Castletown 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

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

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 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.

Since taking over the running of the service the provider had undertaken a full review of systems and processes and made many changes to improve the safe running of the service.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns and give feedback when things went wrong.

Staff told us there was an open culture, and that safety was a top priority. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The practice provided us with both a significant event incident analysis report and complaints report. The significant event report detailed incidents from the time they took over the running of the service. This contained full details of the incidents, actions and learning taken from them and any improvements made. The complaints report listed actions, leaning and improvements from the complaints received.

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.

There were systems in place for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services. Referrals and test results were managed in a timely way.

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.

Safeguarding policies were in place, specific to the service and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled potential risks in the practice. They made sure equipment, facilities and technology supported the delivery of safe care. They had carried out a large amount of work since taking over the running of the premises in relation to the environment to ensure it was suitable and safe for patients. For example, the new provider had to renew health and safety and fire risk assessments as they were out of date and there was no defibrillator.

Contracts were in place to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and risks identified had been addressed. There was a business continuity plan in place which was monitored and reviewed.

Since the taking over of the service the new provider had worked hard to ensure that there were enough staff to ensure the running of the service.

There were now enough qualified, skilled and experienced staff to provide safe care that met patient’s individual needs.

The development of the staff was ongoing, and staff told us they had been offered opportunities to develop in their role.

We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Safe recruitment practices were followed.

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 practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The service had worked hard since the takeover of the practice to ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

We carried out remote searches of clinical records as part of our assessment to check how the practice monitored patients’ health in relation to the use of high-risk medicines. We found that patients mostly received appropriate monitoring at the required intervals. There were a few areas for improvement we identified and raised with the provider so they could take these forward.

They told us there had been challenges regarding the management of medicines when they took over the running of the practice. A strict policy had been put in place to ensure high risk medication was not issued too far in advance. Antibiotic prescribing had been reviewed to ensure it was appropriate.

Further improvements were still to be made. This included the clinical coding of patient records. It was felt there were flaws in the current recall system, which was manual. There were plans in place to use an IT solution to automate the call and recall of patients. This system would interact with the NHS patient app. It could send texts to patients with information, and this could be translated into various languages. It generated reports which would streamline the management of medicines.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. 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. Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines, vaccines, and controlled drugs. Waste medicines were recorded and disposed of appropriately including medicines returned by patients. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.