Crosslands Surgery

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

The practice had a strong 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. In particular, the practice immediately addressed and mitigated the majority of areas of improvement we identified during our site visit on the same day, which showed a culture of learning and improvement.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to concerns raised.

The 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. 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.

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 practice shared concerns quickly and appropriately.

The practice had a system to highlight vulnerable adults, children and household members on their medical records.Safeguarding policies were in place and known to staff, however we found that 2 non-clinical staff files we checked had level 1 adult and children safeguarding training instead of level 2 as per national guidance. Immediately following the site visit the practice submitted the training along with the local guidance they were following. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The practice 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. The practice had a duty clinician every day who was available for advice and support as necessary. Staff could recognise a deteriorating patient and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The 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. We observed fire exits were clear and fire safety equipment was easily available and regularly checked by an external company. The practice had completed legionella, and health and safety risk assessments.

The 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. We found the service recognised the continuing development of staff skills, competence and knowledge was integral to ensuring high quality care and leaders encouraged staff on professional development.

There were a range of clinical and non-clinical roles within the practice. Leaders and management monitored for any gaps in skills and encouraged and arranged for additional training. Staff felt there was an open culture and confirmed they had weekly and monthly meetings where they discussed incidents and learning.We found 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 practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. They ensured that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Cleaning schedules were in place and followed. Risk assessments and audits were completed, and actions taken to mitigate risks.

The practice 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. As part of our assessment, we conducted a series of remote clinical searches of patient records. These searches identified there was no documentation relating to the risks associated with Fournier’s gangrene (a potential complication of a particular medicine) on 5 patient records checked.Leaders showed evidence they previously identified staff were not always following protocols to record discussions about side effects of certain treatments and this was used for quality improvement work. Staff received additional training and support prior to the inspection. Following feedback relating to the clinical searches we analysed during this assessment, the leaders informed us of arrangements to incorporate this into medication workflow, alerts and tracking system to identify all relevant patients.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The service had effective systems to manage and respond to safety alerts and medicine recalls. 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. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.