We carried out an announced inspection at Dr Sathyajith's Practice on 28 April 2021 Overall, the service is rated as Requires Improvement.
Ratings for each key question:
Safe - Requires improvement
Effective - Requires improvement
Caring - Good
Responsive - Good
Well-led - Inadequate
Following our previous inspection on 7 November 2019 when the service was registered as East Ham Memorial Hospital the service was rated Inadequate overall and good for the key questions caring, and responsive. The service was rated inadequate for safe and well-led and requires improvement for effective and issued warning notices for Regulation 12 Safe care and treatment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. Following our previous inspection, the East Ham Memorial Hospital partnership deregistered with CQC. One of the partners, Dr Sathyajith, became the provider of the service.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for East Ham Memorial Hospital on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a comprehensive inspection to follow up on breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. At the previous inspection we found:
- There was no proper and safe management of medicines. In particular: Patient Group Directions.
- Staff not able to use emergency equipment.
- Recording of consent and chaperones inconsistent.
- Health and safety risk assessment not practice-specific.
- Fire risk assessment overdue.
- Practice policies overdue for review or missing information.
- Ineffective governance arrangements.
- Lack of awareness and oversight of potential risks.
- Failure to address concerns identified at the previous CQC inspection
- Lack of monitoring and oversight of staff training, staff appraisals and induction checks and processes.
- Gaps in recruitment checks, including DBS checks, references, checks of professional registration and staff immunity status.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included
- Conducting staff interviews using video conferencing
- Completing clinical searches on the service's patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A short site visit
Our findings
We based our judgement of the quality of care at this service on a combination of:
• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.
We have rated this service as Requires improvement and Requires improvement for all population groups.
We found that:
- The delivery of high-quality care was not assured by the leadership or governance.
- Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
- Many of the issues identified at this inspection had been raised as issues at the previous CQC inspection in November 2019.
- There were weaknesses in the overall governance arrangements, for example in relation to oversight of recruitment checks and training.
- The service adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
We found four breaches of regulation. The provider must:
- Ensure care and treatment is provided in a safe way to patients
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
Please see the specific details on action required at the end of this report.
The areas where the provider should make improvements are:
- Ensure non disposable privacy curtains are cleaned in accordance with the service's Infection Prevention and Control guidelines.
- Ensure actions identified from risk assessments are completed and documented as being completed.
- Ensure learning from significant events are completed.
- Continue to take action to improve uptake of childhood immunisations and cervical screening.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
The previous service, of which the current provider was a senior member, was placed in special measures in December 2019. Insufficient improvements have been made, such that there remains a rating of inadequate for well led. Therefore we are taking 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 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.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care