10 and 17 September 2020
During an inspection looking at part of the service
We carried out an announced focused inspection at Dr Ravinsendra Muthiah on 10 and 17 September 2020.
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. We obtained the information in it by undertaking a remote clinical records review, desk-based inspection and a short on-site visit at the practice premises. As part of the desk-based inspection a GP specialist advisor spoke with the Lead GP by telephone and we have reviewed documentary evidence submitted by the practice.
The practice was previously inspected on 11 February 2020. Following this inspection, the practice was rated Inadequate overall and in the safe, effective and well-led domains and placed in special measures. We issued warning notices for breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance). The practice was required to address the concerns regarding Regulation 12 by 08 April 2020 and for Regulation 17 by 10 June 2020.
We did not review the ratings awarded to this practice at this inspection.
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 found the provider had made not made sufficient improvements in providing safe services regarding:
- The safe management of medicines.
- Safe care and treatment including missed diagnoses.
- Safeguarding systems.
- Recruitment checks.
- Infection prevention and control.
- The management of patient safety alerts.
- Fire safety practices.
- Premises management.
- Premises risk assessments.
- Cold chain.
We found the provider had not made sufficient improvements for providing effective services regarding:
- Staff did not have the skills, knowledge and experience to deliver effective care, support and treatment.
- Clinical supervision for the healthcare assistant
- Appraisals for the healthcare assistant.
We found the provider had not made sufficient improvements to concerns we found in the well led domain. They could not demonstrate they had:
- Effective processes in place for managing risks, issues and performance.
- A fail-safe system to monitor and manage patients who had been referred via the urgent two week-wait referral system.
- A fail-safe system to monitor and manage patient safety alerts.
- A fail-safe system in place to safely manage and monitor cervical smear screening.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The service will remain in special measures until we have undertaken the next inspection and this will be reviewed at that time. This will be kept under review and if needed could be escalated. 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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care