We carried out an announced inspection at Dr Jerome Kaine Ikwueke on 22 July 2021. Overall, the practice is rated as Inadequate.
We had previously carried out an announced comprehensive inspection at Dr Jerome Kaine Ikwueke on 9 January 2017. At that time, the practice was rated as Good overall and Good for providing safe, effective, caring, responsive and well led services. The practice was also rated as Good for all six population groups.
Ratings for each key question (22 July 2021)
Safe - Inadequate
Effective -Requires Improvement
Caring – Good
Responsive - Requires Improvement
Well-led - Inadequate
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Jerome Kaine Ikwueke on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a focused inspection to follow up on information of concern we hold about the location.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Conducting staff interviews using video conferencing
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A short site visit
Our findings
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as Inadequate overall and requires improvement for all population groups.
We found that:
- There were inadequate systems in place to manage risks associated with emergency situations.
- When things went wrong, the approach to reviewing and investigating causes was insufficient.
- We saw instances of where care and treatment were not delivered in line with evidence-based guidance (for example regarding gaps in monitoring high risk medicines).
- Complaints were handled inappropriately and we did not see evidence of discussion, shared learning or how complaints led to improvements in the quality of care.
- Governance arrangements hindered the delivery of high-quality care (for example regarding staff induction arrangements and arrangements for acting on safety alerts).
- Patient feedback was above local and national averages regarding phone and appointments access. Patients fed back that they could access the right care at the right time.
We found two breaches of regulations. The provider must:
- Establish an effective and accessible system for identifying, receiving, recording, handling and responding to complaints.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.