Castle Medical Group

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• 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 staff protected people from avoidable harm and made sure care was delivered from environments that were clean and well maintained. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement because medicines were not always managed safely, patients did not always receive appropriate monitoring and follow-up, and we found a breach of safe Care and treatment.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had arrangements in place to maintain a safe environment for people and staff. Responsibility for the premises was shared between the landlord and the service, with clear arrangements for managing internal and external health and safety responsibilities. Risk assessments, certificates and safety documentation were maintained electronically and reviewed regularly. Staff described how actions arising from risk assessments were monitored to ensure risks were reduced where possible.

The service had arrangements in place to maintain fire safety. Fire alarms were tested regularly, and full fire evacuation drills were carried out twice a year. Actions identified following fire drills were documented and monitored. Staff understood their responsibilities in relation to fire safety and emergency procedures.

The service had appropriate arrangements to ensure the premises were secure. Access to different areas of the building was controlled through a key and fob system and lost access fobs were deactivated. Prescription stationery was stored securely and usage was monitored.

Medical equipment was maintained and calibrated in line with requirements. Staff understood how to report faults and there were systems in place to ensure equipment was repaired or replaced when necessary. Safety alerts relating to equipment and premises were reviewed and shared with appropriate staff for action.

The service maintained a business continuity plan which was reviewed regularly and updated when changes occurred. This helped to ensure arrangements were in place to support the continued delivery of services in the event of disruption.

The service did not always make sure staff were up to date with the training required to carry out their roles safely and effectively.

The service had recruitment processes in place to ensure staff were suitable for their roles. Recruitment checks included verification of qualifications, right to work checks and Disclosure and Barring Service (DBS) checks where required. New staff completed an induction programme tailored to their role, which included shadowing opportunities and competency assessments. Clinical staff received supervision and support from designated GPs, and staff were given opportunities to learn from significant events, clinical meetings and professional development activities.

Staff appraisals were monitored through the service's governance systems and new members of staff received regular reviews during their induction period. Staff were encouraged to undertake additional learning and development opportunities where this would support their role and benefit the service.

However, at the time of the inspection records showed that not all staff were up to date with training deemed by the provider as mandatory. [JO1.1]Although the service monitored training compliance and carried out regular checks, several mandatory training requirements had not been completed within expected timescales. These included Basic Life Support, Health and Safety, Manual Handling and Mental Capacity Act training for some staff members. This meant the service could not provide full assurance that all staff had received the training necessary to carry out their roles safely and effectively. [SS2.1]Whilst we did not identify evidence of direct patient impact during the assessment, these gaps increased the risk that staff may not always have the knowledge and skills required to carry out their roles safely.

The provider recognised this issue and had systems in place to monitor training compliance. However, these systems had not always been effective in ensuring all mandatory training remained up to date.
 

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 service had identified infection prevention and control (IPC) leads who were responsible for overseeing IPC arrangements and supporting staff. Staff received IPC training relevant to their roles, including annual hand hygiene training, and reminders promoting good infection control practices were displayed throughout the premises.

The service carried out regular IPC audits, including monthly room audits, to identify areas for improvement and ensure standards were maintained. Findings from audits and learning were shared with staff through meetings and protected learning time sessions.

Staff vaccination records were maintained and monitored. The vaccination status of new staff was reviewed when they joined the service and risk assessments were completed where appropriate. Staff demonstrated an understanding of their responsibilities for reporting infection-related concerns and described how they would seek clinical advice when required.
These arrangements helped to ensure risks associated with infection prevention and control were identified, monitored and managed appropriately.
 

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 or ensure that people received evidence-based, clinically effective and safe prescribing.
As part of our assessment, a review of patient records was conducted and the findings identified concerns regarding medicines monitoring, medication reviews, management of safety alerts and prescribing oversight.
We reviewed records for patients with diabetes whose most recent blood sugar levels indicated poor diabetic control. We identified 154 patients and reviewed a sample of 5 records. Concerns were identified in 4 out of 5 records reviewed. The records did not demonstrate that appropriate monitoring was always in place and there was limited evidence of the service attempting to address this. We found examples of overdue urine albumin creatinine ratio (ACR) testing, blood pressure readings requiring follow up that had not been reviewed, and patients who were overdue diabetes reviews but continued to receive prescriptions.
We also reviewed records for patients with hypothyroidism who were overdue thyroid function monitoring. We identified 37 patients and reviewed a sample of 5 records. Concerns were identified in 5 out of 5 records reviewed. Patients continued to receive prescriptions despite overdue monitoring, and the records did not demonstrate that effective action had always been taken to address this. Records showed repeat dispensing arrangements had been initiated or continued despite monitoring requirements not being met, increasing the risk that patients could continue to receive treatment without appropriate review.
We reviewed medication reviews completed by the service and identified concerns in 2 out of 5 records reviewed. The records did not always provide assurance that medication reviews were completed in a timely manner. One patient had a medicine added to their repeat prescription without evidence that a planned review had taken place and another did not have recommended monitoring completed in line with guidance.
We also reviewed patients who had been prescribed high numbers of asthma reliever inhalers. We identified 23 patients and reviewed a sample of 5 records. Concerns were identified in 5 out of 5 records reviewed. Our specialist pharmacist concluded that the oversight and management of medicines usage did not ensure patients received safe care and treatment. We found examples where patients had not received timely asthma reviews, planned follow-up appointments had not taken place and opportunities to review treatment following worsening symptoms had been missed.
Our review of records relating to Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts identified concerns regarding the management of medicines subject to national safety requirements. We identified 48 patients and reviewed a sample of 5 records. Concerns were identified in 4 out of 5 records reviewed. Records did not always demonstrate that patient safety alerts had been managed effectively.
The lack of appropriate monitoring, timely reviews and effective management of safety alerts meant patients were exposed to the risk of avoidable harm. The provider acknowledged the findings identified through the assessment and described actions[JM5.1] being taken to improve monitoring and recall processes, strengthen prescribing oversight and implement additional systems to support patient reviews.