Dr Kanjana Paramanathan

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had not fully embedded systems to ensure learning from incidents and complaints was consistently shared and used to improve safety Lessons were not always learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. The provider had processes for staff to report incidents, near misses and safety events, however we found limited evidence to demonstrate that significant events and incidents were used to share learning and mitigate future risks. Evidence provided showed the practice had recorded 2 incidents in the past 12 months, however there was no record of any other incidents having been recorded in the last 2 years. On reviewing the minutes of staff meetings, we found no evidence to demonstrate that incidents or significant events were a standing agenda item, or learning was shared with the team to mitigate future risks.

A complaints form was in place and details on the practice website of how to raise a complaint, however we were not assured there was a system to record and investigate all complaints.

There was evidence that the learning from written complaints was shared with the practice team to improve patient satisfaction, however, verbal complaints were not being documented. Following the onsite assessment, we received assurances that a system had been implemented where all verbal complaints were going to be recorded and monitored by the leadership team. This also included ensuring learning was shared with the team to mitigate future risks and improve patient satisfaction.

Information reviewed demonstrated that people had opportunities to provide feedback.

We received mixed responses to how often practice meetings were held. We found meetings were held on average every three months, however there was no set timetable, it was dependant on whether the leadership team had anything they needed to discuss with the team.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Effective systems were in place for processing information relating to new people including the summarising of new records. The service worked with other providers to deliver shared care and when patients moved between services. We found clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance. This was supported by a system in place to ensure all patient information including laboratory test results and referrals were reviewed and actioned in a timely manner.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding policies were in place and known to staff, who were appropriately trained in safeguarding procedures. The practice maintained a list of vulnerable people and acted on concerns working in partnerships with other organisationsand safeguarding concerns were discussed as part of the practice team meetings to ensure all staff were kept up to date.

There was a safeguarding lead for children and adults, and all staff were aware of who to speak to if they identified a safeguarding concern.

There was a policy in place for the renewal of DBS checks. Records we examined showed that all staff had a DBS check in place. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

All staff were trained in basic life support and staff could recognise a deteriorating patient. They knew of the action to take if they encountered a deteriorating or acutely unwell patient and had been given guidance on identifying such patients. Patients were advised on risks related to their condition and actions to take if their condition deteriorated. Emergency equipment was available and maintained.

The practice maintained registers of patients with additional vulnerabilities, which were used to identify and address risks associated with mobility, communication and access to care.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety related assessments and procedures to manage health and safety were in place. A health and safety risk assessment had been completed in October 2025. Regular monitoring was in place to ensure guidelines were adhered to and all staff had been made aware of the appropriate procedures to follow.

The majority of staff had been provided with training in health and safety related topics such as fire safety, infection control, basic life support and resuscitation training, however the clinical lead had not completed training updates in health and safety. Following the onsite assessment, we received assurances that all training updates had now been completed.

There were policies and procedures in place for the management of health and safety. Fire safety policies were in place and staff were aware of how to access these. Systems were in place for the regular checks of fire alarms, extinguishers and fire evacuation procedures. A fire risk assessment had been completed in September 2025.

The practice had completed assessments in place for the control of hazardous substances (COSHH). Evidence provided by the practice showed equipment was regularly calibrated and electrical items were PAT (portable appliance testing) tested.

There was a business continuity plan in place which was monitored and reviewed. Reception and administration staff who handled calls to the practice and arranged appointments with the clinical team were aware of potential red flag symptoms. Staff knew when to notify a GP or other clinicians with concerns about a patient who may be acutely unwell and/or deteriorating.

During our site visit we found the premises were well maintained. Regular checks were carried out on the premises, facilities and the equipment provided. Contracts were in place to ensure the premises were clean and well maintained. Clear signage around the building supported people and staff in the event of an emergency evacuation.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Evidence provided demonstrated systems were in place for the monitoring of staff, which included regular conversations as part of their clinical supervision. Most staff had completed mandatory training and the practice monitored training compliance. We identified one training update that was overdue for the clinical lead. Following the onsite assessment, we received assurances that all the training updates had been completed. Learning needs and development of staff was managed appropriately and staff were working within their agreed areas of competence.

The practice had recruitment policies in place, and all staff had completed disclosure and barring checks. All newly employed staff had completed an induction to ensure they were competent in carrying out their role. We reviewed 3 personnel files and found appropriate checks such as previous employment record, immunisation status and proof of identity checks had been completed. Personnel folders were well organised and there was a systematic approach to ensure that personnel folders were managed appropriately.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

An infection control audit had been completed to identify potential risks and take appropriate action where required. The latest audit had been completed in August 2025, where the practice had achieved 97%.

The practice had a designated infection, prevention and control lead and all staff had completed IPC training relevant to their role. Staff were aware of the systems and processes to follow to ensure clinical specimens were handled safely.

The practice had policies in place for infection, prevention and control which was accessible to staff and staff were aware of the action to take. For example, in the event of a sharps or contamination injury.

The service did not always ensure systems for monitoring and managing medicines were consistently effective. They did not always involve people in planning.

As part of the assessment, we carried out remote clinical searches to review how patients’ medicines were monitored and if the appropriate care and treatment was being received. We reviewed patients who had been prescribed Aldosterone Antagonist medicines. Aldosterone Antagonist medicines are used in the treatment of high blood pressure and heart failure. The clinical search identified potentially 6 out of 15 patients on these types of medicines who had not had urea and electrolyte (UE) monitoring within the past 6 months. We reviewed the records of 5 patients and found 1 patient was overdue monitoring.

We carried out a search to identify patients who had received a medication review in the past 3 months. The search identified 269 patients. We reviewed a random sample of 5 records and found medicine reviews had been completed by the GPs and clinical pharmacists.

A second search showed the number of people who had been prescribed more than 10 prescriptions of benzodiazepines or Z medicines. Benzodiazepines and Z medicines are used to treat anxiety and aid sleep. The search identified potentially 5 patients. We reviewed all 5 clinical records and found no evidence to demonstrate 3 patients had been supported to come off these types of medicines.

The practice worked with the clinical pharmacists from the local PCN to monitor people and the prescribing of medicines. The provider was aware of safety alerts issued by the Medicines and Healthcare products Regulatory Agency (MHRA); however, we were unable to gain assurances from the clinical team of the system in place to ensure alerts were acted on. We carried out a clinical search on ACE (angiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) medicines plus aldosterone antagonist medicines used for the treatment of patients with heart failure which had potential risks to cause high potassium levels, to check if patients had a urea and electrolyte (UE) test within the past 6 months. We reviewed a random sample of 5 clinical records and 3 out of the 5 patients were overdue monitoring.

Emergency medicines, vaccines and medical equipment had clear monitoring processes in place, however not all the recommended medicines for an emergency were in stock at the practice. We discussed this with the leadership team who were aware that stocks had depleted and this had also been discussed at the last practice meeting on 4 June 2026, where an action point was to replenish the stock, however this had not been acted on. There were appropriate arrangements in place for the management of vaccines and for maintaining the cold chain. A data logger was in place, however no one we spoke with was aware of how to use the data logger to download the information it stored. We saw fridge temperatures were routinely monitored and vaccines reviewed at random were in date and stored appropriately. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments.

People knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms. Staff received regular training, were competency assessed on medicines optimisation, and felt confident managing the storage, administration and recording of medicines.

We found prescription stationery was secure but not appropriately monitored. Blank prescriptions were recorded when they were removed from their location, however, we found the recording of prescriptions was not accurate and did not match what was remaining of the stock or who they had been allocated to. We also found old stocks of blank prescriptions being stored, with no record of the them being in place. The practice used electronic prescribing for patients’ medicines, some patients preferred to collect a prescription. We were told that regular checks of prescriptions awaiting collection took place on average every month, but we found prescriptions awaiting collection dating back to 2025.

Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this. For example, the number of antimicrobials issued by the provider was in line with local and national averages.