Ball Tree 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 72 (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 continually identify and embed good practice.

The service had effective systems to identify and learn from incidents. Managers encouraged staff to raise concerns when things went wrong. Incidents were discussed during staff and clinical meetings to ensure that learning was shared. Staff felt there was an open culture, and that safety was a top priority. The service 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 support.

Learning from incidents and complaints resulted in changes that improved care for others. For example, following an incident where there had been a processing delay for a person issued with a home test kit, the service had improved its systems to ensure that urgent referrals were tracked and urgent test results were followed up.

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.

There were systems in place for processing information relating to people when they newly joined the service. The service worked with other providers to deliver shared care and when people moved between services. Referrals and test results were managed in a timely way. The service had identified an external issue which had impacted on the speed with which referrals were being processed and was looking at ways to improve this. There were effective systems in place to monitor urgent referrals.

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 service maintained a list of vulnerable people and acted on concerns by working in partnership with other organisations.

The service actively followed-up safeguarding cases with the social services team so they were aware of relevant outcomes and actions and could update their records and the clinical team.

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 at both the main and branch surgery sites. Staff could recognise a deteriorating person 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 potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental risk assessments, service and action plans were monitored using a comprehensive electronic spreadsheet which was checked and updated daily.

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 were established and effective systems in place to identify, manage and mitigate risks to people. For example; they contracted with a consultant who carried out a weekly inspection and reviewed environmental risk assessments and checks. The service carried out legionella testing and portable appliance testing to ensure staff and people were safe and revised them annually or more frequently in response to change.

Maintenance contracts were in placed to maintain the accuracy of equipment (calibration), scheduled safety checks were conducted on the fire alarm system, emergency lighting and equipment. Staff had undergone Disclosure and Barring Service checks (DBS is a way for employers to assess the suitability of individuals for certain roles) or if a DBS had not been completed, appropriate risk assessments were in place.

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.

The service employed a multidisciplinary team. There were a range of clinical and non-clinical roles in the service.

We found training was up to date, learning needs and development of staff was managed appropriately, and staff were working in their agreed areas of competence. Safe recruitment practices were followed.

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 service 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.

The staff team understood their roles and responsibilities in relation to the risk of communicable disease. A person had recently presented to the service after possible exposure to a notifiable infection. The team immediately recognised the risk, provided preventive treatment, and informed the appropriate authorities. This was an unusual case and was reviewed by the clinical team as an incident for any further learning.

The service had systems in place to support effective medicines optimisation. However, we found that structured medicines reviews involving the person had not always been completed in a timely way.

We found that structured medicines reviews had not always been conducted in a timely way. The service told us they had identified this as a problem earlier in the year and had taken action to catch up and complete overdue reviews. They provided evidence showing that the backlog had been halved since this process had been implemented and they were on track to eliminate the backlog by the end of the year.

Staff followed protocols to ensure they prescribed medicines safely and ensured people received recommended monitoring. However, when prescribing one medicine (used to treat rheumatoid arthritis among other conditions), the service was not indicating a specific day of the week that the medicine should be taken on the prescription. National guidelines recommend the day is specified to reduce the risk of accidental overdose as this medicine must not be taken more frequently than weekly. Where structured medicines reviews had been completed, staff involved people 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.

The service had systems to manage and respond to safety alerts and medicine recalls, however there were some gaps in implementation. We found the service had not fully implemented a national patient safety alert in relation to the prescribing of certain medicines typically used to treat depression in people over 65. We found 8 people whose prescribing had not been adjusted in line with the alert, although 3 had turned 65 recently. The service had also identified this issue and had booked reviews with 3 people and told us they would be following up with the others.

Staff involved in medicines optimisation received regular training, supervision and were competency assessed on medicines optimisation. The service was supported by a team of pharmacists and pharmacist technicians who conducted regular audits; supported people with their medicines and carried out well-documented medication reviews. The staff team was confident about managing the storage, administration and recording of medicines.

We received wholly positive feedback from local care home managers who told us that the service optimised the management of medicines for people living in the homes, including people coming to the end of life. They told us the GPs took time to discuss people’s medicines with them and their families.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment showed the service was prescribing antimicrobials in line with national norms. There was a planned programme of clinical audits of prescribing that focused on improving care and monitoring trends.

Medicines were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. Waste medicines were recorded and disposed of appropriately including medicines returned by people. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The service managed prescription stationery appropriately and securely.