Crown Street 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 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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. People felt supported to raise concerns and felt staff treated them with compassion and understanding During staff meetings, the whole team discussed and learnt from clinical issues. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support.

Leaders arranged for staff to complete training and upskilled staff to create additional capacity, skills and experience to meet the needs of patients and create a more flexible workforce.

The practice 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 new patients. The service worked with other providers to deliver shared care and when patients moved between services. The leaders explained they had oversight of the workflow tasks to ensure they were all responded to promptly.

The practice 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.People who provided feedback for this assessment had no specific views or concerns in this area.

Safeguarding policies were in place and known to staff. We reviewed four staff files and found safeguarding training was provided appropriately and staff had completed the correct level of safeguarding training for their role. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. They had a system to highlight vulnerable adults and children on their medical records, as well as household members.

The practice 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, risk assessments were provided for emergency medicines that were omitted. Staff could recognise a deteriorating patient and knew of action to take. Non-clinical staff directed patients to appropriate services and booked appointments based on the duty doctor’s guidance. Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

The practice 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. We observed fire exits were clear and fire safety equipment was easily available and regularly checked by an external company. There was a business continuity plan in place which was monitored and reviewed.

During the assessment, we reviewed the practice’s premises safety processes. Leaders informed us there were ongoing escalated repair processes with the landlord for modernisation plans of the building and some work had commenced and this was evident in the latest audit. The practice had 3 temporary drains that were being emptied in open plastic boxes. Leaders informed us this was being emptied daily.

The practice 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.

The practice assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Policies and procedures were available to staff, which provided guidance and information on Infection Prevention Control (IPC) practices. The practice had a designated IPC lead and staff had completed the infection prevention and control training relevant to their role. We saw that cleaning schedules were in place and followed.

The practice 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 followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. As part of our assessment, we conducted a series of remote clinical searches of patient records. These searches identified a small number of patients with hypothyroidism that were not up to date with monitoring and from the system the practice had followed up with these patients.

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. Staff stored medical gases, such as oxygen safely. The practice had effective systems to manage and respond to safety alerts and medicine recalls. Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes.While blank prescriptions were kept locked away, the practice did not have a system in place to manage the audit trail. Leaders informed this would be remedied when the practice migrated to an online system.