Camelford 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.

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

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 have 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 not always learnt to continually identify and embed good practice.
The service had processes for reporting incidents and safety events. Staff knew how to raise concerns and felt supported to do so. Although staff knew how to report incidents and leaders could describe learning from individual events, arrangements to support wider learning were not fully embedded. Incidents and complaints were not routinely reviewed for themes and trends before the assessment, which limited leaders’ ability to identify recurring risks and drive improvement.
However, clinical meetings were used to discuss safety events and actions arising from them. Staff and leaders were able to describe examples of learning. For example, following an incident involving the administration of a vaccine, the service introduced additional procedures and provided further staff training to reduce the risk of recurrence.
Following the inspection, leaders completed an audit of incidents and developed a plan to review these routinely.
 

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 digitalised systems to process information about new people registering to use the service. Staff monitored and audited referral pathways, including urgent cancer referrals. People were provided with information about when and how to contact the service if they had not received communication regarding their referral.
The service had arrangements to oversee clinical triage through a duty GP system. Online consultations were reviewed via a dedicated inbox and people were provided with clear advice regarding the outcome of the triage process, including when an appointment was required and the timeframe in which this should be booked.
The service had systems to manage test results and to ensure GP tasks and results were reviewed during periods of absence, with oversight provided by a GP partner. Urgent results were directed to the duty GP list for timely action. Staff demonstrated awareness of non-attendance management.
 

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 systems to protect vulnerable people from abuse. Staff were aware of the safeguarding leads and knew how to raise concerns. Staff demonstrated a good understanding of safeguarding responsibilities and gave examples of where they had raised concerns appropriately. The service had a safeguarding policy, and staff had received training appropriate to their role.
The service maintained a register of vulnerable people and worked in partnership with other agencies, including the police and social workers, to manage safeguarding concerns. Safeguarding registers were regularly reviewed through meetings with relevant organisations, including adult social care. A review of safeguarding records showed appropriate alerts had been added to people’s records and, where relevant, to household family members’ records.
 

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.
Staff could recognise when a person’s health was deteriorating and knew what action to take in a medical emergency. Reception staff had received training in emergency symptoms, and GPs were available to provide clinical advice and support where required. Non-clinical staff were knowledgeable about when they needed to seek emergency ambulance services for people and staff gave examples of this taking place. Waiting areas at each site were visible from reception desks, which supported staff to identify people who appeared unwell or required urgent assistance. Staff told us the duty GP and senior manager were responsive and provided guidance and support when required.

Staff knew how to access emergency equipment and information to support their response to medical emergencies. People were advised about risks associated with their condition and what action to take if their condition deteriorated. Staff also described effective coordination between clinical and non-clinical staff when responding to medical emergencies.
 

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 found some shortfalls regarding fire safety. Fire drills in the 2 branches had not taken place. Leaders recognised that these had not been documented and addressed this by implementing a fire drill improvement compliance plan immediately after the inspection.

At the St Breward site, staff spoken with during the inspection were unable to confirm the frequency of fire alarm testing. Leaders provided evidence that a fire alarm risk assessment had been completed and was subject to ongoing reviews scheduled at six-monthly intervals.

However, staff were aware of fire safety policies, procedures and risk assessments and could access these electronically. Fire marshal training records were available and identified designated fire marshals within the service. A fire safety policy risk assessment had been completed, and fire extinguishers were serviced annually, and fire call point testing took place weekly.
The service had arrangements to support the safe management of the environment such as a health and safety risk assessment. However, during our inspection we found that cleaning products at the St Breward branch were stored in a storage area within the waiting room which was not secured. In addition, Control of Substances Hazardous to Health information relating to cleaning products was not available on site.
Reception areas across the branch surgeries had limited space to support confidential conversations. Staff told us telephone calls received at reception could be overheard from the waiting room, which may impact on people's privacy. Leaders were aware of this, but environmental constraints were challenging.
The premises were visibly clean and free from clutter. The service had a contract with an external organisation to provide cleaning services across its locations, and staff spoke positively about the standard of cleaning provided. Clear signage throughout the premises supported people to identify fire exits in the event of an emergency evacuation.
Staff had access to the equipment required to deliver care and treatment. We saw equipment had been calibrated and serviced, and the service maintained records of routine safety checks, including checks of defibrillators and mobile phone batteries used in emergency situations.

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.
The service had a workforce comprising of a range of clinical and non-clinical staff, including GPs, practice nurses, a paramedic and care navigators. Staff told us there were enough staff to provide safe and effective care. The service had systems to cover sickness, absence and periods of increased demand.
We reviewed 4 staff files and found employment references and criminal records checks had taken place. However, we reviewed 4 staff files and found that health declaration records were not available in 3 of the files. Leaders took action to address this following the site visit. Leaders also recognised that annual appraisals had not always been completed and introduced a plan to complete these over the following 6 months.

Staff received an induction appropriate to their role and completed training relevant to their responsibilities. Leaders monitored training completion and staff told us they felt supported to develop in their careers. The service provided protected time for continuing professional development and other learning activities that supported the delivery of care. For example, a healthcare assistant had been supported by a learning disability clinical lead to further develop their skills and knowledge.
Staff worked within their areas of competence and the service had systems to ensure people were directed to the most appropriate clinician to meet their needs. Leaders maintained oversight of professional registration and revalidation requirements for clinical staff. The service had a policy for clinical supervision and clinical leads undertook competency assessments to provide assurance that staff remained suitably skilled and competent to undertake their roles.
 

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.
The service had Infection Prevention Control (IPC) policies and had completed an annual IPC statement and IPC risk assessments for all premises. However, we identified gaps in the oversight and implementation of some IPC arrangements. Although environmental cleanliness audits had been completed, actions arising from these audits were not always clearly and consistently recorded. For example, environmental audits identified issues including clutter, the absence of a sanitary waste bin and concerns about the position of an emergency trolley, but records did not consistently demonstrate how actions had been completed and monitored. The service was also unable to provide documented evidence that hand hygiene audits had taken place.
We found environmental issues at Delabole and St Breward branches that increased IPC risks. Some furniture surfaces, including fabric seating, could not be effectively cleaned. At Delabole surgery, all areas, including clinical rooms and the patient toilet, were carpeted. There was no evidence available to demonstrate when the carpets had last been deep cleaned. The flooring at the entrance to the building consisted of bare wooden boards, which were permeable. Leaders told us they were aware of these issues and were experiencing difficulties making necessary improvements.
The service had arrangements for cleaning the premises, which was undertaken by external contractors at each branch surgery. Staff generally reported satisfaction with cleanliness. However, cleaning schedules were not available at Delabole or St Breward branches during the site visit to evidence the cleaning activities undertaken. Staff described communication with cleaning contractors taking place through notes left at reception desks, which did not provide an auditable record of cleaning concerns or actions taken. It was therefore not always clear how the provider monitored the quality and effectiveness of cleaning services. Following the site visit, the service provided cleaning schedules and told us these were now in place at the branches.
Handwashing facilities were available throughout most clinical areas and water temperatures across the branches were monitored and maintained within safe limits. However, at Delabole branch, 1 clinical room did not have immediate access to handwashing facilities and staff used a nearby toilet when needed. Staff explained this room was only used for ECGs and not for other clinical tests or procedures.
The service had arrangements for clinical waste, with waste collected weekly at St Breward and fortnightly at Delabole. However, neither branch had a dedicated area for storing clinical waste between collections. Waste was stored in clinical or store rooms and no risk assessment was available to demonstrate how the associated risks had been assessed and mitigated.
We also identified concerns about disposable privacy curtains. Although curtains appeared visibly clean, several curtains at St Breward were dated September 2021 and others were undated. The service was unable to demonstrate a risk assessment or documented replacement schedule. This meant the service could not demonstrate effective oversight of curtain replacement arrangements.
However, the service had systems and processes to support IPC. The service had a named IPC lead, and staff were aware of who this was. Staff had completed IPC training and demonstrated awareness of IPC procedures, including safe handling and transfer of samples, outbreak management, sharps management and the use of personal protective equipment (PPE) was readily available throughout the service and sharps management arrangements were followed appropriately.
 

The service did not always make sure that medicines and treatments were safe.
Arrangements relating to medicines security and emergency medicines were not always effective. The medicines and equipment were not secure or tamper evident. We could not be assured the emergency medicines and equipment were secure and available when required. At the Camelford site, the emergency trolley was located in a consulting room, which meant this may not be immediately accessible if the consulting room was in use in case of an emergency. At St Breward the emergency trolley was placed in the waiting room and whilst in full view of reception, there was a risk it would be accessible to unauthorised people. Following the inspection the service confirmed that the emergency trolley had been relocated to a locked area.
Some medicines recommended by the Resuscitation Council were not available on emergency trolleys. Staff were able to explain the rationale for this; however, these decisions were not supported by a documented risk assessment. Staff completed and recorded checks to ensure emergency medicines and equipment were stocked and ready for use. Oxygen was available at each location and staff had access to information to support the management of medical emergencies.
We found the vaccines and medicines refrigerator at St Breward surgery was not locked at the time of our visit. This meant medicines were not always stored securely. Leaders recognised this and immediately took action to address the issue.

The service had systems for dispensing medicines including standard operating procedures (SOPs) for dispensing activities and arrangements to review these regularly. The dispensary was overseen by a lead GP, and staff told us they felt supported. Dispensary staff had received appropriate training and competency assessments.
The service had arrangements for the ordering, storage and disposal of medicines, including controlled drugs. Suitable temperature monitoring arrangements took place for medicines requiring cold storage. The dispensary could arrange for medicines to be transferred to other practice sites for collection and maintained appropriate records and audit trails to support this process.
The service managed prescription stationery safely and there were suitable systems for allowing authorised access and track the movement and location of these forms around the service
The service had systems to support the transfer of medicines between sites and maintained records to track medicines during this process. Suitable checks were undertaken where medicines were dispensed into monitored dosage systems. Patient group directions (PGDs’) were appropriately authorised. (PGDs provide a legal framework allowing registered nurses to supply and administer specified prescription-only medicines to pre-defined groups of patients without an individual prescription.)
The service had arrangements to record and review dispensing errors and near misses and we saw examples where improvements had been implemented. Medicines safety alerts and recalls were received, reviewed and acted upon.