Forest Group Practice

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 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 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.

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

The service had contracts, and completed ongoing checks, to ensure the premises were maintained. These included for example, fire, gas, electrical and water safety and equipment calibration. Leaders and staff completed health and safety risk assessments and undertook audits to ensure they had identified and addressed all risks. Staff we spoke with had no concerns about the health and safety and fire arrangements in place. 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.

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.

The service employed staff in a range of clinical and non-clinical roles, which included GPs, nurses, paramedics and pharmacists. Leaders ensured staff were up to date with their training which the service had deemed mandatory and operated within their agreed areas of competence. The service had developed a skills framework for care navigators to ensure competency and support progression.

The service followed safe recruitment procedures when employing staff, which was in line with national legislation. This included identity checks, review of qualifications, obtaining of professional references and Disclosure and Barring Service (DBS) checks. Checks of the professional registration of clinical staff were made at recruitment and on an ongoing basis.

Effective arrangements were in place for staff induction, ensuring staff competence and the oversight of staff working in extended clinical roles, which included those who prescribed medicines. Staff we spoke with told us they were supported well to undertake their roles, could easily obtain advice from a GP or manager and always worked within their agreed areas of competence. Arrangements were in place for the oversight of staff working in extended clinical roles, which included those who prescribed medicines.

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. People we received feedback from gave positive feedback or had no concerns about the cleanliness of the service. A care home representative gave positive feedback about the infection prevention and control (IPC) arrangements followed by visiting clinicians from the service.

The service’s IPC lead with support from other staff, had recently completed a full IPC risk assessment. Other IPC audits, for example handwashing were also completed to ensure ongoing compliance. We reviewed the most recent risk assessment and found some actions identified to mitigate risks had been completed. The provider had recently been awarded a permanent contract and had agreed plans to address all identified IPC improvements in priority order, including replacing flooring in clinical areas.

The service had cleaning schedules available, which outlined how staff should clean the building and its equipment. The service demonstrated how these were monitored for completion to maintain oversight of cleaning arrangements. During our onsite visit, the service's premises and a sample of equipment reviewed were noted to be visibly clean. All staff had completed relevant training in IPC. Appropriate arrangements were in place to manage clinical waste.

The service was working to improve their oversight of staff immunisation status and occupational health advice. Risk assessments had been completed for some staff and the provider continued to complete this work.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences in line with national guidance. The practice delivered good medicines optimisation by embedding robust, proactive safety reviews that ensure people receive evidence-based, clinically effective and safe prescribing. People told us they were actively involved in decisions about their medicines through regular reviews and were provided information to help them understand how to manage their medicines safely. Feedback from a care home representative supported this view.

Our review of clinical records, prescribing data and medicines governance processes provided assurance that medicines were managed effectively. Medicines monitoring were generally up to date, and people had usually been reviewed appropriately in relation to their monitoring requirements. For example, medicines used to treat autoimmune diseases, most commonly rheumatoid arthritis were managed in line with guidance. The clinical records we reviewed showed some gaps in monitoring medicines used for heart failure. However, the provider had taken steps to address this and recall people for outstanding blood tests. There was an effective process in place for the management of safety alerts and medicine recalls. At the site visit, the provider confirmed they had already reviewed 10 of the 13 males identified by the alert and had arranged to review the other 3 people. An information leaflet had also been sent to each of these people.

There was an effective system in place for the management and oversight of medicines which cause dependency. We saw evidence of successful multidisciplinary team working that was reducing people’s medicines that can cause dependence. Individualised withdrawal plans were agreed with people resulting in some people successfully discontinuing treatment and other people remained on planned reduction programmes with the appropriate support. Clinical prescribing audits were undertaken which focused on improving care and treatment.

Medicines were stored, prescribed, administered and monitored safely, in line with current best practice. This included emergency medicines, medical gases and vaccines.