The Care Quality Commission
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Archived: Shanti Medical Centre

Overall: Inadequate read more about inspection ratings

160 St Helens Road, Bolton, Lancashire, BL3 3PH (01204) 665354

Provided and run by:
Shanti Medical Centre

All Inspections

March 2018

During a routine inspection

This practice is rated as Inadequate overall

(Previous comprehensive inspection 8 November 2017 – Inadequate. Follow up focused inspection 28 March 2018 limited improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Shanti Medical Centre on 10 May 2018 as part of our inspection programme, in response to concerns and to follow up on breaches of regulation.

At this inspection we found that there was no sufficient improvement and the concerns from the previous inspections remained the same or had got worse.

  • There were no systems to manage risk so that safety incidents were less likely to happen. When something went wrong, people were not told.
  • Safety was not a sufficient priority and there was no monitoring of incidents.
  • The practice did not consistently and routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence-based guidelines.
  • Not all staff had the right qualifications, skills, knowledge and experience to do their job effectively and the learning needs of staff were not supported.
  • Other stakeholders had raised concerns about the care and treatment at the practice.
  • The needs of the local population were not fully identified or taken into account when planning services, for example in the case of cervical screening.
  • Leaders were not working together for the benefit of the service and patients.
  • Leaders did not consistently have the knowledge, capacity or desire to deliver an effective service and were out of touch with what was happening on a daily basis. There was a lack of clarity about who had the authority to make decisions and quality and safety were not top priority. There was no clear vision or guiding values.
  • There was no innovation or service development and improvement was not a priority among staff and leaders.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients in line with current guidance.
  • Ensure systems are in place so patients are protected from abuse and improper treatment
  • Ensure there is an effective system for identifying , receiving ,recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
  • Ensure specified information is available regarding each person employed; ensure that any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties

Insufficient improvements have been made such that there remains a rating of inadequate overall. We will now 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.

The service will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

28 March 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Shanti Medical Centre on 8 November 2017. The overall rating for the practice was Inadequate and the practice was put into special measures. Three warning notices were served against regulations 12 (Safe Care and Treatment), 13 (Safeguarding) and 19 (Fit and Proper Persons). In addition, a Notice of Decision was served with a condition on the providers’ registration relating to regulation 17 (Good Governance). The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Shanti Medical Practice on our website at www.cqc.org.uk.

This was an announced, focused inspection carried out on 28 March 2018. We went back to inspect whether the practice had carried out their plan to meet the legal requirements in relation to the breaches that were identified at our previous inspection in November 2017. At this inspection we reviewed only the concerns contained in the three warning notices and relevant to regulations 12, 13 and 19. This report covers our findings in relation to those requirements. This focused follow up inspection does not result in any ratings being changed; these will be fully reviewed at a future full comprehensive inspection. However we found that on this focused inspection little or no improvements had been made since our last inspection and the warning notices had not been met.

The practice was not rated at this inspection and the ratings remain the same.

Our key findings were as follows:

  • There was no evidence of improvement or action to address a number of the concerns contained in the three warning notices.

  • There was still no clear system to manage risk so that safety incidents were less likely to happen. When something went wrong, people were not always told. Safety was still not a sufficient priority and there was no monitoring of significant incidents.

  • There was very limited monitoring of the effectiveness and appropriateness of the care provided at the practice. There was minimal evidence to support that care and treatment was being delivered according to evidence-based guidelines.

  • Learning needs of staff remained an issue and they were not being fully supported.As at the previous inspection reception staff still did not have the right qualifications, skills, knowledge and experience to do their job effectively.This was particularly relevant in relation to Regulation 13 (Safeguarding).

  • Staff files we looked at did not contain appropriate information to meet the requirements of Regulation 19 (Fit and Proper Persons).

  • Leaders were still not working together for the benefit of the service and that affected the requirements of the regulations pertaining to the three warning notices.

This service was placed in special measures in November 2017. Insufficient improvements have been made such that the warning notices have not been met. Practices placed in special measures are fully re-inspected within six months and if improvements are not made we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (At the previous inspection on 2 December 2014 the practice was rated as Good)

The key questions are rated as:

  • Are services safe? – Inadequate

  • Are services effective? – Inadequate

  • Are services caring? – Requires Improvement

  • Are services responsive? – Inadequate

  • Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

  • Older People – Inadequate

  • People with long-term conditions – Inadequate

  • Families, children and young people - Inadequate

  • Working age people (including those retired and students – Inadequate

  • People whose circumstances may make them vulnerable - Inadequate

  • People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Shanti Medical Centre on 8 November 2017. The practice was selected as part of our inspection programme in response to concerning information received.

At this inspection we found:

  • The practice did not have clear systems to manage risk so that safety incidents were less likely to happen again. When something went wrong, people were not always told. Safety was not a sufficient priority and there was limited monitoring of safety issues with high levels of serious or significant incidents.

  • The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence-based guidelines.

  • Not all staff had the right qualifications, skills, knowledge and experience to do their job effectively and the learning needs of staff were not fully supported.

  • Some people who used the services, and stakeholders, had raised concerns with CQC and with the practice about poor access and care and treatment.  However all feedback from patients on the day was positive. We saw that staff talked to patients with compassion, kindness, dignity and respect.

  • The needs of the local population were not fully identified or taken into account when planning services, for example in the case of cervical screening.  Some people were not able to access services for assessment, diagnosis or treatment when they needed to and action to address this was not done in a timely or effective way.

  • Leaders were not workinging together for the benefit of the service and patients. Leaders did not consistently have the knowledge, capacity or desire to deliver an effective service and were out of touch with what was happening on a day to day basis. There was a lack of clarity about who had the authority to make decisions and quality and safety were not top priority. There was no clear vision or guiding values.

  • There was no innovation or service development and improvement was not a priority among staff and leaders.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients in line with current guidance

  • Ensure systems are in place so 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

  • Send CQC a written report setting out what governance arrangements are in place and any plans to make improvements.

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2nd December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We inspected Shanti Medical Centre on the 2nd December 2014 as part of our comprehensive inspection programme.

We have rated the practice as good.

During our inspection the comments from patients were positive about the care and treatment they received.

Our key findings were as follows:

  • Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.
  • The majority of patients reported good access to the practice and a named GP which provided continuity of care, with urgent appointments available the same day.
  • Staff understand their responsibilities to raise concerns, and report incidents.
  • The practice is clean and well maintained.
  • There are a range of qualified staff to meet patients’ needs and keep them safe.
  • People’s needs are assessed and care is planned and delivered in line with current legislation.
  • The practice works with other health and social care providers to achieve the best outcomes for patients.

However, there were also areas of practice where the provider needs to make improvements, the provider should:

We saw the infection control policy had recently been updated and were told the practice were in the process of implementing procedures in-line with the new policy, these included a new cleaning schedule, a colour coding scheme to ensure cleaning materials and equipment were not used across all areas, appointing an infection control lead and carrying out infection control audits on a regular basis . During our inspection we noted the cleaning equipment was stored in a multi-use storage area, which was carpeted, this was an issue identified by the practice and they showed us the new space identified to ensure cleaning equipment was safely stored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice