Kirkham Health Centre

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• 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 staff protected people from avoidable harm and made sure care was delivered from environments that were clean and well maintained. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement. The service is in breach of legal regulations in relation to safe environments.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not always control potential risks in the care environment. They did not make sure that the environment supported the delivery of safe care.

The service had undertaken health and safety risk assessments, including those around fire safety and legionella risks. The findings of some assessments indicated that actions were required to reduce the risks identified. Some of those risks had been assessed as high and required immediate action, but not all of those risks had been addressed. Some actions were described by managers as difficult to achieve due to the age and condition of the building as they were logistically challenging and required financial investment.

The service had a business continuity plan which was regularly reviewed and outlined how the service should continue to operate in the event of a disruption. Waste management was in line with expected standards, sharps bins were used appropriately and waste disposed of in line with guidance.

Whilst there were sufficient numbers of qualified, skilled and experienced staff; the record keeping around recruitment and training of staff to provide assurance of their qualifications, skills and experience was not always sufficient to provide adequate assurance of safe staffing. There were gaps in records kept in relation to safe recruitment practice as not all records contained all key evidence required. Some references had not been recorded, others lacked identity documents or the quality of image was insufficient to meet the requirements of the legislation. Some files did not have evidence of current registration although these were checked and corrected immediately. A criminal records check called a Disclosure and Barring service (DBS) check is mandatory for persons working in healthcare. We observed that a record of DBS numbers were retained by the practice for the majority of staff, however, the records did not indicate whether the DBS check had revealed anything of note or whether it was clear. There was a new member of staff recently recruited who had started working at the practice, but whose DBS check had not been requested, nor had a risk assessment been completed to adjudge if it was appropriate to work without one.

Managers did not maintain adequate and accurate training records to provide oversight of mandatory training to provide assurances that staff remained competent. Some training was not relevant to some staff members and so they did not complete it, but it was not possible to know if this was overdue because it was not relevant or whether it was relevant but not completed. It was also not easy to determine how overdue the training was. A manager was in the process of attempting to rationalise training lists and compile a manageable matrix. They had started with training such as life support and safeguarding, but other key mandatory training had not yet been included in the matrix. Managers stated they would further develop this oversight document following the inspection.

The service employed a range of clinical and non-clinical roles, which included GPs, nurses, healthcare assistants, pharmacists and advanced clinicians. Leaders stated supervision for non-medical prescribers was in place, however this was informal and not documented. More formalised supervision had been planned but had not yet been implemented.

Clinical supervision meetings, practice education sessions and other forms of group discussions about cases of interest were completed to upskill staff. Staff also reported that there were opportunities to attend additional training to enable their development which they reported to be positive. A staff member had undertaken a specialist infection prevention and control course and another had undertaken a learning disability qualification.

The service did not always manage the risk of infection. Whilst they usually detected risk they did not always control the risk of infection due to the age and condition of the building and the environment.

During our onsite visit, we observed areas of the practice to be in a poor state of repair. There were damp patches on some walls, there was peeling paint and plaster, chipped paintwork, wallpaper on some walls, fabric window coverings that were not wipeable and there was carpet flooring in some clinical areas. The environment was not conducive to good infection prevention and control.

The service carried out infection prevention and control (IPC) audits and monitored these for completion to maintain oversight. They had identified issues of concern and had a plan in place to remedy some of the issues and had made applications for funding to finance the repairs.

The service had cleaning schedules available, which outlined how staff should clean the building and its equipment. The practice also undertook weekly walk arounds, room checks and environmental spot checks where issues were rectified as they were identified.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.