You are here

Dr Raphael Rasooly Requires improvement

Reports


Inspection carried out on 07 December 2020

During a routine inspection

Dr Raphael Rasooly is a provider registered with CQC. Following a comprehensive inspection on 5 March 2020, we rated the practice inadequate overall and in safe, effective and well-led and across all population groups. Responsive and caring were rated requires improvement.

At the inspection, we found concerns in relation to systems and processes to keep people safe, the safe management of medicines, systems for learning and making improvements when things went wrong, monitoring of the outcomes of care and treatment, staff training, leadership and overall governance. The practice was placed in special measures and issued warning notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out an unannounced focused inspection of Dr Raphael Rasooly on 3 August 2020 to follow-up on information of concern we received, and the warning notices issued following the March 2020 inspection.

At this inspection, we found the provider had made some improvement in providing safe, effective and well-led services. However, we identified further concerns in relation to structured reviews of people with long-term conditions and general governance systems. The practice was issued Requirement notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

We carried out a comprehensive inspection of the practice on 7 December 2020. Following this inspection, we rated this practice requires improvement overall. Safe, effective, caring, responsive and well-led key questions were rated requires improvement along with all the population groups.

We also reviewed remotely specific documentation including policies and audits. (In light of the current Covid-19, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams spend on site. In order to seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This provider consented to take part in this pilot and some of the evidence in the report was gathered without entering the practice premises).

The report of the previous inspections can be found by selecting the 'all reports' link for Dr Raphael Rasooly on our website at www.cqc.org.uk.

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 providers, patients, the public and other organisations

We rated the practice requires improvement for providing safe services because:

  • Although some improvement was evident since the previous inspections. We found continuing concerns in relation to medicine reviews, the effectiveness of the monitoring system for people on Direct Oral Anticoagulants (DOACs) and compliance with safety alerts.

We rated the practice requires improvement for providing effective services because:

  • We found continuing concerns in relation to structured medicine reviews for people with asthma.
  • Cervical screening and childhood immunisation achievement rates were below national targets although there was some improvement since the last inspection.
  • The provider did not monitor the clinical practice of sessional GPs.
  • The provider did not monitor the process for seeking consent.

We rated the practice requires improvement for providing caring services because:

  • National GP Patient Survey results for caring indicators were below local and national averages.
  • Feedback we received from people who used the service showed that people were not always treated with kindness and respect and their privacy upheld.

We rated the practice requires improvement for providing responsive services because:

  • Although nurse capacity had been increased, and there had been some improvement in uptake, cervical screening and childhood immunisation achievement rates remained below national targets.
  • Feedback we received from people who used the service was predominantly negative in relation to access to the service.

We rated the practice requires improvement for providing well-led services because:

  • The provider demonstrated some improvement in leadership and overall governance. However, concerns remained particularly in relation to clinical governance and leadership capacity to sustain improvement.

The areas where the practice 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 areas where the practice should make improvements are:

  • Ensure safeguarding policies consider people accessing online services and relevant safeguarding information is shared with the Out of Hours service.
  • Develop a comprehensive program of quality improvement including clinical audit to drive improvement in care and treatment outcomes.
  • Improve patient satisfaction with the caring aspects of the service provided and continue to improve the identification and support of patients with carer responsibilities.
  • Improve confidentiality arrangements at the reception desk.
  • Improve patient satisfaction with access to the service.
  • Further develop systems to ensure compliance with the requirements of the duty of candour.
  • Take steps to improve patient engagement and involvement in the development of the services provided.

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

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 3 August 2020

During an inspection looking at part of the service

Dr Raphael Rasooly is a provider registered with CQC. Following a comprehensive inspection on 5 March 2020, we rated the practice inadequate overall and in safe, effective and well-led. Caring and responsive were rated requires improvement. The practice was placed in special measures and issued warning notices for breaches of Regulation 12 and 17 of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014.

In June 2020, we received information of concern and a significant number of negative comments and complaints about the standards of care and treatment from people who used the service. In response, we carried out an assessment of patient records through remote access of the providers IT system on 21 July 2020 which led to us deciding that we needed to review the practice in person.

We also reviewed remotely specific documentation including policies and audits. (In light of the current Covid-19, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams spend on site. In order to seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This provider consented to take part in this pilot and some of the evidence in the report was gathered without entering the practice premises).

We undertook an unannounced focused inspection of the practice on 3 August 2020. The purpose of this inspection was to check compliance with the warning notices issued after the 5 March 2020 inspection.

At this inspection we found the provider had addressed most of our concerns:

  • The provider had the full list of recommended emergency medicines available.
  • The provider had ensured all staff had completed appropriate training for their role and had up-to-date Disclosure and Barring Service (DBS) checks or DBS risk assessment.
  • The provider had introduced a system to ensure compliance with Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts.
  • The provider had improved the systems and processes for learning, continuous improvement and innovation. However, there remained areas for improvement.
  • The provider had increased the practice’s nursing capacity.
  • The provider showed that staff had the skills, knowledge and experience to carry out their roles.
  • The provider did not have effective governance structures in place to oversee areas of activity such as: staff recruitment and training records.
  • We found instances when the provider had not ensured care and treatment was not delivered in accordance with national guidance.

Following the focused inspection in August 2020, 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 areas where the provider should make improvements are:

  • Improve the process of clinical auditing to provide a systemic review of the findings against explicit criteria and measure or confirm improvement.
  • Improve the process for disseminating information to staff relating to significant events.

This was an unrated inspection and the provider remains in special measures due to our findings during the inspection on 5 March 2020.

Details of our findings from the remote records assessment review in July 2020 and the focused inspection on 3 August 2020 are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 05/03/2020

During a routine inspection

We carried out an announced comprehensive inspection at the GP practice Dr Rasooly on 5 March 2020 as part of our inspection programme.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last 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 have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

  • The practice did not have clear systems and processes to keep patients safe.
  • Receptionists had not been given sufficient guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • The practice did not learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

  • There was limited monitoring of the outcomes of care and treatment.
  • The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
  • The practice was unable to show that care and treatment was always delivered in line with evidence-based guidance.
  • Some performance data was significantly below local and national averages.

We rated the practice as inadequate for providing well-led services because:

  • Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • While the practice had a clear vision, that vision was not supported by a credible strategy.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.
  • We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing caring and responsive services because:

  • The practice had not acted on feedback from the National GP Patient Survey.
  • The practice needed to improve on the identification and support of patients with carer responsibilities.
  • There was insufficient nursing capacity to meet patients’ needs which was reflected in low child immunisation and cervical screening achievement rates.

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 areas where the provider should make improvements are:

  • Improve on the identification and support of patients with carer responsibilities.

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

Inspection carried out on 7 November 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Raphael Rasooly’s practice on 7 October 2016. The overall rating for the practice was good.

However we rated the practice as requires improvement for being effective and issued a requirement notice in relation to a breach of regulation 18. This was because the practice could not demonstrate it had sufficient nursing capacity to meet the needs of patients. We rated the practice as requires improvement for providing care to working age people (including those recently retired and students) because the practice’s cervical screening uptake rate was low.

We also noted that the practice:

  • had not fully embedded completed clinical audit cycles as a quality improvement tool
  • was not always implementing non-clinical safety alerts
  • carried out checks of its emergency medicines but had not identified a missing medicine
  • had identified fewer than 1% of its patients as carers
  • and did not actively share its vision and values with patients.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Raphael Rasooly on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 7 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 7 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good. We have also rated the practice as good for providing effective care and for the care provided to working age people (including those recently retired and students).

Our key findings were as follows:

  • The practice had recruited a practice nurse since our previous inspection. The practice provided evidence to show it now had sufficient nurse capacity to meet the needs of patients.

  • Since the recruitment of the nurse, the practice could demonstrate marked improvement in the cervical screening coverage of eligible patients.

  • The practice carried out clinical audit as part of its quality improvement work. The practice provided evidence that audit was used to ensure that effective practice was being sustained.

  • The practice provided evidence that it routinely circulated information about non-clinical safety alerts and acted on these when relevant.

  • The practice carried out monthly checks of the emergency medicines which included a specific check of the quantity held in addition to expiry dates.
  • The practice had increased the number of patients identified as carers from 67 at our previous inspection to 91 patients by the end of November 2017. The practice provided carers with appropriate support.

  • The practice made information about its vision and values available to patients, for example in the patient waiting areas.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 7 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection covering Dr Raphael Rasooly's practices, Neasden Medical Centre and Greenhill Park Medical Centre, on 7 October 2016.

The inspection was carried out to follow up our previous inspections carried out  at Neasden Medical Centre on 30 October 2014 and at Greenhill Park Medical Centre on 26 March 2015. Both services were rated as 'requires improvement' overall and we identified a number of breaches of regulations. (The previous reports can be read by selecting the ‘all reports’ link for Dr Raphael Rasooly on our website at www.cqc.org.uk).

After the inspections the practice drew up action plans to improve its performance and meet all relevant regulations in response to our findings. At the follow up inspection on 7 October 2016, we reviewed the practice’s progress in implementing these plans. We found that the practice had made improvements and overall the practice is now 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.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Most risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Most patients said they found it easy to make an appointment with urgent appointments available the same day.
  • The practice was equipped to treat patients and meet their needs. The practice was planning to extend the main surgery to better meet the needs of the practice population.
  • There was a clear leadership structure and staff felt supported by the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice had effectively acted on most of the concerns identified at our previous inspections.

The areas where the provider must make improvement are:

  • The provider must ensure there are sufficient staff with suitable skills available in the main surgery to undertake health screening activities for example cervical screening to improve rates to CCG and national levels and reduce the risk of patients developing avoidable cancers.

The areas where the provider should make improvement are:

  • The practice should ensure that it reviews non-clinical safety alerts. For example it should risk assess its use of vertical blinds with looped cords in line with the relevant alert issued by NHS England.
  • The practice should complete two-cycle clinical audits to ensure that observed improvements to clinical practice are sustained as part of the quality improvement programme.
  • The practice should ensure that staff carrying out monitoring checks of the emergency medicines check that all items are present within packaging and are available for use in an emergency.
  • The practice should make information about its vision, values and strategy more widely available to patients.
  • The practice should continue to actively identify patients who are carers to ensure that they receive appropriate support and their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 30 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr Raphael Rasooly, also known as Neasden Medical Centre. The practice is registered with the Care Quality Commission to provide primary care services.

We carried out a comprehensive inspection on 30 October 2014. We spoke with patients and staff, including the management team.

The practice is rated as ‘requires improvement’ for the service being safe, effective, caring, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including all the population groups. We gave the practice an overall rating of ‘requires improvement’.

Our key findings were as follows:

  • Procedures were in place to report and record safety incidents
  • The practice used up to date best practice guidance to ensure good outcomes for patients
  • The practice met with local providers to share best practice and improve patient outcomes
  • Patients found it easy to access the service and make an appointment
  • Patients said they were treated with kindness and respect

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

Importantly, the provider must:

  • Have a system to regularly assess and monitor the quality of the service, and manage risks relating to the health and safety of patients and staff.
  • Ensure that the appropriate pre-employment checks are carried out before staff commence work at the practice. Ensure that all staff acting as chaperones have had a Disclosure and Barring Service check.
  • Ensure that confidential information is stored securely.

In addition the provider should:

  • Keep records to show that learning from serious events, safety incidents, complaints, and feedback is shared with staff.
  • Provide relevant staff with chaperone training and make patients aware they can request a chaperone during their consultation.
  • Carry out a legionella risk assessment to identify and monitor the risks associated with legionella bacteria.
  • Complete audit cycles to monitor and improve quality of care.
  • Formalise their vision and values and share these with patients and staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice