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

Reports


Inspection carried out on 17 February 2017

During a routine inspection

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 carried out on 5 September 2016

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Asha Sen 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 practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration. Because of the concerns we found during the inspection we 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.

We undertook a focused inspection on 5 September 2016 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 was not rated on this occasion, but we found that they had not made sufficient improvements to the service; therefore we have taken the decision to extend the provider’s suspension by a further six months.

This report only covers our findings in relation to our focused inspection. You can read about our findings from our last comprehensive inspection via our website: http://www.cqc.org.uk/location/1-572075752/reports.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 10 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Asha Sen on 10 March 2016. Overall the practice is rated as inadequate. We took the decision to urgently suspend this service for a duration of six months due to the nature of the concerns we identified during our inspection.

Our key findings across all the areas we inspected were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. This was in relation to infection control, risk assessments, fire safety, recruitment processes, medicines management and prescribing practices.

  • The practice did not have several emergency medicines, a defibrillator or oxygen available and they had not conducted risk assessments to mitigate the risk of not having these available.

  • Staff were not clear about the process for reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff. There was no evidence that incidents were recorded.

  • There were no documented records of complaints, and the practice was unable to demonstrate that complaints and concerns had been handled appropriately.

  • Data showed patient outcomes were comparable to the locality and nationally. An audit had been carried out but we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

  • The practice had insufficient leadership capacity and limited formal governance arrangements. Minimal effort had been made to understand the needs of the local population.

  • There was a lack of awareness of the performance of the practice. Several policies and procedures to govern activity were not in place and many were overdue a review. Training needs had not been identified and some training required updating.

  • Results from the national GP patient survey showed the practice was rated significantly below average for several aspects of care, but the practice had not reviewed or implemented any plans to address this. Some patients we spoke with said they were treated with compassion, dignity and respect.

  • Urgent appointments were usually available on the day they were requested.

  • There was minimal engagement with people who used the services. The practice had not proactively sought feedback from patients and did not have an active patient participation group. It had sought feedback from staff through appraisals.

The areas where the provider must make improvements are:

  • Take action to address identified concerns with medicine prescribing and management, infection prevention and control, health and safety and fire safety processes.

  • Ensure there are sufficient quantities of emergency medicines, and oxygen is available and all staff know how to use it.

  • Ensure there are effective systems in place for safeguarding patients from abuse.

  • Ensure all staff receive mandatory training at appropriate intervals.

  • Ensure recruitment arrangements include all necessary checks for all staff.

  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

  • Securely maintain records in respect of service users at all times.

  • Ensure staff have appropriate policies, guidance, competence and experience to carry out their roles in a safe and effective manner.

  • Assess, monitor and improve the quality of services provided and establish systems for seeking feedback from patients and managing complaints.

The areas where the provider should make improvement are:

  • Ensure a defibrillator is available or conduct a risk assessment to mitigate the need to have one available.

  • Ensure risk assessments are conducted for blinds in the waiting area, asbestos and the control of substances hazardous to health, and any risks identified are actioned.

  • Introduce robust processes for reporting, recording, acting on and monitoring significant events.

  • Ensure prescription pads are managed securely and establish a system for monitoring their use.

  • Establish an effective system for identifying and supporting carers.

  • Ensure translation services are advertised.

  • Undertake on-going quality improvement activities, such as clinical audits, with suitable follow up to ensure improvements have been achieved.

  • Improve systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

  • Ensure patients are informed that CCTV recording is in use in the waiting area, and their rights relating to this.

  • Ensure there is a comprehensive business continuity plan in place.

  • Ensure there is effective leadership capacity to deliver all improvements

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice