Adam House Medical Centre

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.

The provider had made improvements in the following areas: summarising and coding of clinical records; recruitment of staff; staff training and monitoring of people’s medicines. However, improvements were required in a number of areas such as maintaining a safe environment, provision of emergency equipment across both sites and management of prescription stationery. Following our site visit, the provider sent us evidence of improvements they had made in response to our findings.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating remains the same.

This service scored 59 (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 identify and embed good practice. People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Forum felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. Incidents were discussed and learning disseminated through staff meetings. Staff felt there was an open culture, and they could raise concerns. 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 the necessary support. Learning from incidents and complaints resulted in changes that improved care for others.

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, including when people moved between different services. Local health care providers used the same electronic patient record system and could easily access information about people using the service.

Improvements had been made to the systems in place for processing information relating to new patients. Summarising of patient notes was undertaken by administrative staff, which enabled the service to keep up to date with this task. To improve management and oversight, paper records were now stored at the main site only. The service worked with other providers to deliver shared care and when patients moved between services. Systems were in place to ensure referrals and test results were managed in a timely way. However, a small number of people commented the referral process was not always as efficient as they would like it to be.

Improvements had been made to the processes in place for coding information in patient records. Staff worked to a set list of codes, and the GP reviewing the information was responsible for ensuring it had been coded correctly.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

Safeguarding policies were in place and known to staff who were appropriately trained in safeguarding procedures. However, the safeguarding policies did not include information about categories of abuse or the risks associated with these. Neither policy included contact details for external agencies and the Children’s policy did not reference the safeguarding lead for the service. Following our assessment, the provider sent us the updated policies.

Multidisciplinary team meetings were used to raise awareness of potentially vulnerable groups of people. The service had systems in place to generate and corroborate the children’s register with health visiting services and relevant cases were discussed at the monthly meetings.

There were systems in place to follow up people who failed to attend appointments in primary and secondary care or, were frequent attenders to the emergency department.

The service worked with people to understand and manage risks. Care was provided to meet people’s needs. The majority of emergency equipment was available and maintained. However, the branch site did not have a paediatric self-inflating bag with reservoir, paediatric high concentration oxygen masks or paediatric pulse oximeter (this had been sent for calibration and returned back without the paediatric probe), and the branch site did not have portable suction equipment. The provider forwarded information following our assessment which demonstrated the missing paediatric equipment was now in place and suction equipment had been ordered.

Staff could recognise a deteriorating patient and knew of action to take. People were advised on risks related to their condition and actions to take if their condition deteriorated.

The service detected and controlled the majority of potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The majority of risk assessments were in place where appropriate. Cords to blinds were not secured to the wall in the 3 rooms we looked in, in line with a central alerting system (CAS) alert. The provider forwarded information following our assessment indicating safety hooks for the blinds had been ordered. A fire risk assessment had been completed, and staff completed online fire training and attended regular fire drills. Legionella risk assessments had been completed at both sites, but there was no evidence to support the required action as outlined in the action plans had been completed. The provider contacted the company during our onsite visit to request an update on the action plan. The provider forwarded information following our assessment with the proposed action plan for completion of the actions identified in the risk assessment. Regular testing of water temperatures took place. Electrical and medical equipment had been tested and calibrated as required. 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 service. Two salaried GPs had recently joined the service which had improved continuity of care for people. 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. Staff were positive about the support, training and development they received. All nursing and non-clinical had received regular appraisals. However, although the nurse practitioner had support and regular debrief sessions with the GPs, formal clinical supervision (reviewing of consultations) was not taking place. Safe recruitment practices were followed.

The service assessed and managed the risk of infection. Improvements had been made to the systems in place to assess and manage the risk of infection. The service now had a designated infection, prevention and control (IPC) lead and staff were up to date with IPC training. Risk assessments and IPC audits had been completed, and action plans put in place were required. However, the audit identified a number of sinks in clinical areas with overflows and these had not been included on the action plan or the risk register for the practice.

Clinical waste procedures were in place. Staff vaccination was maintained in line with current UK Health and Security Agency (UKHSA) guidance if relevant to their role.

Cleaning schedules were in place, however there was general sign off for completion rather than signing off individual tasks on completion. The day after our assessment, the provider informed us new logs had been printed for completion by the cleaning staff.

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. The service 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. However, our clinical searches identified although most people received the recommended monitoring, this was not always consistent. For example, not everyone who received treatment following an exacerbation of their asthma had a follow up within 48 hours. The service said they were in the process of introducing a template to ensure the follow up monitoring took place. Our clinical searches also identified people prescribed medicine that was potentially additive were overdue their annual medicine review to ensure correct compliance, avoid overuse and monitor for side effects. However, they had either been contacted to book a review or had a review booked in the near future.

Systems for managing the prescribing of medicines and treatment of other medicines were safe and met people’s needs. Protocols effectively supported the safe prescribing of medicines and staff involved people in reviews of their medicines. However, oversight of the nurse prescriber’s prescribing by the provider was not in place.

Systems were in place for checking the stock levels and expiry dates of all medicines, including emergency medicines and vaccines. Medical gases, such as oxygen, were stored securely.

Prescription stationery was stored securely, however systems to track prescription stationery throughout the practice were not effective. The service was not recording the number of the prescriptions in each box on receipt. Staff were not aware of the sequencing numbers on the prescription stationery. Although staff were recording the numbers of prescriptions used they had gone out of sequence, so it was not possible to identify where the prescriptions were in the practice, and a large number of prescriptions were unaccounted for. There was no tracking system in place for prescription pads, the number of prescriptions left on the pads was not recorded and some staff were unaware these were available. The day after our assessment, the provider informed us of the action they were taking to rectify this. The provider forwarded further information indicating the planned action had been completed and an investigation had been carried to identify and share learning.