Rock Healthcare Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

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

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

However, the practice did not always make sure people’s care and treatment was effective. For example, a CQC GP specialist advisor carried out a number of set clinical record searches of patients with long-term health conditions to check the required monitoring was taking place. The clinical searches identified 20 patients as having a potential missed diagnosis of diabetes, 3 of the records sampled identified issues in relation to coding and delays in following up of patients with a high HbA1c, meaning these patients were at potential risk of harm. Additionally the clinical searches also identified shortfall in relation to patients with Asthma who have had 2 or more courses of rescue steroids in the last 12 months. We found inconsistent approach to assessment undertaken at time of prescribing rescue steroids and not all the patients had been followed up following their acute exacerbation of asthma in line with guidance.

Following the inspection the provider took the necessary actions to review their systems and process to ensure people’s needs were being assessed appropriately.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. In the main, systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Staff told us that they were encouraged to learn about new and innovative approaches to help improve the way their service delivers care. Staff demonstrated how clinical meetings were used to ensure evidence-based care was followed. The provider had systems to ensure staff were up to date with national legislation, evidence-based good practice and required standards. Within the clinical system staff followed templates to ensure care was delivered in the most up to date and consistent way.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, the main waiting area had 4 separate boards that displayed information and leaflets for patients. The information displayed encouraged patients to stop smoking, manage obesity and other long-term conditions there was specific information for people that identify as LGBTQ+ and those people that are carers.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. However, data available at the time of inspection showed us that the practice did not always meet all national targets for screening and immunisations. The practice were proactive in educating and promoting the benefits of screening to increase uptake.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The national GP Patient Survey showed us that 64.7% of respondents to the GP patient survey responded positively to the overall experience of their GP practice. This compared to a national average of 73.9%.

The service always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment. Evidence gathered by speaking to staff and looking at training records showed that staff understood and could apply the correct legislation relating to consent. Capacity and consent were clearly recorded within peoples records as needed and do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. There was information displayed in the reception area and within the clinical rooms on the chaperone services available to people.