All inspections: Dr Abdul-Kader Vania - Care Quality Commission

We carried out an unannounced inspection at Dr Abdul-Kader Vania on 8 February 2022. Overall, the practice remains rated as inadequate.

Safe - inadequate

Effective - inadequate

Caring – requires improvement

Responsive – inadequate

Well-led - inadequate

The practice was inspected by the Care Quality Commission (CQC) in January 2020 and was rated overall as requires improvement, with an inadequate rating for providing effective services. This led to a further inspection being undertaken in April 2021 to see if improvements had been made.

This practice was rated as inadequate at the inspection in April 2021, and was placed in special measures. Following the inspection, the practice was issued with four warning notices in relation to breaches of regulation 12 (safe care and treatment); regulation 13 (safeguarding service users from abuse and improper treatment); regulation 17 (good governance); and regulation 18 (staffing). A requirement notice was also issued in relation to regulation 12.

An inspection was undertaken in July 2021 to review compliance with the warning notices that were issued and had to be met by the end of June 2021. We found that the practice was mostly compliant with the warning notices, but further work was required in some areas, therefore further requirement notices were issued. The inspection was not rated and therefore the ratings remained unchanged.

This inspection on 8 February 2022 took place to review the practice’s special measures status, and also in response to a number of whistle-blowing allegations received by the CQC. Following our inspection, the practice is still rated as inadequate.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Abdul-Kader Vania on our website at www.cqc.org.uk

Why we carried out this inspection/review

This inspection was a comprehensive inspection to follow up on:

Areas of concerns which led to the practice being placed into special measures.
Breaches of regulations and ‘shoulds’ identified in previous inspection.
To seek assurances with regards to concerns reported to the CQC by a series of whistle-blowers

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account 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 less time on site. This was in line with all data protection and information governance requirements.

This included:

Conducting GP and practice staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records remotely to identify issues and clarify actions taken by the provider
Requesting evidence from the provider to be submitted electronically
The inspection incorporated both the GP practice and the private circumcision clinic held as these were registered with the CQC as one registration.

Our findings

This inspection looked at the following key questions;

Safe
Effective
Caring
Responsive
Well-led

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, with inadequate ratings for the four key questions of safe, effective, responsive and well-led. Caring is rated as requires improvement.

We found two breaches of regulations. The provider must:

Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

This service was placed in special measures in June 2021 (following our inspection in April 2021). Insufficient improvements have been made such that there remains a rating of inadequate for Dr Abdul-Kader Vania. Therefore, we are taking action in line with our enforcement procedures.

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

We carried out an announced focused inspection at Dr Abdul-Kader Vania on 15 July 2021 to review compliance with four warning notices issued following our previous inspection on 22 April 2021.

In April 2021, the practice was rated as inadequate overall and also for the key questions of safe, effective and well-led. The practice was placed into special measures. This inspection on 15 July 2021 was undertaken to review compliance with the warning notices which had to be met by 30 June 2021, but the inspection was not rated. The ratings from April 2021 therefore still apply and will be reviewed via a further inspection to take place within the next six months.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Abdul-Kader Vania on our website at www.cqc.org.uk

Why we carried out this inspection.

This inspection was a focused inspection to follow up on:

Compliance with warning notices issued in respect of breaches of regulation 12 (safe care and treatment); regulation 13 (safeguarding service users from abuse and improper treatment); regulation 17 (good governance); and regulation 18 (staffing).
A review of the standards of record-keeping associated with the private circumcision service provided on site.

How we carried out the inspection.

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account 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 interviews using video conferencing.
Undertaking remote access to the practice’s patient records system to identify issues and clarify actions taken by the provider and to discuss findings. This was in relation to safeguarding and circumcision patient records only.
Requesting evidence from the provider to be submitted electronically.
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 not rated this practice as the rating remains unchanged until we have completed a further inspection incorporating all relevant key questions.

However, we found that:

Action had been taken to address the breaches identified in the warning notices and it was evident that improvements had been made. However, we found that some required actions were ongoing and were not yet fully completed or embedded. These related to the warning notices for regulation 13 (safeguarding service users from abuse and improper treatment) and regulation 17 (good governance). As a result, the areas where the provider must make improvements are:

Ensure patients are protected from abuse and improper treatment.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We were satisfied that sufficient work had been completed to demonstrate compliance with the warning notices issued in respect of regulation 12 (safe care and treatment) and regulation 18 (staffing).

We also found that patient records for circumcisions were predominantly maintained in accordance with good record keeping guidance.

In addition, the provider should:

Continue to deliver the action plan supported by evidence, which should be reviewed and updated on an ongoing basis.
Further develop the inclusive and structured approach to improvement with the practice team and promote specialist input from local leads, for example the CCG’s safeguarding lead GP and infection control team
Improve staff awareness of key responsibilities, for example, safeguarding, dealing with complaints, and infection control.
Improve the uptake of cervical screening and childhood immunisations, building on the improvements made since our previous inspection.
Develop the evidence base for all employed staff and locums with regards their immunisations status in line with national guidance.

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

We carried out an announced inspection at Dr Abdul-Kader Vania on 22 April 2021. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - inadequate

Caring – not inspected

Responsive – not inspected

Well-led - inadequate

Following our previous inspection on 27 January 2020 the practice was rated requires improvement overall, and in the safe and well-led domains. The practice was rated as inadequate in the effective domain and in the working age people and families, and children and young people population groups. All other population groups were rated as good, as were the caring and responsive key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Abdul-Kader Vania on our website at www.cqc.org.uk

Why we carried out this inspection.

This inspection was a focused inspection to follow up on:

Breaches of regulations and ‘shoulds’ identified in previous inspection
Ratings carried forward from previous inspection

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account 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
The inspection incorporated both the GP practice and the private circumcision clinic held on site twice a week.

Our findings

This inspection looked at the following key questions;

Safe
Effective
Well-led

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 inadequate for the population groups of people with long-term conditions, families, children and young people, and working age people. The population groups of older people, people whose circumstances make them vulnerable, and people experiencing poor mental health (including dementia) are rated as requires improvement.

We found four breaches of regulations. The provider must:

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

In addition, the provider should:

Review the remote searches undertaken by the GP specialist advisor and take action to learn and make improvements in relation to medicines management.
Develop and improve the approach to the Accessible Information Standard, particularly in respect of providing information in languages appropriate for their patients.
Continue to identify and support carers, with a focus towards younger carers due to the demographics of their registered patients.
Review and improve access and the availability of appointments, particularly for patients to be offered a choice in when they see the nurse.
Implement reviews of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) notices to be undertaken if they are not determined as being indefinite.

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.

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

We carried out an announced comprehensive inspection at Dr Abdul-Kader Vania on 27 January 2020. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions;

Safe
Effective
Caring
Responsive
Well-led

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 requires improvement overall and in the safe and well-led key questions. The practice is rated as inadequate in the effective key question and the “Working age people” and “Families, children and young people” population groups. All other population groups were rated as good, as were the caring and responsive key questions.

We rated the provider as inadequate for providing effective services because;

The practice cervical screening and childhood immunisations uptake rates were lower than local and national averages. Although aware of this, the practice was unable to demonstrate any actions taken to address this.
The provider was unable to evidence that systems were in place or working effectively in relation to sharing information with other organisations or professionals. For example, Multi-Disciplinary Team (MDT) meetings or those involving health visitors.
In addition, the practice was also unable to demonstrate that the system in place to ensure quality improvement was fully effective or being used to make improvements.

We rated the provider as requires improvement for providing safe and well-led services because;

The practice was not always able to demonstrate that systems in place to consider or mitigate risks were effective, or that there was an overall system of oversight to ensure systems were updated or working as intended.
Prior to the new management, the practice was unable to demonstrate that systems to keep patients fully safe or to oversee systems and process in relation to overall governance, were effective or working as intended, which led to gaps in risk management and overall governance systems. During the inspection, the practice was unable to demonstrate that all of these had yet been resolved, but the practice was aware of the majority of these and assured us that action would be taken to address these as soon as practicable. Systems put in place since December 2019 were not yet fully embedded.

We rated the provider as good for providing caring and responsive because;

The practice demonstrated that patient feedback was reviewed and acted upon where necessary and satisfaction levels in relation to both the caring key question and access to care and treatment were in line with local and national averages.

The areas where the provider MUST make improvements are;

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 areas where the provider SHOULD make improvements are;

Review cancer screening and childhood immunisation uptake systems to ensure that improvements in uptake are made.
Ensure that oversight of training for staff is fully established and staff remain up to date.
Review arrangements for appraisals and support mechanisms for staff to ensure that learning and development needs are addressed, and staff are held to account.
Continue to identify and support those who are in a caring role.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Abdul-Kader Vania on 28 January 2016. Overall the practice is rated as good.

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

There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

Risks to patients were assessed and well managed.

Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

The practice had good facilities and was well equipped to treat patients and meet their needs.

A clinical pharmacist worked in the practice on a regular basis to carry out medicines and prescribing audits.

There was a clear leadership structure and staff felt supported by management. The practice proactively sought 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 should make improvements are:

Ensure all individual policies and procedures are dated and include a review date in-line with the dates held on the software system used to coordinate and store all policies and procedures.
Ensure the practice zero tolerance policy is displayed for patients.
Ensure translation services are promoted for patients to ensure they are aware of these services available to them.
Ensure a process is in place to record all informal complaints received and actions taken.
Ensure a process is in place to cross check the temperature of the vaccination fridge.
Ensure a process is in place to reduce the probability of accidental interruption of the electricity supply.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: Dr Abdul-Kader Vania Also known as Ar-Razi Medical Centre

All Inspections

8 February 2022

During a routine inspection

15 July 2021

During an inspection looking at part of the service

22 April 2021

During an inspection looking at part of the service

27 January 2020

During a routine inspection

28 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)