Little London 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 service had a proactive and positive culture of safety, based on openness and honesty. Staff we spoke with confirmed this. Lessons were learnt to continually identify and embed good practice. Since the last inspection we found where people had raised concerns these were actioned by the provider to improve not only the safety of people and staff, but also to show they listen.

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 made improvements when these were identified. Managers also encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team would discuss and learn from concerns identified. The provider had processes in place to report incidents, near misses and safety events. We saw that a complaints process was in place to record and investigate complaints. When things went wrong the provider would apologise and take action to put thing right and support people if this was needed. Learning from incidents and complaints resulted in changes that improved the environment in which services were delivered.

The service worked with people 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 people moved between different services.

The provider worked with other partners to ensure people received the best care and treatment. For example, the provider worked with its local Primary Care Network (PCN) where they discussed patient care and treatment. The provider was also able to access a range of services like social prescribers and physiotherapy to enhance the level of care people received.

The provider had systems in place to ensure when referrals were made for other services like blood tests and scans that the results were actioned in a timely manner to ensure people’s care and treatment was delivered promptly.

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.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. The provider also had a safeguarding lead who could support staff on concerns related to safeguarding and they regularly held safeguarding meetings.

The provider had recruitment processes in place to ensure proper checks were conducted to appoint appropriate staff. The disclosure and barring Service (DBS) checks were also carried out. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable. References were also taken to ensure the character of staff were suitable for the role, and nursing staff were required to show that their registration with the Nursing and Midwifery Council (NMC) was up to date, and this was monitored annually.

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. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

We found from the comments people told us that they were generally involved in the care and treatment they received and that where there were potential risks staff were flexible in ensuring they could see a clinician quickly.

The service 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 found the environment clean and tidy and appropriate facilities were available and being monitored where needed. We found the provider had made several improvements to the building and car park area to improve the safety for people for example, the entrance area to the building now had electrically operated doors so as people approached them, they would open and shut automatically. This reduced the risks to people who found it difficult to enter the building.

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.

We found that systems were in place to ensure staff had the appropriate skills to support people safely. These systems were monitored to identify and address gaps in competence. Staff told us that they were given the appropriate time to refresh their skills through training.

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.

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. We found that substances subject to the Control of Substances Hazardous to Health (COSHH) regulations were stored securely and were not accessible to unauthorised staff or others.

Staff knew who the Infection prevention and Control Lead was and could get advice and direction from this person when needed. We checked a range of areas and found checks/monitoring was taking place and all staff received the appropriate training. The provider also had policies and procedures in place to ensure infection prevention could be managed appropriately and any risks reduced. The premises were observed to be clean and well maintained

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. 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.

A selection of clinical searches was carried out to check how people’s medicines were managed and monitored. We reviewed a random sample of 5 people’s clinical records for patients who had asthma and had received 2 or more courses of rescue steroids in the last 12 months. They had all received an appropriate assessment at the time they were prescribed medication. During our searches we also found some areas where there was no examination details recorded in the patients’ records showing what was found by the clinician. This was shared with the lead clinician to raise within their next clinical meeting.

Pregabalin is a medication commonly used to treat nerve pain, epilepsy and generalised anxiety and should generally be avoided when a person is pregnant. We found a situation where it was unclear as to whether a person who was pregnant was still using this medication. This was also shared with the lead Clinician to follow up on immediately.

The monitoring of patients with chronic kidney disease was also looked at and we found people’s care and treatment was being managed as expected.

Staff followed protocols to ensure they prescribed all medicines safely, and people received all recommended medicines reviews and monitoring. 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. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff we spoke with were able to explain the processes they were following which were in line with the provider policies and procedures. Staff followed established processes to ensure people prescribed medicines with specific risks received the recommended monitoring. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.