Neston 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 assessed all quality statements under this key question. At our last assessment, we rated this key question as good. The rating remains good following this assessment.

Systems were in place to protect people from abuse and avoidable harm.

We found safety was a priority, and the provider took all concerns seriously. Feedback from people who used the service indicated that they felt they received safe care and treatment. The provider acted upon feedback from people and made improvements to the service in response.

Safety events were investigated, and lessons were learnt to identify any shortfalls, prevent a recurrence, and embed good practice.

Members of the staff team provided positive feedback about staffing levels.

Systems and procedures were in place to safeguard patients who may be at risk of abuse. Staff had undergone checks to ensure they were suitable for the role and they had been provided with safeguarding training at a level appropriate to their role.

Staff had been provided with training to meet their roles and responsibilities.

Procedures for managing health and safety were in place. The premises were safe and well maintained. There were processes for monitoring patients’ health in relation to the use of medicines including medicines that require regular review.

Formal and informal complaints were investigated and learning from these was shared across the staff team and used to drive improvement.

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 proactive and positive culture of safety, based on openness and honesty. Processes were in place for staff to report incidents, near misses and safety events. The provider listened to concerns about safety and investigated and reported safety events. Staff felt there was an open culture, and that safety was a priority.

Incidents and complaints were investigated, and regular meetings were held where the learning from these was shared and discussed. The provider held a log of significant incidents and a log of complaints which they used to identify themes and trends.

Staff told us they were supported to identify their training needs and protected learning time was provided for them to undertake training, learning and professional development. Training was provided within the service and through attendance at locality wide training and educational events.

The provider worked alongside other stakeholders and worked within the Primary Care Network (PCN) to develop services.

The provider worked with people who used the service and healthcare partners to establish and maintain safe systems of care. There were systems and processes to share information with staff and other agencies to enable them to deliver safe care and treatment. The service worked with other providers to deliver shared care and when patients moved between services.

Feedback from people who used the service indicated they felt involved in decisions about treatment pathways and they reported prompt follow up care.

Members of the staff team were aware of local services and support networks that they could refer patients to in order to support them with their needs and to prevent ill health. Reception staff had been trained in care navigation to direct patients to the most appropriate service or services to meet their presenting needs.

Regular multi-disciplinary meetings were held where the needs of patients with more complex needs or those approaching the end of life could be discussed.

Clinicians followed care and treatment pathways for treating and referring patients to other services. Referrals to secondary or specialist care were made promptly, and patients referred under the two week wait rule for suspected cancer were followed up appropriately. Correspondence from secondary care such as discharge letters/summaries were processed quickly.

The service worked to safeguard people from the risk of abuse. This included working with partner agencies. There were systems and processes to respond when it was suspected that people may be subject to abuse or neglect.

Staff had been provided with safeguarding training at a level that was appropriate to their roles and responsibilities. Staff had a clear understanding of safeguarding and were able to tell us who the responsible lead for safeguarding and knew the action to take if they had concerns about a patient’s safety and they told us they would feel confident to report concerns. Alerts were added to the patient record system when a patient was subject to a safeguarding concern so that all relevant members of the staff team could readily identify this. The patient record system could alert staff to a vulnerable adult but there was no register for these patients.

Feedback from people who used the service did not include any concerns with regards to safeguarding.

Staff recruitment procedures were in place to ensure staff were appropriate to work in the service.

The service worked with people to understand and manage risks. The care and treatment provided was safe, supportive and encouraged people to remain healthy. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Staff were trained in areas to support people who lived with long term health conditions, for example, diabetes. Patients were called in for regular checks on their health when they were living with a long term condition.

The provider encouraged patients to attend for health screening. People who had not attended for cancer screening were followed up and encouraged to attend. Childhood immunisation uptake was high and met the World Health Organisation targets in all age categories.

Our review of the patient clinical record system showed that patients who were prescribed high risk medicines were being monitored effectively overall. We noted that a number of patients prescribed gabapentin were overdue checks. The provider told us how they planned to address this.

There was an effective system in place for dealing with patient safety alerts.

The service was located in a purpose built building that provided the required facilities such as safe access for people with physical disabilities. The premises were clean and contained the appropriate facilities to support infection prevention and control.

The provider detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were carried out on the premises, facilities and equipment provided. Contracts were in place to ensure the premises were clean and well maintained.

Health and safety related assessments and procedures to manage health and safety were in place. This included fire safety. Staff had been provided with training in health and safety related topics such as fire safety, infection control and manual handling. Staff told us in discussions and feedback forms that they had no concerns with the arrangements in place for ensuring health and safety.

There was a business continuity plan in place to provide guidance for dealing with a major disruption to the service, for example an IT failure.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and opportunities to develop. Staff told us they had protected learning time for them to undertake training, learning and professional development and that they had received training appropriate and relevant to their role.

Patients experienced care and treatment from a stable clinical team and consistency of care was provided as a result of this. Staff told us that they felt there were enough staff to provide safe, high quality care and they worked effectively as a team. There were appropriate arrangements in place for covering staff sickness, absence and vacancies and the use of temporary staff was minimal.

Feedback from people who used the service that was shared directly with CQC was overall highly positive with comments indicating high levels of satisfaction with members of the staff team.

We looked at the recruitment records for a sample of staff. These showed recruitment practices were carried out in line with requirements. However, not all staff had been required to provide evidence of their immunisation status.

All new staff underwent an induction programme and were required to undertake mandatory training within an appropriate timescale. Staff were provided with the support they need to deliver safe care.

The facilities and premises were appropriate to support cleaning and the spread of infection. Personal protective equipment was in good supply and located appropriately around the premises.

The provider assessed and managed the risk of infection. There were clear roles and responsibilities around infection prevention and control with a dedicated lead person. Staff had been provided with training in infection prevention and control and they told us they were aware of their roles and responsibilities in this. Cleaning schedules were in place and infection prevention control and cleaning audits were carried out on a regular basis. Cleaning equipment was stored securely and in line with best practice.

The provider made sure that medicines and treatments were safe and met people’s needs. We reviewed clinical records for patients who had been prescribed medicines which required routine monitoring. Our review showed that medicines were managed safely overall and the approach to medicines reflected current and relevant best practice and professional guidance. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. We did note that a number of patients who had been prescribed gabapentin had not undergone the required monitoring and patients with asthma who received rescue steroids had not always been followed up within the recommended timescales. The provider took immediate action to remedy these shortfalls.

Regular medicines reviews were carried out for people who used the service to ensure their medicines were appropriate to their needs and safe. The provider should consider reviewing standard operating procedures for managing repeat prescribing for patients who fail to attend for required health checks .

Staff had access to emergency medicines and equipment including oxygen and a defibrillator. These were regularly checked for stock availability and to ensure they were in date. Vaccines were stored appropriately, and regular checks were carried out to ensure safe storage and stock.

The provider had effective systems to manage and respond to safety alerts and medicine recalls. Appropriate action had been taken for the medicines alert we looked at.