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Inspection summaries and ratings from previous provider


Overall summary & rating

Good

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Chandrika Ramu on 19 May 2015. Breaches of the legal requirements were found.

  • Staff did not have a common understanding of what constituted a significant event and all significant events that took place had not been appropriately reported and recorded.
  • Staff had not undertaken training in safeguarding children or vulnerable adults to the appropriate level.
  • The practice was unable to demonstrate checks on the medicines held in the practice had been carried out and blank prescription forms were not always kept securely or tracked through the practice.
  • The practice did not have a member of staff designated with lead responsibility of infection control. Staff had not been trained or undertaken audits to identify infection control risks at the practice. The practice had not considered the risks associated with legionella (a germ found in the environment which can contaminate water systems in buildings).
  • The practice had not always undertaken recruitment checks prior to the employment of staff. The practice was unable to demonstrate that a risk assessment had been undertaken to determine the roles required to have Disclosure and Barring Service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • The practice was unable to demonstrate that emergency equipment and emergency medicines were checked on a regular basis. We found emergency equipment that was out of date.
  • The practice was unable to demonstrate they had carried out a fire safety risk assessment and did not have a fire safety action plan. Staff had not received fire safety training and the practice was unable to demonstrate that regular fire drills were carried out.
  • The practice had undertaken some clinical audits. However, information from the clinical audits did not clearly identify the findings or any subsequent changes that had been implemented as a result.
  • The practice did not have a system to undertake other audits to monitor the quality and safety of the service.
  • The practice did not have an established system for managing and mitigating risks in relation to the premises.
  • The practice did not have an active patient participation group (PPG).
  • The practice was unable to demonstrate that appraisals had been carried out for any of their staff.

Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook a focussed inspection on 14 April 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. At or focussed inspection on 14 April 2016, the practice provided records and information to demonstrate that some of the requirements had been met. However, breaches of the legal requirements were found.

  • The practice had carried out a legionella risk assessment. However, were unable to demonstrate they were monitoring water temperatures from hot and cold water outlets or carrying out regular flushing of infrequently used water outlets.

  • All staff had received a DBS check. However, the practice had failed to carry out other recruitment checks prior to the employment of staff.

  • The practice was unable to demonstrate that all staff who acted as chaperones had received training for this role.

  • The practice was unable to demonstrate that all staff were up to date with fire safety training.

  • Records demonstrated emergency equipment and emergency medicines were checked on a regular basis. However, we found emergency equipment at the practice that was out of date.
  • The practice had carried out clinical audits but were unable to demonstrate that these had led to improvements in the quality of patient care.

  • The practice had undertaken risk assessments for fire safety and legionella. However, there were no formal arrangements for identifying, recording and managing risks or implementing mitigating actions.

Following the focussed inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focussed inspection on 13 December 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the requirements had been met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Chandrika Ramu on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for providing safe services.

  • Staff did not have a common understanding of what constituted a significant event and all significant events that took place had not been appropriately reported and recorded.
  • Staff had not undertaken training in safeguarding children or vulnerable adults to the appropriate level.
  • The practice was unable to demonstrate checks on the medicines held in the practice had been carried out and blank prescription forms were not always kept securely or tracked through the practice.
  • The practice did not have a member of staff designated with lead responsibility of infection control. Staff had not been trained or undertaken audits to identify infection control risks at the practice. The practice had not considered the risks associated with legionella (a germ found in the environment which can contaminate water systems in buildings).
  • The practice had not always undertaken recruitment checks prior to the employment of staff. The practice was unable to demonstrate that a risk assessment had been undertaken to determine the roles required to have Disclosure and Barring Service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • The practice was unable to demonstrate that emergency equipment and emergency medicines were checked on a regular basis. We found emergency equipment that was out of date.
  • The practice was unable to demonstrate they had carried out a fire safety risk assessment and did not have a fire safety action plan. Staff had not received fire safety training and the practice was unable to demonstrate that regular fire drills were carried out.

At our focussed follow-up inspection on 14 April 2016, the practice provided records and information to demonstrate that some of the requirements had been met. However, the practice had been rated as requires improvement for providing safe services.

  • The practice had carried out a legionella risk assessment. However, were unable to demonstrate they were monitoring water temperatures from hot and cold water outlets or carrying out regular flushing of infrequently used water outlets.
  • All staff had received a DBS check. However, the practice had failed to carry out other recruitment checks prior to the employment of staff.
  • The practice was unable to demonstrate that all staff who acted as chaperones had received training for this role.
  • The practice was unable to demonstrate that all staff were up to date with fire safety training.

  • Records demonstrated emergency equipment and emergency medicines were checked on a regular basis. However, we found emergency equipment at the practice that was out of date.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the requirements had been met.

  • Records showed that the practice was monitoring water temperatures from hot and cold water outlets as well as flushing infrequently used water outlets in line with their legionella risk assessment action plan.
  • The practice had revised their recruitment process to help ensure recruitment checks were carried out prior to the employment of staff.
  • All staff who acted as chaperones had received training for this role.
  • All staff were up to date with fire safety training.
  • Emergency equipment we checked was in date and fit for use.

Effective

Good

Updated 16 February 2017

Caring

Good

Updated 16 February 2017

Responsive

Good

Updated 16 February 2017

Well-led

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for providing well-led services.

  • The practice had undertaken some clinical audits. However, information from the clinical audits did not clearly identify the findings or any subsequent changes that had been implemented as a result.
  • The practice did not have a system to undertake other audits to monitor the quality and safety of the service.
  • The practice did not have an established system for managing and mitigating risks in relation to the premises.
  • The practice did not have an active patient participation group (PPG).
  • The practice was unable to demonstrate that appraisals had been carried out for any of their staff.

At our focussed follow-up inspection on 14 April 2016, the practice provided records and information to demonstrate that some of the requirements had been met. However, the practice had been rated as requires improvement for providing well-led services.

  • The practice had carried out clinical audits but were unable to demonstrate that these had led to improvements in the quality of patient care.
  • The practice had undertaken risk assessments for fire safety and legionella. However, there were no formal arrangements for identifying, recording and managing other risks or implementing mitigating actions.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the requirements had been met.

  • Clinical audits were driving improvements in the quality of patient care.
  • The practice had introduced formal arrangements for identifying, recording and managing other risks and implementing mitigating actions.
Checks on specific services

People with long term conditions

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of people with long-term conditions. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of people with long-term conditions. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

Families, children and young people

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of families, children and young people. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of families, children and young people. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

Older people

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of older people. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of older people. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

Working age people (including those recently retired and students)

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of working aged people (including those recently retired and students). The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of working aged people (including those recently retired and students). The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of people with poor mental health (including those with dementia). The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.

People whose circumstances may make them vulnerable

Good

Updated 16 February 2017

At our previous comprehensive inspection on 19 May 2015 the practice had been rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our previous focussed follow-up inspection on 14 April 2016 the practice had been rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider had been rated as requires improvement for providing safe and well-led services and good for providing effective, caring and responsive services. The resulting overall rating applied to everyone using the practice, including this patient population group.

At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the legal requirements had been met. The provider is rated as good for providing safe and well-led services. The resulting overall rating applies to everyone using the practice, including this patient population group.