Castle Place 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 that people were protected from abuse and avoidable harm.

This is the first inspection for this service since its registration with CQC. This key question has been rated as 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 service had a 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. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During clinical meetings, the GPs, clinicians and practice manager discussed and learnt from clinical issues. Minutes of these meetings were shared with all staff.

Staff felt there was an open culture, and that safety was a priority. The provider had processes for staff to report incidents, near misses and safety events.

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.

There were systems for processing information relating to new patients. The service worked with other providers to deliver shared care and when patients moved between services.

Referrals were managed in a timely way. There was a system and process for monitoring and managing 2-week-wait referrals, which all staff knew and understood (the 2-week-wait referral system allows a patient with symptoms that may indicate an underlying cancer to be seen as quickly as possible).

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.

There were safeguarding policies that were known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnership with other organisations. A review of safeguarding records showed that alerts were appropriately placed on patients records and those of household family members.

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. Staff could recognise a deteriorating patient and knew of action to take. We reviewed staff training records for national early warning score (NEWS), records showed that 81% of staff had completed this to date. Where policy stated some staff did not require this training, there were no risk assessments completed to underpin why and how this had been determined for individual staff members deemed to be exempt. Following the site visit, the provider sent us evidence of staff having completed this training and dates set in the future for staff to complete this training and/or risk assessments (where required). Additionally, where staff were unable to attend training on the planned dates, the practice management team were sourcing dates in collaboration with other in collaboration with other local practices.

Patients 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.

There were contracts to ensure the premises were maintained. Health and safety risk assessments and audits had been undertaken and the risks identified had either been addressed or had an action plan with timescales for these to be completed.

There was a business continuity plan (one for the Royal Devon University Healthcare NHS Foundation Trust and one which was practice specific) both of which were monitored and reviewed.

Outcomes of legionella (a bacterium found in water supplies which can cause severe respiratory illness) testing, calibration of equipment and testing of portable appliances were unclear, as these were held centrally or by external companies and not within the practice. Following the site visit, the provider sent us evidence of outcomes of legionella testing, calibration of equipment and testing of portable appliances which had been completed within the last 12 months.

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.

There were a range of clinical and non-clinical roles within the practice. Safe recruitment practices were followed. We found learning needs and development of staff was managed appropriately, and staff were working within their agreed areas of competence. Staff told us they were supported to achieve career progression.

We found that training was not always up-to-date for a small number of staff being absent during training or trainers for particular courses not having availability.The provider sent us evidence of staff having completed these training modules or dates set in the future for staff to complete this training (where required). Additionally, where staff were unable to attend training on the planned dates, the practice management team has sourced dates in collaboration with other local practices. This ensured all staff had access to relevant mandatory training.

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 practice had a designated infection, prevention and control (IPC) lead and all staff had had relevant training. There were cleaning schedules which were followed. Risk assessments and audits were completed. The overall infection prevention and control audit was good and included multiple audits to support the compilation of this. For example, handwashing and hand hygiene audits, environmental cleanliness and waste management. However, an annual IPC statement was not available to view during our site visit. Following the site visit, the provider sent us evidence of the Royal Devon University Healthcare NHS Foundation Trust’s (RDHU) annual IPC statement, which included practice specific details.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. This was accurately recorded in people’s consultation records. People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. We found that patients who were prescribed high-risk medicines were monitored appropriately in most cases.

There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.

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 managed prescription stationery appropriately and securely. Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring.

The provider had systems to manage and respond to safety alerts and medicine recalls.

Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring in most cases.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antibiotics issued by the provider was lower than local and national averages.

We found that Patient Group Directives (PGDs are signed documents which state who can supply and/or administer specific medicines to patients without a doctor under a PGD and which medicines can be administered) were not always appropriately maintained. We found 6 PGDs had blank spaces which had not been scored through, to avoid clinical staff signing the document after they had been authorised by a GP. Following the site visit, the provider sent us evidence of PGDs having been updated, blank lines having been scored through and extension pages in use for new staff to sign and be authorised by a GP (where required).