Dr Mohan S Saini Also known as Soho Medical Services

This practice is currently rated as Inadequate. This rating was given at our previous inspection on 22nd July 2019.

We carried out an announced focussed inspection of Dr Mohan S Saini on 14 November 2019. This inspection was undertaken to follow up on breaches of regulations which had been identified at our previous inspection in July 2019 in relation to safe care and treatment and protecting patients from abuse and improper treatment. We issued the practice with two warning notices requiring them to achieve compliance with the regulations set out in the warning notice by 17 September 2019 and 1 October 2019.

At this inspection we found that all the requirements of the warning notice had been met.

Our key findings across the areas we inspected for this focused inspection were as follows;

• We found that the practice had reviewed and updated their system for ensuring that prescriptions were kept and used securely and monitored appropriately. The practice demonstrated that this was working effectively.
• The practice was able to demonstrate that systems were in place to ensure the health and safety of patients and staff and the management of infection control had been reviewed and updated. Baseline checks had been established by the leadership team to ensure that these were working as intended and were effective.
• Patient specific Directions were in place and appropriate. Staff we spoke with were clear about the importance of these and were able to articulate the system in place to ensure appropriate authorisation was in place before vaccines were given.
• Systems in place to manage the safe storage and usage of medicines had been reviewed, updated and baseline checks had been established to ensure that these were working effectively and as intended. Staff we spoke with were clear and knowledgeable on the process and were able to articulate their role and responsibility well.
• We found that the system to ensure that patients were safeguarded from abuse and improper treatment had been reviewed and strengthened. The practice had developed additional templates for the clinical system to ensure that information was recorded correctly, easily retrieved and shared with relevant professionals promptly and appropriately.

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

We carried out an announced comprehensive inspection at Dr. Mohan S. Saini on 22 July 2019.

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.

This inspection focused on the following key questions:

• Safe (this key question was opened on the day of the inspection)
• Effective
• Responsive
• Well-led

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

• Caring

We have rated this practice as inadequate overall.

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

• The practice was unable to demonstrate that safety systems in place to ensure patients were safe and safeguarded from abuse were effectively managed or working as intended. For example, management of prescriptions, consideration and mitigation of risks and recruitment systems and procedures.

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

• The practice was unable to demonstrate that clinical meetings were recorded for learning or that clinical quality improvement activity was effective.
• Due to significant errors in coding and the practice’s inability to demonstrate that they were effectively monitoring this, they were unable to demonstrate that the data produced in the public domain was accurate. As a result, the practice were unable to assure themselves that they were providing effective care or treatment overall.

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

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

• There was limited effective clinical quality improvement activity.
• The practice was unable to show that staff always had the skills, knowledge and experience to carry out their roles.
• The overall governance arrangements were ineffective.

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

• The practice was unable to demonstrate that management of all complaints was effective. For example, the practice told us that verbal complaints were resolved on an ongoing basis but were unable to demonstrate any formal recording or documenting system to enable the practice to learn from these or continually improve.
• Patient feedback data relating to access to care and treatment were higher than local averages in almost all questions.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients
• Ensure patients are protected from abuse and improper treatment
• Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation.
• 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).

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