Drs Sanomi and Olajide

We previously carried out an announced comprehensive inspection of Drs Sanomi and Olajide on 24 October 2019 and found the practice was in breach of regulation 12: ‘safe care and treatment’ and regulation 17: ‘good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued two warning notices which required Drs Sanomi and Olajide to comply with the Regulations by 1 February 2020.

The full report of the 24 October 2019 comprehensive inspection can be found by selecting the ‘all reports’ link for Drs Sanomi and Olajide on our website at www.cqc.org.uk.

We carried out this announced focused inspection on 5 March 2020 to check whether the practice had addressed the issues in the warning notices and now met the legal requirements. This report covers our findings in relation to those requirements and does not change the current ratings held by the practice.

At the inspection on 5 March 2020 we found the provider had taken action to address the requirements of the warning notices.

Our key findings were as follows:

• Actions from fire and health and safety risk assessments had been implemented and resolved.
• The practice had created a new staff induction policy, updated the recruitment policy and created a locum checklist.
• Appropriate recruitment checks were carried out for new staff members.
• There was a system in place to monitor staff training and training was up to date.
• The practice held a record of staff immunisations as per ‘Green Book’ guidance.
• The complaints register had been updated to include the date the complaint was discussed at a meeting, and the most recent complaint had been shared with all staff at a meeting.
• Policies had been reviewed and updated and contained required information.
• There was an effective system for safety alerts.
• The practice had a failsafe system in place to monitor urgent two week wait referrals.
• The practice had created a policy for high-risk medicines and was carrying out regular searches, and generally there was safe prescribing and effective monitoring of patients on high-risk medicines.
• There was a policy in place regarding taking medicines on home visits and a system to check medicines in the doctor’s bag.
• Security levels had been changed on the clinical system to ensure non-clinical staff could not re-authorise repeat prescriptions.
• Blank prescriptions were monitored and kept securely.
• There were protocols in place for the healthcare assistant and regular documented supervision sessions for the healthcare assistant and practice nurses.
• Leaders had demonstrated they had the capacity and skills to address issues identified from the previous CQC inspection.
• There were effective arrangements for identifying, managing and mitigating risks at the practice.

Although there were no breaches of regulations, we identified areas where the provider should make improvements:

• Put in place version controls and review dates for all policies, procedures and protocols.
• Keep any controlled drugs at the practice safely, and manage and dispose of them appropriately.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of Dr Beheshti on 24 October 2019 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 16 July 2018. At the last inspection in July 2018 we rated the practice as requires improvement overall.

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:

• There were gaps in recruitment checks, including in relation to Disclosure and Barring Service (DBS) checks, references, checks of professional registration, and immunity status.
• Recommended actions from fire and health and safety risk assessments had not been completed in line with the suggested timeframes.
• There were gaps in staff training, including for fire safety, safeguarding, basic life support and infection control.
• There was no failsafe system in place for urgent two week wait referrals.
• There was no documented risk assessment in place to support the decision not to take any medicines in the doctors’ bags to home visits.
• We identified examples where safe prescribing of high-risk medicines could not be evidenced.
• We saw a non-clinical staff member re-authorise repeat prescriptions for a patient.
• There was no log or formal system to log receipt of safety alerts and record what action was taken by the practice.

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

• The delivery of high-quality care was not assured by the leadership, governance or culture.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
• There was no documented business strategy in place.
• There were weaknesses in the oversight of governance arrangements, for example in relation to effective recruitment and locum checks and clinical oversight of the healthcare assistant, the nurses and the pharmacist.
• There was no effective oversight or monitoring of staff training.
• Some of the practice’s policies did not contain all the necessary information, for example the adults at risk policy and the test results policy.
• The systems for managing risks were not consistently effective, as some risks has not been identified or dealt with.

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

• Care and treatment was not always delivered in line with evidence-based guidance, as we found risks associated with high-risk medicines and urgent two week wait referrals.
• Some of the practice’s childhood immunisation uptake rates were below the World Health Organisation target.
• Gaps in mandatory training demonstrated the learning and training needs of staff were not assessed effectively.
• There were no documented protocols for the healthcare assistant to follow and there was no evidence their induction included completion of the Care Certificate standards.
• There was a lack of oversight of the clinical work being carried out by the healthcare assistant, the nurses and the pharmacist.

These areas affected all population groups, so we rated all population groups as requires improvement for providing effective services.

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

• The practice’s GP patient survey result relating to access by telephone was significantly below the national average.
• The system to share learning from complaints with staff was ineffective.

These areas affected all population groups, so we rated all population groups as requires improvement for providing responsive services.

We rated the practice as good for providing caring services because:

• Staff treated patients with kindness, respect and compassion.
• Feedback from patients was generally positive about the way staff treated people.
• The practice respected patients’ privacy and dignity.

The areas where the provider must make improvements are:

• 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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to improve uptake rates for childhood immunisations and cervical screening.
• Improve how patients with caring responsibilities are identified to ensure they receive the appropriate support.
• Take action to improve low scores around telephone access as highlighted in the national GP patient survey.

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 table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care