Parkway

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 inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We found the service did not always have effective systems to ensure staff had completed their mandatory training, including safeguarding training. The premises did not have an adequate legionella assessment. We found a number of concerns relating to the governance and storage of medicines.

However, we also found areas of good practice. The service had enough staff to care for people. Premises and equipment were clean and well-maintained.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most staff we spoke with knew what incidents to report and how to report them. The service had an electronic incident report system which staff had access to when needing to report an incident and managers told us that staff received feedback from incidents when these were reported. The director of quality and performance reviewed any reported incidents, however there was limited opportunity for staff learning from incidents due to the ability of staff in the service to meet regularly. There appeared to be a general lack of awareness of incidents and shared learning from incidents and limited evidence of improvement in practice as a result of any incidents which had occurred. We saw an example of an incident that had been reported to NHS England’s Learning from Patient Safety Events (LfPSE) database, which concerned a diagnostic delay. There had been no reports of patient deaths, never events, or serious incidents in the service during the past 12 months.

Staff had a general understanding about the duty of candour but did not give any examples of where this had been used. They knew about the need for openness and transparency and the importance of giving patients and families a full explanation, if things went wrong.

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’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Referrals were initially triaged by clinical staff in the service and prioritised accordingly.

Staff told us people had a consultation prior to surgery to determine their suitability and to identify their needs and preferences. They were able to describe the provider’s policies for admission, discharge and transfer of people who used the service. Patient records we reviewed indicated that appropriate care pathways were followed for different surgical procedures.

Staff liaised with people’s general practitioner (GP) if there were any queries around a person’s health status or if any test results were required, prior to admitting people for surgery. The service had arrangements with an external service for results of any diagnostic tests which had been requested for patients following their surgery.

Staff told us they used an electronic booking system to manage people’s appointments and post-operative follow-up appointments. They also used paper-based care records and to document people’s care and treatment. We requested but did not receive details of any care record audits that were completed. Where we reviewed these, we saw that care records were complete and up to date.

Clinical and administrative staff had completed life support training, although the provider’s records showed completion of life support training by clinical staff was below target. For clinical staff, 84% of required staff had completed Basic Life Support training, with 63% of staff completing Automated External Defibrillators (AED) training. The service had an ‘Emergency Treatment & Transfer of a Critically Ill Patient Policy’ for staff to follow when managing people whose health deteriorated during surgery. There had been no instances in the past 12 months where a person required emergency transfer to hospital.

The service had a safeguarding policy which incorporated relevant aspects of safeguarding, including for example, domestic violence and modern slavery. Staff had access to this policy which provided details of actions to follow in cases of any safeguarding concern. The service documented two safeguarding incidents in July 2024 in incident report records. Leaders of the service reviewed any safeguarding concerns regarding the welfare of a patient. Whilst actions had been followed up appropriately, we did not see any evidence of where there had been feedback to staff or information shared to raise awareness following any safeguarding concerns.

Not all staff had completed their mandatory safeguarding training. On the first day of inspection, training data we reviewed showed 100% of required staff had completed safeguarding adults level 1, and 87.6% of required staff had completed safeguarding adults level 2. For staff who were required to complete this, 88% of staff had completed safeguarding children training level 1 and 68.97% of staff had completed safeguarding children training level 2. A safeguarding lead was identified in the service who had completed safeguarding level 4 training.

Staff communicated with people so that they understood their care and treatment. Staff were able to describe how they monitored people’s care and treatment. They understood how to identify and manage people whose health condition deteriorated.

Care records showed staff completed risk assessments for each person on admission to the clinic, such as risks for venous thromboembolism (VTE – blood clots).

Staff enabled people to give feedback on the service they received via surveys and feedback questionnaires. The service documented feedback in a quarterly experience report. The most recent report showed a total of 1413 service users had completed a satisfaction survey, with 15519 service users seen in total. This showed 91% of respondents across the service were either extremely likely or likely to recommend services to friends and family.

The service detected and controlled potential risks in the care environment. They made sure equipment, and facilities supported the delivery of safe care. However, when requested, the service did not provide details of separate legionella test certificate for within the clinic premises. The certificate provided was for the whole building owned by a commercial company, stating that rented premises needed to have their own legionella assessment and certificate.

People who used the service told us that they felt the clinic was safe and provided a suitable environment for their care and treatment. They told us they had not experienced any issues relating to equipment and felt the premises and equipment were suitably maintained.

Staff said the premises and equipment were suitable for providing safe care and treatment. They told us there were sufficient quantities of equipment and consumable items and they could easily access them when needed. A designated member of staff was responsible for oversight of different stock items used regularly in the service and ensured these were available when needed. Where we checked these, we saw that consumables and single use sterile items, including theatre equipment, were within expiry dates.

The premises had a secure shared entrance, with a separate reception area to the clinic based on the ground floor. Access to the clinic was via coded entry, managed by the receptionist. The waiting area was spacious and comfortable; there was sufficient seating and accessibility provided for any disabled people.

The service made sure there were enough qualified, skilled and experienced staff to provide safe care that met people’s individual needs. They worked together well. However, they did not always receive effective support, supervision and development.

People who used the service told us there were enough staff in the clinic and they provided safe care and treatment. They told us staff communicated well and interacted with them in a professional, friendly manner. They said staff were responsive to their needs.

Staff told us there were enough staff to provide safe care and treatment. They told us their workload was manageable, and they received good support from managers. Staff were also positive about their learning and development opportunities and told us that managers supported them in this area.

The service’s ‘Workforce Establishment Review Report’ (March 2025) indicated the total number of staff employed in substantive roles across the whole service as 77. Of these, 30 were identified as clinical staff, 45 as administrative, with 2 as ‘dual role’. In addition, there were 20 clinical and 2 administrative bank staff employed, and 31 freelance employees. The service analysed its capacity and demand in the report, which demonstrated that current staff levels were appropriate to ensure good care delivery, and forecasted changes that would need to be made to staffing as activity levels changed. The service had a low overall sickness absence rate.

There were two consultants working directly in the surgery service under practicing privileges, who both had evidence of a recent appraisal. There was an appropriate system via email in place to provide service users with advice if this was required, when consultants were not immediately available in the service.

At the time of our inspection two out of three service manager posts were vacant. The provider had recently recruited to the posts and the candidates were due to begin their roles within the next month. We heard during the inspection from various staff and managers how these vacancies had added to the day-to-day pressures of work in the service, although some cover had been provided by other senior staff.

Staff told us that they completed their mandatory training by using e-learning programmes, with different subjects required and completed dependent on their role. We saw that some targets for completed mandatory training rates were not met, including: infection prevention and control (Tier 2) (completed 80%, target 90%); Information Governance (completed 82%, target 90%); lone workers (completed 57%, target 90%); and consent (completed 77%, target 90%). Data provided by the service indicated lower completion rates for some staff groups, such as a rate of 43% for healthcare assistant and support workers.

Staff understood and adhered to infection prevention and control principles (IPC) and had access to suitable handwashing facilities. Personal Protective Equipment (PPE) was available and used correctly by staff, and we saw that the clinical environment met a good standard of cleanliness.

Staff maintained equipment well and kept it clean. Staff were aware of the provider’s policies for IPC and knew how access these. Cleaning records were up to date and demonstrated that premises and treatment areas were cleaned regularly. Infection control processes were audited quarterly and had demonstrated good compliance across all key areas. The latest quarterly audit completed showed a staff compliance level of 99% with IPC regimes. The service had not reported any post-procedure infections.

The service did not make sure that medicines and treatments were stored safely and met people’s needs, capacities and preferences. Staff did not always follow good practice in medicines management or do this in line with national guidance.

Medicines used in minor surgery included injectable Kenalog, lidocaine, and depo-medrone. Despite not being cold chain dependent, these were stored in a fridge required to be maintained between 8-12°C, according to the service’s policy. Routine checks showed that the temperature of the fridge had regularly exceeded the service policy’s intended temperature, with no action having been taken. The medicine was also not stored securely, with both the fridge and its associated clinic room left unlocked.

Some medicines were also not being used within their product licenses. This is only considered acceptable practice when service users are clearly informed of the risks of this, and the service was not doing so.

At the main site, the service had one emergency trolley in the recovery area on the first floor and a second trolley on the corridor of the ground floor intended for anaphylaxis emergencies only. Both trolleys contained the appropriate concentrations of adrenaline for each type of emergency, but these were not distinguished appropriately in the emergency trolley checklist.