Rock Healthcare Limited

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 72 (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 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 supported to raise concerns and felt managers treated them with compassion and understanding. Managers encouraged staff to raise concerns when things went wrong. During monthly staff meetings clinical and non-clinical issues were discussed. All staff were invited to attend, minutes and learning outcomes were shared widely within the practice to ensure they could be seen by all staff, including those that could not attend. 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, these were responded to appropriately with written response given, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

The service worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services. The practice worked closely with the Primary Care Network (PCN) and had a good working relationship with Bardoc. There were systems in place for processing information relating to new patients. 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. There were no delays in recording or coding of information coming to the practice from other services.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. There was a good safeguarding procedure in place and staff could sign post to where this was stored on the system. The practice always shared and acted upon concerns quickly and appropriately working with organisations to keep people safe. Staff were trained appropriately in safeguarding and to the correct level for their roles. Staff were aware of who the safeguarding leads were for the practice.

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. Staff could recognise a deteriorating patient and knew of action to take. On the clinical system there was the ability to press an alert button to highlight to everyone using the system that they had a patient with them that they required assistance with. This could be for medical assistance or if a patient was aggressive. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service was aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. The building was managed by NHS Property services and the correct 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 at regular intervals. The waiting area was clean and tidy and free from clutter. There were adequate chairs which were comfortable and could be wiped down easily.

The service made sure there were enough qualified, skilled and experienced staff, who received support, supervision and development opportunities. They worked together well to provide safe care that met people’s individual needs. There was 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. Safe recruitment practices were followed. The admin team managed staff rotas effectively to ensure the needs of people using the services were met. Rotas were displayed for all staff to see. Good arrangements were in place to support short falls in staffing levels with support from other practices within the PCN available.

The service thoroughly assessed and managed the risk of infection. They quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly. The practice had a designated infection, prevention and control lead and all staff had had relevant training. There was a good procedure in place that was kept up to date and was easy for staff to follow. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

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.

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.

Overall the provider had effective systems to manage and respond to safety alerts and medicine recalls.

As part of the assessment a CQC GP specialist advisor carried out number of set clinical record searches to review medicines requiring monitoring. These searches were visible to the practice.A sample of patient records were then checked to ensure the required monitoring was taking place. The clinical searches identified shortfalls in patient monitoring for certain medicines. For example, monitoring of patients prescribed DMARDs such as Methotrexate.

Additionally we found the service had built in clinical searches (Arden’s EMIS) on their patient records system which flagged alerts that patients required follow up. The clinical searches identified an inconsistent approach to clinicians following up on alerts and warning in the patients’ clinical records putting some patients at potential risk of harm.

Following the inspection the practice reviewed and strengthened its systems to ensure appropriate monitoring and review.

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. For example, the number of antimicrobials issued by the provider was lower than local and national averages. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.