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Archived: Dr Asha Sen Inadequate Also known as Dr A Sen

Inspection Summary


Overall summary & rating

Inadequate

Updated 15 June 2017

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection of Dr Asha Sen at the location of 12 The Slade, Plumstead, London, SE18 2NB, on 10 March 2016. Overall the practice was rated as inadequate and placed into special measures. Being placed into special measures represents a decision by the Care Quality Commission (CQC) that a provider has to improve their service within six months to avoid the CQC taking steps to cancel their registration. Because of the concerns we found during the inspection we also served the provider with a notice to impose an urgent suspension of the provider’s regulated activities for a period of six months from 18 March to 18 September, under Section 31 of the Health and Social Care Act 2008. The comprehensive report was published on 26 May 2016 and can be found by selecting the ‘all reports’ link for Dr Asha Sen on our website at www.cqc.org.uk. During the March 2016 inspection our key findings were as follows:

  • There was insufficient leadership capacity and limited governance arrangements. Policies had not been updated and there was no evidence of regular staff meetings. Some staff were not aware of their roles.

  • Systems and processes in relation to infection control, assessing and managing risks, fire safety, responding to serious incidents, recruitment processes, medicines management and prescribing practices were not effective enough to keep patients safe.
  • Confidential information had not been stored securely.
  • The provider did not have sufficient amounts of emergency medicines and equipment.
  • There was no evidence to demonstrate that complaints had been handled appropriately.
  • There was no evidence to show that audits were driving improvement.
  • Patients rated the provider significantly below local and national averages for several aspects of care, and there was minimal engagement with people who used the service.
  • Training needs had not been identified and there were gaps in key training.
  • Recruitment processes were not effective.

Practices placed in special measures are inspected again within six months. The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook an announced focused follow-up inspection on 5 September 2016 to check the provider had followed their action plan, and to confirm that they had met the legal requirements. Because the provider had made very limited improvements and had not addressed key issues which affected the safety and wellbeing of patients, they remained rated as inadequate and in special measures. We took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service by extending their suspension for a further period of six months. We also issued the provider a notice informing them that we intended to cancel their registration with the CQC. The follow-up inspection report was published on 17 November 2016 and can be found by selecting the ‘all reports’ link for Dr Asha Sen on our website at www.cqc.org.uk. Our key findings across all the areas we inspected in September 2016 were as follows:

  • Governance arrangements were still not effective, and the provider had made very limited improvements. Policies required updating. There was still no evidence of regular staff meetings.

  • The provider had still not established an effective system for recording and sharing learning from serious incidents.

  • Systems and processes in relation to infection control, assessing and managing risks, fire safety, responding to serious incidents, recruitment processes, medicines management and prescribing practices were still not effective.
  • The provider still did not have sufficient amounts of emergency medicines and equipment.
  • There was still not established a programme of quality improvements including clinical audits.
  • Training needs had not been identified and there were still gaps in key training.
  • The provider had still not reviewed or addressed areas of performance that patients had rated as being significantly below local and national averages.
  • Recruitment processes had not been improved.

The provider submitted an updated action plan. They were kept under review and on 17 February 2017, while the practice remained suspended and rated as inadequate, we carried out an announced focused follow-up inspection of the service to check whether the provider had made sufficient improvements to allow the suspension to end, and if any further enforcement action was necessary. The provider had made further improvements but was still not addressing key issues that affected the safety and wellbeing of patients, and we took the decision to close the service by cancelling the provider’s registration with the CQC. The provider remains rated as inadequate.

This report only covers our findings in relation to our focused inspection in February 2017, which are as follows:

  • The provider was still not addressing key issues affecting the health and safety and wellbeing of service users. There was a lack of cohesion and shared understanding between the practice’s leaders.

  • Serious incidents had still not been recorded or discussed with practice staff to share learning and prevent similar occurrences from happening again.

  • The provider had still not established effective arrangements for assessing, managing and monitoring risks, and had not established a schedule of quality improvement.

  • Several members of staff had either not received key training, or required training updates.

  • Some policies were still not fit for purpose.

  • The provider had taken some positive steps to improve medicines management, holding and documenting meetings, the availability of emergency medicines and equipment, and they had begun to address an aspect of feedback from patients.

During this inspection we identified breaches of regulations 12 (safe care and treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Had we not cancelled the provider’s registration, we would have advised that they must:

  • Ensure effective and sustainable clinical governance systems and processes are implemented to assess, monitor and improve the quality of the services provided, and implement an effective strategy to ensure the delivery of high quality care. This includes establishing a programme of audits including clinical audits, recording and discussing serious incidents, ensuring there are appropriate policies to enable staff to carry out their roles, practice policies are followed, relevant records for persons employed are obtained, and all records pertaining to the running of the service are suitably maintained.

  • Establish an effective system to assess the training needs of staff, ensure all staff receive training relevant to their roles, and ensure this training is appropriately updated.

  • Assess, mitigate and monitor risks to the health and safety of service users and others that may be at risk. This is particularly in relation to fire safety, Legionella infection, and the availability of medicines.

We would also have advised that the provider should:

  • Continue efforts to address feedback from patients and implement actions to improve patient satisfaction, and advertise translation services to inform patients that they were available.

We cancelled the registration of this provider on 29 March 2017.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Inadequate

Updated 15 June 2017

The provider is rated as inadequate for providing safe services.

  • There was a significant event recording form available to ensure that a log of significant events could be maintained, but none of the significant events the provider had previously informed us about had been recorded or discussed in the previous 12 months.

  • The practice was clean and tidy but some actions to address infection control issues had not been completed in accordance with deadlines stated in their action plan.

  • The provider was not able to demonstrate that all staff had received training for infection control (including the practice’s infection control nurse lead), mental capacity, fire safety, and information governance.

  • The provider ensured they were better-equipped to deal with medical emergencies by purchasing a defibrillator, oxygen, and more emergency medicines. One emergency medicine was absent and the provider had not assessed the risks relating to this.

  • The provider had improved arrangements for safeguarding vulnerable people. However, two nurses had not received deprivation of liberties training in accordance with their action plan. The ‘at risk adults' policy, child protection protocol, and chaperone policy either omitted key information, contained incorrect information or information that was not consistent with what was happening in the practice.

  • Risks to patients were not adequately assessed monitored or well managed. This was in relation to the absence of an emergency medicine, fire safety, blind cords in waiting areas that had not been placed out of the reach of young patients, and Legionella infection.

  • The provider was unable to demonstrate that all electrical equipment and emergency lighting had undergone safety and functionality testing.

  • The provider did not follow their infection control policy in ensuring all staff had received infection control training and that blood spillage kits were available.

Effective

Inadequate

Updated 15 June 2017

The provider is rated as inadequate for providing effective services.

  • There was no evidence to demonstrate a programme of clinical audits was in place to drive improvement.

  • The provider had created a system to identify the learning needs of staff; however, this was ineffective as it had not identified gaps in key training for several members of staff.

  • We requested but were not provided with evidence of training for information governance, infection control, fire safety, and mental capacity for all staff.

Caring

Inadequate

Updated 15 June 2017

The provider is rated as inadequate for providing caring services.

  • Translation services were not advertised to inform patients they were available.

Responsive

Inadequate

Updated 15 June 2017

The provider is rated as inadequate for providing responsive services.

  • The provider had established a system for recording complaints; however, the complaints protocol displayed in the waiting area included inaccurate information.

In response to feedback from the national GP patient survey, the practice manager had conducted an audit on the length of time patients had to wait to see practice nurses.

Well-led

Inadequate

Updated 15 June 2017

The provider is rated as inadequate for being well led.

  • There was a lack of evidence to demonstrate improvements made could be sustained.

  • There was a lack of cohesiveness in the understanding of the practice protocols and performance of the practice amongst the practice’s leaders. Although some changes had been made, these changes were not sufficient or embedded well enough to ensure the safety of patients.

  • There was no business plan or strategy in place. The provider had created an action plan in response to our findings at previous inspections but had not followed it in all areas.

  • Policies had been updated but some still required further modification to make them practice-specific. There were inconsistencies between what was stated in some of the provider’s policies and risk assessments and their action plan, and what was happening in practice.

  • The provider had reviewed its performance in relation to the national GP patient survey.

  • There was no evidence of a clinical audit plan to monitor and improve outcomes for patients.

  • Appraisals had been conducted for most staff (except two nurses) but content control was inadequate and some had either not been dated or signed by either the appraiser or the appraisee.

  • The provider did not have adequate arrangements for identifying, monitoring and managing risks. Some actions taken in response to risks had not been documented, and other actions had been incorrectly recorded as being completed.

  • The practice had scheduled and held documented governance meetings and a clinical meeting to discuss issues identified at our previous inspection, and to discuss a strategy for making the necessary improvements. However, there had been insufficient action taken to resolve the outstanding issues.

Checks on specific services

People with long term conditions

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of people with long-term conditions. It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.

Families, children and young people

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of families, children and young people. It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.

Older people

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of older people. It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.

Working age people (including those recently retired and students)

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of working age people (including those recently retired and students). It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.

People experiencing poor mental health (including people with dementia)

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of people experiencing poor mental health (including people with dementia). It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.

People whose circumstances may make them vulnerable

Inadequate

Updated 15 June 2017

The provider was rated as inadequate for the care of people whose circumstances may make them vulnerable). It was rated as inadequate for being safe, effective, caring, responsive and well-led. The issues identified as inadequate overall affected this population group.