The Care Quality Commission
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Archived: The Shehadeh Medical Centre

Overall: Requires improvement read more about inspection ratings

Quebec Road, Tilbury, Essex, RM18 7RB (01375) 842396

Provided and run by:
Dr Emil Shehadeh

All Inspections

14/10/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Emil Shehadeh on 14 October 2015. This inspection was in follow up to our previous comprehensive inspection at the practice on 2 December 2014 where breaches of legal requirements were found. The overall rating of the practice following the 2014 inspection was inadequate and the practice was placed into special measures for a period of six months. After the December 2014 inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to safe, effective and well-led services.

At our inspection on 14 October 2015 we found that the practice had improved. The two requirement notices we issued following our previous inspection related to the safe and effective delivery of care and both had been met. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as requires improvement overall, and specifically requires improvement for providing safe and well led services, and good for providing effective, caring and responsive services.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • Arrangements to safeguard children and vulnerable adults by the detection of suspected non-accidental injury were robust and well managed.
  • Patients told us that they felt well cared for and were treated with dignity and respect.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Patients told us that it was easy to contact the practice and they could get an appointment when they needed one.
  • Risks relating to infection prevention and control also ensuring staff had received the necessary training required better management.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that the risks to patients, staff and visitors from healthcare associated infections are minimised by establishing, and if required taking action on, the immunity of staff to vaccine preventable illnesses.
  • Ensure that accurate and required records are kept of staff members’ suitability for employment and have oversight of the training they have undertaken.

In addition the provider should:

  • Consider the implementation of guidance issued by Public Health England on the storage of vaccines. In particular, consideration of a second method of checking fridge temperature that is independent of mains power. Also, to minimise the risk of mains power to the fridge being turned off unintentionally.
  • Review the practice infection prevention and control policy and appoint responsibility and governance to a suitably trained and skilled person to carry out the role.
  • Expand practice held emergency medicines to include treatments for a sudden drop in a patient’s responsiveness level due to hypoglycaemia (low blood sugar) or prolonged seizures (fitting).
  • Evaluate the methods of gathering feedback from patients, to ensure they reflect a wider representation of patients registered at the practice.

I confirm that this practice has improved sufficiently to be rated requires improvement overall. This practice will be removed from special measures.

Further progress must be made; therefore we will re-inspect the practice in 2016 to ensure the requirements of further improvements detailed in this report have been met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

On 2 December 2014 we conducted an announced comprehensive inspection of Dr Emil Shehadeh. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective and well led services. It was also inadequate for providing services for the all the population groups. Improvements were also required for providing caring and responsive services.

Our key findings across all the areas we inspected were as follows:

  • Patients we spoke with on the day of our inspection told us they were happy overall with the service. Comments from the National Patient Survey and the practices own patient survey, were mixed. Patients reported experiencing difficulties accessing appointments. In response, the practice had introduced walk in clinics to meet patient demand for on the day appointments.
  • Patients reported receiving a variable service with some staff were polite, supportive, kind and respectful to them. The practice has spoken with staff and are arranging customer service training for them.
  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, we found no infection control audit had been conducted, staff had not received training in infection control and the cleaning schedules were not comprehensive to reflected enhanced risks in relation to minor surgical procedures. We found there was no medicine management policy or repeat prescribing policy in place and no system to ensure patient medication reviews were organised, conducted and recorded in a timely and appropriate way.
  • There was insufficient assurance to demonstrate people received effective care and treatment. For example, we found there was no system in place for the management of patients receiving Lithium used to treat manic depression. We also found there were not robust systems in place to ensure the timely review of patient results when the GP was on leave and out of the country.
  • Staff understood how to report incidents, near misses and concerns but there was no recorded evidence of learning and communication with staff.
  • The practice had clear leadership structure, but limited formal governance arrangements, discussions and decisions were not recorded.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure the safe prescribing and monitoring of patients receiving medicines.
  • Ensure risks are identified and appropriately managed, Such as, ensuring there are robust systems in place to ensure the timely review and actioning of test results, risks are identified and appropriately managed in respect of employing effective cleaning systems and risks are assessed for staff undertaking chaperone duties.
  • Ensure there are arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to their care and treatment.

In addition the provider should:

  • Ensure staff who carrying out chaperone duties are appropriately trained to undertake the role.
  • Ensure patients can access a translation service to enable them to fully understand and engage in decisions relating to their care and that of those they are responsible for.
  • Consider the tone of practice literature on patients.
  • Develop a whistleblowing policy and ensure staff are aware of how to access it and follow the procedure.
  • Ensure accurate record keeping in respect of meetings and decision making.

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 vary the provider’s registration 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice