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Dr Kodaganallur Subramanian Requires improvement

Reports


Inspection carried out on 23 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kodaganallur Subramanian on 20 December 2016 and 24 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the December 2016 and January 2017 inspections can be found by selecting the ‘all reports’ link for Dr Kodaganallur Subramanian on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 23 October 2017. Overall the practice is now rated as requires improvement.

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

  • There was an effective system for reporting, recording, investigating and learning from significant events. However, two recent incidents had not been investigated in a timely manner.
  • There was an ineffective system for reviewing and cascading safety alerts.
  • Improvements to risk management had been made. However, some risks to patients, staff and visitors were not adequately assessed and well managed.
  • There had been improvements in arrangements to deal with emergencies and major incidents.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) demonstrated a positive change in patient outcomes. However, further improvements were still required to benefit patients.
  • Some new staff members had not completed necessary training including Safeguarding, chaperoning and equality and diversity.
  • The practice followed up patients recently discharged from hospital and had worked with other health care professionals when necessary to understand and meet the range and complexity of patients’ needs.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to book appointments with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Improvements to governance arrangements at the practice had taken place. However, further improvements to risk assessment, governance and management were found to be required.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are;

  • Record the daily visual checks of the cleanliness of the practice environment.
  • Increase uptake of childhood immunisations.
  • Consider installing a hearing loop for patients who are hearing aid users.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 20 December 2016 and 24 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kodaganallur Subramanian on 20 December 2016 and 24 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the December 2016 and January 2017 inspections can be found by selecting the ‘all reports’ link for Dr Kodaganallur Subramanian on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 23 October 2017. Overall the practice is now rated as requires improvement.

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

  • There was an effective system for reporting, recording, investigating and learning from significant events. However, two recent incidents had not been investigated in a timely manner.
  • There was an ineffective system for reviewing and cascading safety alerts.
  • Improvements to risk management had been made. However, some risks to patients, staff and visitors were not adequately assessed and well managed.
  • There had been improvements in arrangements to deal with emergencies and major incidents.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) demonstrated a positive change in patient outcomes. However, further improvements were still required to benefit patients.
  • Some new staff members had not completed necessary training including Safeguarding, chaperoning and equality and diversity.
  • The practice followed up patients recently discharged from hospital and had worked with other health care professionals when necessary to understand and meet the range and complexity of patients’ needs.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to book appointments with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Improvements to governance arrangements at the practice had taken place. However, further improvements to risk assessment, governance and management were found to be required.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are;

  • Record the daily visual checks of the cleanliness of the practice environment.
  • Increase uptake of childhood immunisations.
  • Consider installing a hearing loop for patients who are hearing aid users.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 2 October 2013

During a routine inspection

We spoke to people visiting the surgery on the day of our inspection. People told us they were happy with the service provided by the GP at the practice. One person said, “it is brilliant here. I have received excellent care.” Another person told us that “the GP has improved in recent years. To get an appointment it has never been a problem.”

We found that people's care was planned and delivered in a way that met their individual needs and that the practice co-operated with other healthcare professionals and services.

We also found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children and staff we spoke with were aware of these procedures.

We found that people's privacy and dignity was respected.

The provider had effective recruitment procedures in place to ensure only suitable staff were employed at the service.

You can see our judgements on the front page of this report.

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone.