Cobalt Health

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 5 quality statements in the safe key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at learning culture during this assessment. The score for this quality statement is based on the previous rating.

We did not look at safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating.

The leaders provided notes of the benefits that staff received for working for the organisation which included occupational health services, webinars on a variety of self help and supportive topics, and the use of mental health first aiders to support staff. Staff stated that the culture was open and supportive and staff were actively engaged and fed ideas and suggestions into future plans and well being initiatives.

All staff we spoke to were clear on their role and responsibilities to identify and report abuse. All staff could name the types of abuse and we were given 2 examples where staff had sought advice and worked with other healthcare partners including GPs and the local authority to safeguard vulnerable people. Posters were displayed for patients, visitors and staff in all areas we visited. All staff had undertaken level 2 safeguarding adults and children training and had access to a lead who was level 3 trained. When patients with cognitive decline attended for examinations from other care settings, staff ensured patients were accompanied by their notes and identification and preference forms such as forget me not. Staff were clear that since there had been a change in senior leadership and realignment of middle managerial structures, there was much better and cohesive cross modality working and awareness. All staff we spoke to were aware of the duty of candour and could explain what it meant.

We did not look at involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating.

Staff were knowledgeable about safety protocols to reduce risk for patients and staff. Managers used a schedule of quality assurance checks to ensure equipment was safe to use. Maintenance agreements were used and staff could access maintenance and repair services between scheduled visits if required. Staff were trained in the use of specialist equipment. Practical training scenarios were used to embed staff knowledge and skills.

The service maintained standards of cleanliness and hygiene and all areas of the departments we visited were visibly clean. All oxygen cylinders we saw were stored correctly and we saw warning signs alerting people to their presence. Oxygen was not given in any circumstance other than an emergency or if a patient had pre-existing prescription for it. Resuscitation equipment was readily available, adequately stocked and there was evidence of regular review. The service employed paramedics who over saw the checking and restocking of all resuscitation equipment. The service used grab bags as they were more portable and could be carried upstairs if necessary. All relevant MRI equipment was labelled in line with MHRA recommendations. In the event of an emergency, the service’s evacuation policy was to bring the patient and the equipment outside of the MRI magnetic field. We saw all equipment needed for an evacuation was marked MRI safe and any equipment such as portable suction was clearly marked as not MRI safe. The imaging service ensured that where ionising radiation or magnetic fields were used, there were arrangements to control the area and restrict access to those areas. All areas were key code controlled and there were visual and physical warnings and barriers at the entrance to all rooms where ionising radiation or magnetic fields were in use. In addition, in PET/CT, patients were given individual rooms to wait in after their radioactive injections.

Staff spoken with confirmed that supervision and appraisals were undertaken and there were appropriate training opportunities. Radiographers who worked out on mobile units, also visited the static site, so gaps in rota's could be filled without the need for agency use.

The provider used a protocol which ensured that minimum radiographic staffing levels were understood for the safe operation of imaging equipment. The document stated that 'If staffing levels fell below the minimum level the equipment should not be operated'. Records were kept on retention of employees and staff training and development was supported by the provider who ensured that staff attended internal and external training with networking opportunities to meet their clinical and continuing professional development needs. To ensure new staff were qualified, skilled and experienced the provider used a new starter checklist which ensured that all requirements were met. All staff were required to undergo a disclosure and barring service (DBS) upon commencement of employment and certificate dates and numbers were kept confirming this.

All staff we spoke with understood infection prevention and control and had participated in infection prevention and control training. Staff and leaders explained the cleaning processes and were able to describe enhanced infection prevention and control measures they would take when working with medically vulnerable patients.

All areas of the departments we visited were visibly clean and in PET/CT flooring had been adapted to carry on up the wall to remove gaps where skirting boards would have met the flooring. Staff we spoke to explained that if they had a medically vulnerable patient or if someone expressed concerns, staff were happy to wear masks for the duration of that patient’s appointment. Staff undertook mandatory training in waste management. Each department had a series of infection prevention and control checks staff needed to compete each day. All staff we spoke to understood the basic principles of hand hygiene and could explain the limitations of alcohol gel. We saw staff decontaminating their hands before and after patient contact using both alcohol gel and handwashing. We saw the departments we visited had ample supplies of PPE including in MRI where the department had metal free MR safe masks. In all areas we visited, we saw staff used waste bags correctly and tied and stored them in line with policy and best practice guidance. All waste, including sharps bins was stored safely.

Prescribing Patient Group Directions were in place and for specialist procedures, medicines were prescribed and administered by doctors. The service had employers procedures in nuclear medicine and the service had a lead practitioner (radiologist) who held an Administration of Radioactive Substances Advisory Committee ARSAC certificate for the administration of each radiopharmaceutical used. The service performed allergy and safety checks prior to contrast administration. Information was provided to patients before they attended for their scan. This included information about the length of time they would need to be in the department and if they needed an injection as part of their scan. Consent to cannulate was obtained verbally and documented by staff. Before cannulating, staff obtained the patients’ consent to have the contrast injection which they could decline. Contrast media were stored correctly and the rooms in which they were stored were temperature controlled and monitored to ensure medicines were stored in line with manufacturer guidance. Oxygen cylinders were stored correctly and there were warning signs to alert people to their presence.

Medicines were ordered, transported, stored and disposed of safely and securely. Contrast in both MRI and CT was securely stored at the recommended temperature range and rooms were temperature controlled and monitored. Saline and other medicines were securely stored and there were effective systems to sign medicines in and out. Medicines such as local anaesthetics, were risk assessed and documented so they could be administered by staff. All medicines were stored securely and only radiologists administered the local anaesthetic's and other medicines used for some specialist procedures. Staff used the Society of Radiographers pause check guidance to make sure the right patient got the correct scan