Archived: Central 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 Requires Improvement. At this assessment, the rating has changed to Good.

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.

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. Managers encouraged staff to raise concerns when things went wrong. Staff felt there was an open and supportive culture, and that safety was a top priority. The provider 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. Staff we spoke to provided examples of the practice’ approach to significant events including sharing learning, acting on the Duty of Candour and by implementing changes where necessary to prevent recurrence.

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 practice worked with other providers to deliver shared care and when patients moved between services. For example, when children moved to adult services, or for those receiving care from multiple teams, there were discussions in multidisciplinary meetings and care plans were updated appropriately. In addition, patients and families were informed about what to expect when transferring between services, and practice contact details were given to them to use if they had concerns.

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 practice shared concerns quickly and appropriately.

During our last inspection we found:

• Not all clinical staff had completed safeguarding training. Following the inspection the practice took action to address this issue.
• The practice was actively reviewing and monitoring patients where concerns existed, however, there was no register or audit to ensure ongoing oversight of those patients. Following the inspection, the practice addressed that concern.

At this inspection we found that all staff had completed safeguarding training.

Safeguarding policies were in place and known to staff. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations.

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.

The practice audited emergency equipment and medicines to ensure they remained functional and there were sufficient in-date stocks available.

Staff were trained to recognise deteriorating patients, both during triage and whilst on the premises. They also knew what action to take.

Patients were advised on risks related to their condition and actions to take if their condition deteriorated.

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

The practice conducted a range of regular assessments, including health and safety risk assessments and audits. There were weekly fire alarm tests with, at least, twice yearly full evacuation fire-drills to ensure staff remained aware of the precautions and were able to assist patients in leaving the building.

There was a business continuity plan in place which was monitored and reviewed.

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.

At our last inspection we found that not all staff had completed all recommended training, including basic life support, safeguarding and infection prevention and control.

At this assessment we found that all staff had completed all recommended training.

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.

At our last inspection we found:

• One member of clinical staff had not completed infection prevention and control (IPC) training.
• The practice was undertaking IPC audits but there were no clear dates for completion of actions identified.
• We also found that the cleaning equipment storage cupboard was badly organised and unclean.
• A sluice was unclean. A sluice is a dedicated, closed area for the hygienic disposal of clinical waste

At this assessment we found:

• All clinical staff records we looked at showed staff had completed IPC training.
• The practice was undertaking and acting upon IPC audits. For example, the practice was working with the building management company to ensure common areas were kept appropriately clean.
• The cleaning cupboard was better organised and clean.
• The sluice was no longer in use and had been decommissioned.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. Clinical staff were responsible for cleaning clinical rooms and equipment they used at the end of their sessions. There were also dedicated cleaning staff who worked to cleaning schedules. Risk assessments and audits were completed, and actions taken to mitigate risks.

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.

At our last inspection we found:

• Some Patient Group Directions (PGDs) were not appropriately authorised. PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment.
• There was also evidence of a lack of monitoring before prescribing some medicines.
• We also found that although there was a system for recording and acting on safety alerts, a number of patients continued to be prescribed an incorrect dose of a medicine contrary to updated guidance. The practice did have a system for reviewing older safety alerts, but this had not been wholly effective.

At this assessment we found:

• All PGDs we looked at had been appropriately authorised.
• We looked at medical records for several patient groups, including those being prescribed medicines requiring regular monitoring. We found that the practice was able to evidence that all patients were receiving treatment and/or monitoring in line with national guidelines.
• Our review of prescribing in accord with medicine safety alerts found no concerns. The practice had a robust system for reviewing historic safety alerts to ensure prescribing remained in line with guidance.

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 managed prescription stationery appropriately and securely. Blank prescriptions were stored in a safe location and were locked away. Serial numbers of prescriptions were recorded.

Protocols were followed to ensure safe prescribing and people received all recommended medicines reviews and monitoring. Medicines were stored securely and at appropriate temperatures.

Staff regularly checked the stock levels and expiry dates for all emergency medicines. Waste medicines were recorded and disposed of appropriately including medicines returned by patients.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls.