Cornerstone Medical Practice

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, we rated this key question as Good. At this assessment, the rating remains the same.
 

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Cornerstone Medical Practice 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.
People felt staff treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt 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.

Cornerstone Medical Practice 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 and recall and follow-up systems were in place for pathology monitoring, investigations, and reviews. 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, and daily systems ensured specimens were transferred to laboratories and not kept overnight onsite.
 

The practice 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 and known to staff, who were appropriately trained in safeguarding procedures. Cornerstone Medical Practice held regular safeguarding meetings with external partners, and there was multidisciplinary oversight of safeguarding cases. The practice maintained a list of vulnerable children and acted on concerns working in partnership with other organisations. Although the practice did not have a formal vulnerable adult's register, the practice had already commenced work to develop a structured vulnerable patient register and monitoring process.
 

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, and structured triage templates were used for all patient contacts. Staff could recognise a deteriorating patient and knew of action to take, including escalating all clinical concerns to clinicians. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.
 

Cornerstone Medical Practice detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
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, and emergency medicines, oxygen and defibrillator were available and routinely checked.
 

Cornerstone Medical Practice 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.
There were a range of clinical and non-clinical roles within the practice. 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. The service followed safe recruitment procedures when employing staff, which were in line with national legislation. This included identity checks, review of qualifications, obtaining of professional references and a criminal records check.
 

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning was provided by property services and cleaning schedules were in place and weekly audits conducted by a property service supervisor. During the inspection we observed areas of the practice which required cleaning. This was addressed following the inspection and flooring was replaced. Risk assessments and audits were completed, with bi-annual external infection control audits undertaken by Public Health England and actions taken to mitigate risks.

Staff we spoke to could demonstrate an understanding of spillages, specimen handling, and PPE. However, during the inspection, we found no aprons were available in 2 clinical rooms inspected, and clinical staff we spoke with were unable to identify where they were stored.

Cornerstone Medical Practice overall 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.

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. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring, for example staff could demonstrate an understanding of vaccine storage and medicines security arrangements. 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 practice had effective systems to manage and respond to safety alerts which were then allocated for action. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. However, review of patients prescribed gabapentinoids identified 17 out of 67 patients had not received a documented medication review within the previous 12 months. In response to this, Cornerstone Medical Practice committed to checking the gabapentinoid cohort and liaising with the pharmacy team to ensure required reviews and safety discussions had taken place. Additionally, within the sample reviewed, a female patient of childbearing age prescribed pregabalin had no documented evidence that risks associated with use in pregnancy had been discussed. Following the inspection, the provider took action to address these issues.