Devon Square 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 in October 2015, we rated this key question as Good. At this assessment, the rating remains unchanged.

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 service had a 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 staff treated them with compassion and understanding.

During clinical meetings, the GPs, clinicians, and practice manager discussed and learnt from clinical issues. For example, changes were made to the school age vaccines checking systems, to ensure records were clear in relation to children having been vaccinated at school or not (to avoid the child receiving the vaccine twice). Minutes of these meetings were shared with all staff.

Staff felt there was an open culture, and that safety was a priority. The provider had processes for staff to report incidents, near misses and safety events.

The service 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.
There were systems for processing information relating to new people.

The service worked with other providers to deliver shared care and when patients moved between services.

Referrals were managed in a timely way. There was a system and process for monitoring and managing 28-day Faster Diagnosis Standards two-week wait referrals (A system which prioritises people receiving a diagnosis or ruling out cancer within 28 days of an urgent referral over), which all staff knew and followed, as well as a process to enable staff to check that the referral had been sent and the person using the service has received cancer safety netting (advice given describing what someone should do if their condition got worse or they were not contacted by secondary care).

The service 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.
All staff were aware of safeguarding policies and were appropriately trained in safeguarding procedures. Staff members were able to give examples of where they had spoken to the Safeguarding Lead or deputy, when they had concerns about a person.

There were safeguarding registers held for both adults and children which were regularly reviewed at meetings with other relevant organisations. Updates were recorded in meeting minutes. The service had a system to monitor people who had turned 18 years of age and may transition from a child at risk to an adult at risk, to ensure oversight of these people was maintained and appropriate support continued.

A review of safeguarding records showed that alerts were appropriately placed on patient records and their household family members.

The service had taken steps to continually improve its process by undertaking a self-assessment safeguarding toolkit and leaders were able to tell us that this resulted in changes to their practice, such as improvements in terminology used in communications with people who used the service.

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. We reviewed staff training records for sepsis awareness and evidenced all reception staff had received this training.

People were advised on risks related to their condition and actions to take if their condition deteriorated. GPs were available to support the receptionists with clinical advice where required.
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were contracts to ensure the premises were cleaned and maintained and we noted that the premises were clean and tidy on the day of the site visit, with no visible hazards.

The service had appropriate fire policies, and a risk assessment had been undertaken. Actions for improvements had been identified, and these had been completed within the required 6-month period. Fire drills took place in line with the services policies and procedures, and the service has a trained fire marshal.

Health and safety risk assessments were carried out and where actions were required, this was clearly documented as to the timeframe within which they were completed. Health and safety risk assessments and audits had been undertaken and risks identified had either been addressed or had an action plan with timescales for these to be completed. These included legionella and portable appliance testing.

There was a business continuity plan, made up of several documents and policies, which was governed by the objectives of the service.

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 was a range of clinical and non-clinical roles within the service. Safe recruitment practices were followed. We reviewed 4 recruitment files and evidenced that staff had appropriate recruitment checks, including references and a Disclosure and Barring Service (DBS) Checks. (Disclosure and Barring Service (DBS) is a check which enables employers to check the criminal records of current and potential employees to ascertain whether they are suitable to work).

We evidenced learning needs and development of staff were managed appropriately, and staff were working within their agreed areas of competence. However, in our review of staff files we saw limited examples of competency assessments taking place. Following our site visit the service provided a plan to address this.

The service did not record and monitor clinicians GMC numbers (a General Medical Council (GMC number is a unique identification number given to a doctor who is registered with the GMC in the UK) to assure themselves that clinicians registration remained current. Following our site visit the service provided a plan to address this.

There were processes to ensure staff were appropriately trained and received an induction and ongoing training relevant for their role.

Staff said they were supported to progress in their career. All staff were encouraged to attend courses and share new skills and knowledge with the wider staff team.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All staff received relevant training. There were cleaning schedules which were followed. Risk assessments and audits were completed. The service had completed an annual infection prevention control (IPC) statement and had undertaken audits such as hand hygiene. The service had completed an IPC risk assessment.

The service held records of staff immunisations. There were appropriate systems for waste, clinical specimen management and sharps management.

The environment and equipment were visibly clean at the time of the site visit. However, we did note that cleaning cupboard was cluttered and untidy. This was discussed with the service leaders during our site visit, and the provider has sent evidence of this area now being clean and organised.
Medicines optimisation
 

The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. They involved people in planning.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. This was accurately recorded in people’s consultation records. 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, and felt confident managing the storage, administration and recording of medicines.

Staff managed prescription stationery appropriately and securely.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including those prescribed certain high-risk medicines.

The service had effective systems to manage and respond to safety alerts and medicine recalls.

The service stored medical gases, such as oxygen, safely and completed required safety risk assessments.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics.

Staff adhered to safety protocols for prescribing and ensured medicines reviews and monitoring were completed. However, we lacked evidence of audits for non-medical prescribers. After our site visit, the service shared examples and plans to record these audits.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor.

We evidenced during the clinical searches that there were effective reviews and monitoring of people with with hypothyroidism (an underactive thyroid) and diabetes.

We reviewed the records of people who required high-risk medicine reviews. All 5 reviewed records were coded and included detailed consultation documentation.