Balsall Common and Meriden 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 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 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 to ensure the premises were maintained.

Staff and leaders completed health and safety risk assessments and carried out audits to identify and address potential risks. During the visit, we observed that the premises were step free and had support railings which were in good condition. Wheelchairs were also available to people using the service and these were found to be clean and in good working order. However, there were no records to demonstrate safety checks were carried out to ensure wheelchairs were in good working order. The provider told us that they visually inspect regularly, however agreed that a written audit would ensure these important checks were not missed by staff and that they could be assured checks had taken 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.

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Effective systems were not in place to ensure staff maintained up‑to‑date skills and competencies, as we identified gaps and inconsistencies in training provision.

Leaders did not always ensure all staff were up to date with mandatory training. We found that not all managers and administrative staff had completed Infection Prevention Control (IPC) training. Not all leaders had completed updated Deprivation of Liberty (DoLS) training or the Mental Capacity Act training. However, all staff and leaders were able to demonstrate knowledge of IPC, DoLS and the Mental Capacity Act. Staff were able to identify IPC risks and tell us about actions they would take with regards to spills such as ensuring hygiene standards were maintained whilst keeping patients and other staff away from clinical spills.

The provider told us that they would priorotise this training immediately and we saw they had already initiated a comprehensive plan to ensure oversight of training records are better maintained with a system to alert leaders when training was overdue. Policies around training stated that all mandatory training should be is completed every 3 years.

We also found that not all staff were trained in chaperoning. The provider explained that not all staff would complete any chaperone duties, however they accepted that in times of staff shortage it would be prudent to ensure all staff receive this training to make availability of chaperones better.
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 a criminal records check. However, we found that there were no effective systems or policies in place to provide assurance that locum GPs who sometimes worked at the service had completed all necessary training such as Safeguarding or IPC. The provider assured us that they would implement a locum policy that would be robust and to include all the points raised within our inspection.

Staff and leaders worked together well to provide safe care that met people’s individual needs. The provider employed a range of clinical and non-clinical staff, including practice nurses, and a health care assistant.
 

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 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 was noted to be visibly clean. The service’s infection prevention and control lead conducted regular risk assessments and audits to ensure compliance and acted where necessary to mitigate any identified risks.
 

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