Aylesford Medical Centre

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 Requires Improvement.

We found; one breach of the legal regulations in relation to safe care and treatment. Safeguarding systems, processes and practices; complaints management, infection prevention and control (IPC) systems and procedures and medicines management were not always sufficient.

Following our site visit, the provider sent us evidence of improvements they were intending to make in response to our findings. For example, implementing new policies, procedures and processes. However, these needed time to be implemented and embedded effectively. The evidence also included actions taken to recall patients for routine tests required as part of monitoring processes.

We will review these improvements at our next assessment.

This service scored 56 (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. However, improvements were required.

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. However, improvements were required for complaints management, as this was not conducted in line with the providers own complaints policy.

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.

The practice provided minor procedure services. The provider was not maintaining appropriate records of procedures undertaken. We were told this was recorded in people’s records. There was no log of when or what procedure had been undertaken, dosage/administration of local anaesthesia, when samples had been sent to histology and when the results had been returned and the patient informed. Policies and procedures to underpin this were also not in place.

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. However, improvements were required.

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 not appropriately placed on patients records, nor on 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. 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 risks identified had been addressed. There was a business continuity plan which was monitored and reviewed.

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. 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 service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. However, improvements were required.

The practice had a designated infection, prevention and control lead and all staff had had relevant training. There were cleaning schedules which were followed. Risk assessments and audits were completed. The infection prevention and control (IPC) audits were not in line with the Integrated Care Boards IPC toolkit and required more detail of actions to be taken to address issues identified and by when.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Staff involved people in reviews of their medicines and helped them understand how to manage their medicines safely. However, this was not always 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. Staff received regular training. We were told staff were competency assessed for medicines optimisation. However, there was no policy or written records to support this.

Staff managed prescription stationery appropriately and securely. Staff did not always follow protocols to ensure they prescribed all medicines safely, as medicines reviews were not always recorded appropriately, and monitoring did not always ensure that people had up to date blood tests taken before prescribing medicines.

Medicines were not always stored securely, vials of medicines used for joint injections and local anaesthesia were found in an unlocked cupboard. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. There was evidence of missed daily fridge temperature monitoring records. We found 7 occasions when the fridge temperature had not been recorded and the data from an internal thermometer, was downloaded significantly after these events. There was no system for recordings to be maintained when the designated persons were absent from the practice. Therefore, potential risks of the medicines being stored at the incorrect temperature would not be identified quickly enough to ensure their efficacy.

Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. At the time of our site visit, the provider was unclear about the systems to manage and respond to safety alerts and medicine recalls. Evidence submitted following our site visit showed there was a process being completed by the primary care network pharmacist.

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. However, we found some exceptions. For example,staff did not always follow established processes to ensure people prescribed medicines with specific risks received recommended monitoring. There was no policy or process to ensure primary care network staff undertaking reviews were completing the appropriate monitoring checks. Staff did not always take the recommended steps to ensure they prescribed medicines appropriately to optimise care outcomes. Prescribing data reviewed as part of our assessment confirmed this. For example, we identified that incorrect doses of steroids had been prescribed and prescribed over the telephone (with no face to face (F2F) consultation of the patient) and in 2 cases where a F2F consultation had occurred but there was no blood pressure or peak flow rate recorded. There was a programme of regular clinical audits of prescribing that focused on improving care and treatment.