Chelsfield 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 inspection, we rated this key question as Requires Improvement. At this inspection, the rating has changed to Good.

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.

Patients 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 the service. For example, PPG members told us the practice had worked with them to make information on the practice website clearer and easier to find.

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.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when patients 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 service worked with patients 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. Staff had also received training to support people experiencing domestic violence. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

The service worked with patients to understand and manage risks by thinking holistically. They provided care to meet patients’ needs that was safe, supportive and enabled people to do the things that mattered to them.

Emergency equipment was available and maintained. The emergency equipment was kept in a number of different locations in the practice, including behind reception, a storage room, and clinical rooms. Following our site visit, the provider sent evidence that all emergency equipment had been moved to be kept behind reception to make this easier to access in an emergency. The practice did not hold a spare set of adult defibrillator pads. Following our site visit the provider sent us evidence that an additional set of adult defibrillator pads had been purchased. 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. GPs had completed training in suicide prevention for men.

The practice had a system where appointments requests were triaged based on the urgency of the request. This ensured patients received the right care for their condition in a timely manner.

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 reception desk and waiting area was situated as such that people in the waiting area were not always visible to staff working on reception. Therefore, staff may not be able to see a patient whose condition deteriorated whilst in the practice and needed immediate attention. Following our inspection, the provider told us they had plans to install cameras in the waiting area to enable staff to have a clear view of people in the waiting area.

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.

The service 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. Safe recruitment practices were followed.

The practice had a designated infection, prevention and control lead and all staff had had relevant training.

The service carried out regular infection prevention and control (IPC) risk assessments and audits. These audits had identified a number of areas that required action. We saw that most actions had been completed or had dates for completion. The service had identified carpet in non-clinical areas needed to be replaced, whilst this was being resolved there were cleaning schedules to ensure these areas were cleaned regularly and thoroughly. An IPC audit had identified that soap was not always placed in soap dispensers. During our site visit we observed bottles of liquid soap used in some toilets and clinical rooms rather than in dispensers attached to the wall. Following our inspection, we saw evidence that the provider had purchased soap dispensers for use in the practice to reduce IPC risk.

The service 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. Patients 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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. 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 provider had effective systems to manage and respond to safety alerts and medicine recalls. 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. 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. This included antibiotic prescribing for clinical staff.