Ariel Healthcare

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 December 2017, we rated this key question as good. At this assessment, the rating remains the same.

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 service did not always listen to people’s concerns and did not always investigate and respond to complaints. The service investigated safety events. Lessons were learnt to continually identify and embed good practice.

The service had a complaint policy, but the complaint handling processes did not fully adhere to the policy. There were delays in acknowledging, investigating and responding to some complaints. Following the assessment, the service developed an action plan for oversight of the complaint handling process, but it had yet to be embedded in the system.

Staff understood how to raise concerns and report incidents. The service had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate incidents. The service held regular meetings to discuss incidents and complaints. Meeting notes were shared with all staff, including those who could not attend. Learning was shared to improve people’s care.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services.

The service had a summarising policy for processing information relating to new patients. The summarising process extracted significant and accurate medical information from clinical records from previous GP services to inform clinical judgment and provide safe care in the new service. However, during the site visit, we identified boxes of clinical records awaiting summarising. The service could not provide the total number of the summarising backlog, to define the extent of the issue at the time of the site visit. There was also no documented evidence of discussion or risk assessment to resolve the backlog prior to our assessment. The exact number of the backlog amounting to 660 sets of clinical records was provided after the site visit. Following the assessment, the service conducted a risk assessment and developed an action plan to clear the backlog, prioritising people with higher clinical risk. The action plan started in early January 2026 and planned to re-audit the summarising backlog after 8-12 weeks for evidence of improvement.

Staff had clear responsibilities and followed systems to ensure continuity between secondary and primary care. Referrals and clinical correspondence, including test results, were managed in a timely manner, which included a system for covering arrangements during staff absences. Designated administrative staff were responsible for managing and monitoring referrals to ensure people were referred to other services appropriately and were prioritised for urgent actions.

The service 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 with relevant partners.

The service had separate safeguarding teams for children and adults, each comprising a safeguarding lead, a deputy, and a safeguarding administrator. The service maintained lists of vulnerable children and adults, which were regularly reviewed within the service every 2 weeks and with external partners such as health visitors and midwives quarterly and when needed. The safeguarding team engaged with the local integrated care board (ICB – an NHS organisation responsible for planning and funding of services for their local population) for advice and attended their safeguarding training and forums.

The service had clear systems and processes to keep people safe and safeguarded from abuse. Alerts on clinical records flagged people with safeguarding concerns, including their household members. The service had safeguarding policies for children and adults, which were accessible to all staff. Staff could explain the safeguarding processes and felt confident in raising concerns. Staff knew who the safeguarding leads were. Staff were all up to date with their safeguarding children and vulnerable adults training at the appropriate level for their roles.

The service worked with people to understand and manage risks. They provided care to meet people’s needs that was safe and supportive.

Staff could recognise a deteriorating patient and knew of action to take. Staff could summon help quickly in an emergency using the emergency button on the computer system. The duty GP was readily available to provide support to the receptionists. A staff member described noticing a person had difficulty speaking during a phone call, raising concern for a possible stroke. They immediately arranged an ambulance and stayed on the line to monitor the person until help arrived.

The service had a medical emergency policy covering actions to take, staff roles and responsibilities. The service held appropriate emergency medicines and equipment.

People received advice on risks related to their condition and the actions to take if their condition deteriorated.

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.

Health and safety and fire risk assessments were carried out. However, there was no documentation of actions taken. Following the site visit, the service provided an action plan that documented the actions taken. However, there were several unresolved issues, including no regular fire drills, a fire door closer was not functioning (the closer should automatically shut in the event of a fire to slow down fire spread), and some new portable electronic appliances had not received necessary testing. The service conducted risk assessments with a plan of action and a timescale for completion within January 2026.

Fire equipment checks were documented. The service had a health and safety policy and business continuity plan detailing what actions were to be taken in the event of any incident which would affect the running of the services. There was a lone working policy to promote staff safety.

The service made sure there were enough qualified, skilled and experienced staff. Staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, we found shortfalls in the reference check for recruitment and clinical supervision documentation.

Safe recruitment practices were generally followed with all staff required to complete Disclosure and Barring Service (DBS) check upon employment. However, there were gaps in obtaining 2 references upon employment as required in their policy.We sampled and reviewed 4 recruitment records and found 1 of them only provided 1 reference and the relevant risk assessment was conducted 2 months after the staff started work. Another staff submitted their second reference 20 months after started working at the service. Following the site visit, the service developed an action plan to review the affected staff, update the recruitment policy to detail the reference requirements and develop a standardised pre-employment recruitment checklist within a month and plan of ongoing audits on recruitment compliance every 6 months.

The clinical staff could approach the urgent care hub (UCH) clinicians for their advice when needed. There were time slots on the clinical system designated for debrief with UCH clinicians. However, there was no documented evidence of clinical supervision. The clinical supervision policy did not cover the frequency of clinical supervision. After the site visit, the service updated the clinical supervision policy to include the frequency of clinical supervision and formalised the process with a structured supervision record form.

There were a range of clinical and non-clinical roles within the service. Staff received induction appropriate for their roles and staff were working within their agreed areas of competence. All staff were up-to-date with their mandatory training.

Staff had regular appraisals and they were able to discuss their learning needs. The service provided protected training time at 12.30-2.30pm every Wednesday for continuous professional development and supervision.

We saw evidence of staff being upskilled to support the service and their professional development. For example, the service supported their staff by giving protected time and funding to pursue training in advanced clinical practitioner and GP assistant.

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.

During the site visit, we saw the premises were visibly clean and tidy. The service had a designated infection prevention and control (IPC) lead, and all staff had completed relevant training.

Up to date IPC risk assessments and audits were completed, and actions taken to mitigate risks. Personal protective equipment (PPE) was available to staff.Sharps waste bins used for disposing of used medical instruments such as needles or syringes were safely managed.

Cleaning schedules were followed and the service met with the external cleaning company regularly to discuss any identified issues.

During the site visit, the clinical waste bins at the main site were locked but not secured to avoid unauthorised removal. Following the site visit, the service chained and applied padlocks to the bins to ensure security.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Emergency medicines and equipment held by the service were in line with guidance for GP practices; and were regularly checked to ensure there was sufficient stock and were safe to use.

The service stored medical gases, such as oxygen, safely and completed required safety risk assessments. The service had effective systems to manage and respond to safety alerts and medicine recalls.

The service had policies and procedures for the management of medicines. Blank prescription stationery was securely stored and accessible only to authorised staff. Vaccines were appropriately stored and monitored in line with national guidance to ensure they remained safe and effective. The service shared a previous example of an incident when the vaccine fridge door was not closed properly which could impact the storage temperature and vaccine effectiveness. The service actioned this immediately in accordance with their established protocol.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes. For example, the service regularly monitored their prescribing practice and conducted multiple prescribing audits throughout the year. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials and hypnotics (medicines that help people sleep) issued by the provider were lower than national averages.

As part of our inspection, a number of set clinical record searches were undertaken remotely by a CQC GP specialist advisor. These searches were visible to the service. We sampled 5 clinical records to look at the quality of medicine reviews and found all of them were reviewed appropriately.

There were no formal audits for non-medical prescribers (NMPs, healthcare professionals who can prescribe medicines but are not GPs) although all NMPs had an assigned GP supervisor for advice at any time. The service immediately set up an NMP audit process, developed the audit form and provided evidence of the first completed NMP audits which would be conducted monthly onwards.

The service had a process for authorising staff to administer medicines including Patient Group Directions (PGDs) or Patient Specific Directions (PSDs). (PGDs are a written instruction for the supply and/or administration of a named licensed medicine for a defined clinical condition. PSDs are a written instruction from a doctor or other independent prescriber for a medicine to be supplied or administered to a named patient.) However, we reviewed a sample of PGDs during the site visit and found they had not been completed correctly in line with guidance. After the site visit, the service provided assurance that all the PGDs were rectified.