The Paradise Road Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The management of assessing and reviewing patients’ health was robust and comprehensive. For example, during asthma reviews the nurse used evidence‑based templates, checked inhaler technique, discussed triggers, and provided follow-up advice to ensure personalised and effective care. They also checked whether patients required any additional support, such as immunisations.

The practice had good systems in place to identify patients at risk of developing long‑term conditions. Patients’ needs were assessed holistically through structured reviews. For example, staff told us that they identified and invited patients for their reviews and carried out a comprehensive assessment.

Feedback from people using the service was positive. People told us they felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. For example, the practice was signed up to receive safety alerts and received updates from CQC and NHS England.

Clinical records we saw demonstrated care was provided in line with current guidance.

The service worked well across teams and services to support people. For example, information noted in patient’s records could be accessed by the community nursing team and the local hospital.

They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services such as community services, commissioners, and voluntary organisations to ensure continuity of care, including where clinical tasks were delegated to other services.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. For example, the Health Care Assistant (HCA) ran a smoking cessation clinic, providing tailored support to help patients stop smoking.

Registration forms were used to identify individuals as well as those at risk of alcohol‑related harm and they could refer them to local alcohol support services where appropriate. Forms used in routine consultations also included questions that helped to identify mental health needs, enabling patients to be signposted to wellbeing services for further support.

Processes were in place for patients to be referred to a social prescriber for support with social issues such as housing and emotional support.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The practice was below target for cervical screening and for 1 of the 5 childhood immunisation indicators. Whilst the practice was below these targets, we saw that they were taking action to try and increase uptake. Cervical screening was supported by a follow‑up system, with contact, support, and referral for abnormal results. Saturday Hub appointments were used to increase attendance. The provider told us childhood immunisation performance was influenced by families using private providers, or having vaccinations abroad, which delayed data collection.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. We reviewed training records and saw that staff had completed relevant mental capacity training. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation(DNACPR) decisions were appropriate and were made in line with relevant legislation.