmental and cleanliness concerns.

At Stirling Road, an accessible toilet was not visibly clean at the time of inspection and deterioration to decoration was observed in some clinical rooms. Additionally, a tile was missing behind the toilet in the reception area with water damage affecting boarding behind a patient toilet which reduced assurance that the area could be effectively cleaned.

At Mannamead, cleaning checklists had not always been completed or signed, which reduced assurance that cleaning activities were consistently monitored.
However, the service had made improvements in its infection prevention and control (IPC) systems and processes since the last inspection. This included refurbishment plans and environmental improvement works, replacement of damaged furniture, review of cleaning arrangements, and strengthened oversight of sharps management and stock checks.

The service had IPC arrangements across the 5 sites, supported by an IPC policy and annual IPC statement. We saw evidence that IPC audits had been completed across all sites and that environmental and equipment audits were undertaken on a regular basis, with findings reviewed and monitored through governance processes.
There was an IPC lead in place, they had implemented monthly hand hygiene, personal protective equipment and aseptic technique audits, alongside quarterly environmental and equipment checks.
Staff had completed relevant IPC training and were satisfied with IPC arrangements within the service. We saw training compliance was monitored and the IPC lead was undertaking additional specialist IPC training.
The service had arrangements to oversee cleaning and environmental hygiene. Cleaning was provided by an external contractor across all sites, with cleaning records subject to both internal review and contractor audit. The provider had also developed an IPC Compliance Plan which outlined expectations for ongoing audit activity, competency assessments and compliance monitoring across the organisation.
Following the inspection the service completed a cleanliness audit of all sites and introduced monthly independent IPC spot checks, with escalation routes to operational and senior leaders where standards were not met, as well as cleanliness becoming a standing meeting agenda item; which was to be included in their IPC Compliance Plan.
 

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.
The service had made improvements in its medicines optimisation systems and processes since the last inspection.

Now, the service had a medicines management policy and supporting policies and standard operating procedures covering controlled drugs, medicines which required to be stored within a strict range (known as cold chain), medicines delivery and dispensing. These arrangements supported the ordering, storage, supply, monitoring and review of medicines. A standard operating procedure required staff to document the level and rationale for medicine reviews, including contact with people or where further monitoring or escalation was required. Staff used structured templates, and governance meetings and audits were used to monitor compliance.

Prescription stationery was stored securely, with suitable records and systems for monitoring and tracking its use. There were suitable arrangements for Patient Group Directions (PGDs), and Patient Specific Directions (PSDs) across the service.

As part of our assessment, a GP specialist advisor undertook remote clinical searches. We found that people prescribed medicines requiring regular safety monitoring, including blood thinners, lithium (a mood-stabilising medicine used to treat and prevent manic and depressive episodes in bipolar disorder), and certain medicines used to treat arthritis or high blood pressure, had received appropriate monitoring.

People prescribed medicines requiring pregnancy prevention measures had effective contraception and appropriate advice recorded. However, of the 5 clinical records reviewed, one person had an incomplete and out-of-date annual risk awareness form. Following the assessment, the service arranged an appointment to review this.

Emergency medicines and equipment were available at all sites and a risk assessment determined which medicines would be stocked.
However, at Mannamead branch site, an oxygen cylinder was stored on its side; at Mount Gould, oxygen and automated external defibrillator (AED) warning signage was absent and staff were not consistently aware of the AED’s location. Following the assessment, the service provided evidence that additional signage had been installed and staff had been reminded of the location of emergency equipment, including the AED and oxygen, to improve accessibility in an emergency

There were generally suitable arrangements for the storage of medicines. However, temperatures were not monitored in one medicine storage cupboard at Stirling Road. In response, the service introduced a non-fridge medication storage policy requiring twice daily temperature checks and weekly inventory checks.
There were established arrangements for the ordering, supply and storage of vaccines. However, we identified concerns with the oversight of cold chain management across several sites. At Ernesettle and Trelawny, there were gaps in fridge temperature records, which reduced assurance that medicines requiring refrigeration had been consistently stored within the recommended temperature range. At Mount Gould, refrigerated medicines were touching the sides of the fridge which affect the air circulation and effectiveness of the fridge. At Stirling Road, there were discrepancies in minimum and maximum temperature records and the vaccine fridge required servicing.
Following the inspection, the service provided evidence showing remedial action had been taken and leaders introduced an updated fridge management policy which included twice daily manual temperature checks, and a defined escalation process. Cold-chain oversight became a standing agenda item at monthly clinical governance meetings.