What is the Quality of Safety at Bracknell Urgent Care Centre

Positive

"• The provider has policies for staff regarding privacy dignity and confidentiality."

Positive

"• Curtains were provided in treatment rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Neutral

"• Whilst the reception was open patients we spoke with did not raise issues about their privacy being compromised."

Positive

"Curtains were provided in consulting rooms so that patients’ privacy and dignity was maintained during examinations investigations and treatments."

Positive

"• Patients were treated in a clean and tidy environment and their privacy was respected."

Neutral

"We observed that consultations and treatment with both the GP and the nurses took place in the privacy of a consulting or treatment room."

Positive

"Our key findings across all the areas we inspected were as follows: • The service had a clear vision that had improvement of service quality and safety as its top priority."

Positive

"The centre had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health infection control and a legionella risk assessment Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"The maintenance issue had been resolved and the waiting area was in the original location in clear view of both the reception desk and nurse assessment area ensuring patients safety and wellbeing was continually monitored."

Positive

"The service had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken."

Positive

"• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events."

Positive

"Lessons were shared to make sure action was taken to improve safety in the service."

Positive

"There was a health and safety policy available with a poster in the communication corridor leading to offices and kitchen facilities which identified local health and safety representatives."

Positive

"However we still found concerns specifically related to the effectiveness safety and governance of the service."

Positive

"When there were unintended or unexpected safety incidents patients received reasonable support truthful information a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again."

Positive

"This included increasing the number of staff at the centre supporting patient demand ensuring clinical safety and supporting the local health economy resilience."

Positive

"• When there were unintended or unexpected safety incidents patients received reasonable support truthful information a verbal and written apology."

Positive

"We reviewed safety records incident reports national patient safety alerts and minutes of meetings where these were discussed."

Positive

"This affected patient flow and patient safety as the services team stabilised and managed patient care until the ambulance arrived."

Positive

"A receptionist would also complete a brief set of safety questions ruling out chest pain shortness of breath and heavy blood loss ensuring the patient was safe to wait to see an assessment nurse."

Positive

"• Staff received training that included: health and safety fire procedures basic life support and information governance awareness."

Positive

"The service had systems in place for knowing about notifiable safety incidents."

Positive

"When there were unexpected or unintended safety incidents: • The service gave affected people reasonable support truthful information and a verbal and written apology."

Neutral

"It covered such topics as infection prevention and control fire safety health and safety and confidentiality."

Positive

"However the sharing of information following such events still required improvement and it was too early to determine whether the new system was effectively improving safety openness and transparency."

Positive

"However we still found concerns specifically related to the effectiveness safety and governance of the service."

Positive

"• Some information about safety was recorded monitored appropriately reviewed and addressed."

Positive

"National patient safety alerts and medication alerts were disseminated among staff and action taken to ensure patient safety."

Positive

"We noted that locum GPs had a very limited access to One Medicare Ltd policies and internal systems which they needed to access supporting information in relation to the safety care and treatment of patients."

Positive

"Monitoring safety and responding to risk The service had systems processes and policies in place to manage and monitor risks to patients staff and visitors to the service."

Positive

"For example reported incidents and national patient safety alerts as well as learning from complaints received from patients."

Positive

"Reliable safety systems and processes including safeguarding The service had systems to manage and review risks to vulnerable children young people and adults."

Positive

"The service also had a health and safety policy."

Positive

"The provider had not assessed the safety risk if clinicians were not able to access key policies procedures or Are services wellled?"

Neutral

"The service had an induction programme for new members of staff that covered such topics as safeguarding fire safety health and safety and confidentiality."

Positive

"Our findings Safe track record Bracknell Urgent Care Centre received safety alerts from One Medicare Ltd’s head office and it was the responsibility of local management to ensure action was taken."

Positive

"All staff were fully trained on the system and commented positively about the system’s safety and ease of use."

Positive

"Induction training and the mandatory training package for staff covered various aspects of health and safety including fire safety control of substances hazardous to health COSSH and lone working."

Positive

"Learning and improvement from safety incidents The service had a system in place for reporting recording and monitoring significant events."

Positive

"Although the service carried out investigations when things went wrong lessons learned were not communicated consistently and so safety was not improved."

Positive

"The provider produced an action plan for the CCG and had assured them that measures would be put in place to improve patient safety and waiting times."

Positive

"One described their induction as being given access to important policies and procedures being briefed on the health and safety procedures and being taught their job by other staff of a similar grade."

Positive

"Whistle blowers who spoke with us after the inspection confirmed that most of the staff had left because they felt the management of systems and processes were not robust and patient safety was at risk."

Positive

"There were records showing that senior officers of One Medicare Ltd undertook quarterly safety inspections."

Positive

"There was evidence that the provider had responded to earlier safety concerns relating to staffing levels at weekends."

Positive

"Reliable safety systems and processes including safeguarding The service had systems to manage and review risks to vulnerable children young people and adults."

Positive

"Another member of staff said their induction comprised nine hours of being taken through the provider structure and essential health and safety procedures."

Neutral

"Staff received an induction that covered health and safety essentials including fire safety and maintaining confidentiality."

Neutral

"We saw that these staff had attended one half day of training organised by the CCG and had also completed the provider’s mandatory health and safety training."

Neutral

"There was a record of nurses attending one study afternoon organised by the CCG and records of their mandatory safety training."

Positive

"Staff we spoke with knew how to recognise signs of abuse in older people vulnerable adults and children."

Positive

"The centre had a variety of other risk assessments in place to monitor safety of the premises such as control of substances hazardous to health infection control and a legionella risk assessment Legionella is a term for a particular bacterium which can contaminate water systems in buildings."

Positive

"We saw recent audits for infection control sepsis xray prescribing and needle stick safety."

Neutral

"The service had a lead for infection control who had undertaken further training to enable them to provide advice on the service infection control policy and carry out staff training."

Neutral

"All staff received induction training about infection control specific to their role and received annual updates."

Positive

"Cleanliness and infection control We observed the premises to be clean and tidy."

Positive

"An infection control policy and supporting procedures were available for staff to refer to which enabled them to plan and implement measures to control infection."

Neutral

"The service had a lead for infection control who had undertaken further training to enable them to provide advice on the service infection control policy and carry out staff training."

Neutral

"All staff received induction training about infection control specific to their role and received annual updates."

Neutral

"For example the infection control policy did not refer to the layout of the premises or clinical areas at the site and referred to protocols related to treatment which did not take place at the service."

Positive

"Cleanliness and infection control The centre was visibly clean and tidy."

Positive

"An infection control policy and supporting procedures were available for staff to refer to which enabled them to plan and implement measures to control infection."

Neutral

"The provider had a lead for infection control who had undertaken further training to enable them to provide advice on the infection control policy and carry out staff training."

Neutral

"All staff received induction training about infection control specific to their role."

Positive

"• When patients arrived at centre there was clear signage which streamed patients to the reception area."

Positive

"• Patients said they were treated with compassion dignity and respect and they were involved in decisions about their care and treatment."

Positive

"• We saw staff treated patients with kindness and respect and maintained patient information confidentiality."

Positive

"All five patients reported that they felt that all the staff treated them with respect listened to and involved in their treatment."

Positive

"• The provider has policies for staff regarding privacy dignity and confidentiality."

Positive

"• Curtains were provided in treatment rooms to maintain patients’ privacy and dignity during examinations investigations and treatments."

Positive

"Patients said they were treated with compassion dignity and respect and they were involved in decisions about their care and treatment."

Positive

"We also saw that staff treated patients with kindness and respect and maintained confidentiality."

Positive

"Patients were treated with dignity and respect."

Positive

"Some staff felt they were not treated with respect when they did report concerns."

Positive

"Curtains were provided in consulting rooms so that patients’ privacy and dignity was maintained during examinations investigations and treatments."

Positive

"Patients said they were treated with compassion dignity and respect and they were involved in decisions about their care and treatment."

Positive

"• Patients were positive about their interactions with staff and said they were treated with compassion and dignity."

Positive

"We found that staff concerns were raised in respect of these matters but appropriate action had not always been taken."

Positive

"We also saw that staff treated patients with kindness and respect and maintained confidentiality in an environment that made this difficult."

Positive

"Adjustments to staffing and service delivery in respect of this data had not implemented and the provider continued to operate the service on the staffing levels initially set to meet forecast demand."

Positive

"Tackling inequity and promoting equality The provider had access to a telephone translation services."

Positive

"The service did not provide equality and diversity as part of the mandatory training package."

Positive

"None of the patients we spoke with had ever needed to make a complaint about the service."

Positive

"We saw evidence of dissemination of complaint information in the form of emails and during daily morning briefing meetings known as ‘huddles’."

Neutral

"We saw that information was available to help patients make a complaint or comment on the service they received through a leaflet displayed onsite."

Positive

"• There was an overarching governance framework which supported the delivery of the strategy and good quality care."

Positive

"• The service had an effective governance system in place was well organised and actively sought to learn from previous Care Quality Commission inspections performance data complaints incidents and feedback."

Positive

"• Findings were used by the centre to improve services and patient outcomes; one example was a review of antimicrobial prescribing habits within Bracknell Urgent Care Centre ensuring prescribing guidelines and clinical governance was being adhered."

Positive

"However we still found concerns specifically related to the effectiveness safety and governance of the service."

Positive

"Governance arrangements At the previous inspection we found inadequate governance arrangements specifically there was limited involvement in governance from staff who worked at the centre."

Positive

"The provider s head office had strategic systems for governance which were cascaded to the individual centres they provided care from."

Positive

"The latest report relating to a breach in regulation with regards governance arrangements."

Positive

"• Staff received training that included: health and safety fire procedures basic life support and information governance awareness."

Positive

"For example there was limited involvement in governance from staff who worked at the centre."

Neutral

"The centre had a number of service specific policies and procedures to govern activity and held regular governance meetings."

Neutral

"The limited governance systems that were in place were unclear and not always effective."

Positive

"The delivery of high quality of care was not always assured by effective governance procedures."

Positive

"However we still found concerns specifically related to the effectiveness safety and governance of the service."

Positive

"The provider s head office had strategic systems for governance which were cascaded to the individual centres they provided care from."

Positive

"However nurses and receptionists employed at the centre did not have the opportunity to provide feedback via meetings and were not involved in the governance structure."

Positive

"There was limited involvement in governance from staff who worked at the centre."

Positive

"The minutes of the meetings we reviewed showed that significant events were discussed at clinical governance meetings."

Positive

"At the time of inspection there was no clinical lead at the centre but the new lead was due to start working in midOctober and part of their role would be attending clinical governance meetings."

Positive

"Local Bracknell Urgent Care Centre staff were also not present at the provider governance meetings."

Neutral

"Clinical governance meeting minutes included senior clinicians and managers from One Medicare Ltd who were not always present at the site and who did not provide patient services."

Neutral

"Therefore staff who understood the provision of services at the centre were not involved in the governance arrangements or decisions."

Positive

"The complaints were fully recorded and we saw they were reported to the provider and were discussed at provider level governance meetings."

Neutral

"The provider held regular governance meetings but outcomes from the governance meetings were not communicated consistently."

Neutral

"The minutes of the meetings showed us that the governance group identified any trends in events."

Neutral

"We saw minutes of the One Medicare Ltd integrated governance committee."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"The delivery of high quality of care was not always assured by effective governance procedures."

Positive

"This report describes our judgement of the quality of care at this service."

Positive

"This report describes our judgement of the quality of care at this service."

Neutral

"Between the first and second inspections we received further information from a whistleblower telling us that significant events were not being reviewed thoroughly and that actions identified to prevent similar occurrences in the future were not always reported back to staff at the service."

Positive

"• There was an increase in quality monitoring including clinical audit which demonstrated quality improvement."

Positive

"There was also minimal quality monitoring with a limited clinical audit programme."

Positive

"There was minimal quality monitoring such as clinical audit but contract monitoring did take place."

Positive

"There was minimal quality monitoring to identify improvements such as clinical audit."