The Care Quality Commission
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Archived: Dr Rajan Mohile Also known as Chadwell Medical Centre

Overall: Inadequate read more about inspection ratings

Chadwell Medical Centre, 1 Brentwood Road, Chadwell St Mary, Grays, Essex, RM16 4JD (01375) 842289

Provided and run by:
Dr Rajan Mohile

All Inspections

31 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajan Mohile, also known as Chadwell Medical Centre on 21 March 2016. The overall rating for the practice at that time was inadequate. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajan Mohile on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection following a rating of special measures carried out on 31 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 31 March 2016. As this was a comprehensive inspection following a rating of special measures, we revisited all key questions and population groups as well as following up on the previous breaches of regulation identified.

We carried out an announced comprehensive inspection at on 31 January 2017. Overall the practice is rated as inadequate.

Our key findings were as follows:

  • Although significant events were reported and recorded, learning was not implemented and patients were at risk.
  • The practice did not act upon MHRA alerts.
  • Data showed some patient outcomes were low compared to the locality and nationally. There had been little or no improvement since our previous inspection.
  • Steps had been taken to monitor patients taking some high risk medicines, as identified by our previous inspection. However, not all patients taking high risk medicines were being effectively monitored to ensure their medicines were prescribed at the correct and safe dosage.
  • Not all referrals were made in a timely manner. Opportunities to physically examine patients who were at risk were missed.
  • Although some administrative audits had been carried out, these had not identified and rectified all serious risks.
  • Staff carrying out chaperone duties now had a DBS check in place to assess their suitability for the role.
  • Patients continued to praise staff, but there was concern with the availability of GP appointments. There was a two week wait for routine appointments with the GP.
  • Feedback from the GP survey was below national and local averages in respect of access to the practice, and in line with averages in relation to care and treatment by the clinicians.
  • The practice was not pro-active in supporting patients to live healthy lifestyles and systems in place to recall patients for health checks and reviews were not robust.
  • Effective improvements had not been implemented.
  • There was now a legionella risk assessment in place.
  • Information about services and how to complain was available and easy to understand.
  • Patients’ records were still incomplete. There had been seven significant events relating to incomplete patient records in the last year, but effective learning had not been implemented.
  • There had been no improvement which sought to ensure that all clinicians were keeping up to date with and implementing NICE guidelines. We found evidence where NICE guidelines were not being followed in relation to diabetes checks.
  • Measures had been put in place to monitor prescription stationery.
  • There continued to be insufficient nursing provision.
  • Nurses were not using the most up to date Patient Group Directions (PGDs) to authorise them to administer vaccines safely. These were not all signed.
  • Care plans were either incomplete or not being used.
  • There were not effective procedures in place to recall patients for cervical screening. The practice did not follow up children who did not attend for their vaccinations.
  • The practice had identifies 54 patients as carers which amounted to 1% of the practice population.
  • The practice was in the process of having their contract terminated with NHS England and did not have a vision or a strategy.

As a result of the findings at this inspection, we considered enforcement action against the provider and extending their period of special measures. However, shortly after the inspection the provider applied to de-register all regulated activities with the Care Quality Commission. A new provider is in the process of being identified by the Clinical Commissioning Group with effect from 1st April 2017 and the practice will receive their support to manage and reduce the risks identified at this inspection, so that the risks to patients are managed.

Had the provider continued to be registered with the Care Quality Commission, we would have issued the provider with requirements notices to make the following improvements; :

  • Implement a system to receive, action and respond to safety alerts.
  • Review and monitor patients taking all high risk medicines.
  • Improve the system for referrals.
  • Ensure actions resulting from significant events are implemented to prevent reoccurrence.
  • Put in place a robust system of quality improvement including clinical and non-clinical audit.
  • Ensure nurses are working with signed, up to date PGDs.
  • Put in place up to date care plans for patients experiencing poor mental health.
  • Take steps to act on patient feedback raised in the National GP Patient Survey.
  • Improve the systems to recall patients to their routine checks and appointments and put systems in place to encourage and advise patients on a healthy lifestyle.
  • Ensure all patient records represent a complete and accurate picture of their medicines and attendances at the practice.
  • Increase nursing provision.
  • Implement systems to ensure clinicians are working in line with NICE and other best practice guidance.

In addition the provider should:

  • Improve uptake for health checks for patients with learning disabilities.

This service was placed in special measures on 16th June 2016. Insufficient improvements have been made such that there remains a rating of inadequate for effective and well-led. Further risks identified have now resulted in safe being rated as inadequate. The practice therefore remains as inadequate overall and also remains in special measures for a further period of six months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

21 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajan Mohile, also known as Chadwell Medical Centre on 21 March 2016. Overall the practice is rated as inadequate.

Our key findings were as follows:

  • Significant events were not consistently reported and recorded in line with the practice policy. Some significant events were missed and not investigated until they happened for a third time.

  • Data showed some patient outcomes were low compared to the locality and nationally. Although some audits had been carried out, these had not identified and rectified serious risks. There was no other system in place for quality improvement.

  • Patients taking high risk medicines were not being effectively monitored to ensure their medicines were prescribed at the correct and safe dosage.

  • Some staff carrying out chaperone duties had not undertaken a DBS check and there was no risk assessment in place as to why this was not required.

  • Patients praised the kind, sensitive attitude of all staff but expressed concern with the availability of appointments. There was a three week wait for routine appointments with the nurse.

  • The practice was not pro-active in supporting patients to live healthy lifestyles and systems in place to recall patients for health checks and reviews were not robust.

  • There were robust recruitment checks, and all staff had received an appraisal in the last 12 months.

  • There was no legionella risk assessment to assess and manage the risk of legionella.

  • Information about services and how to complain was available and easy to understand.

  • Feedback from the GP survey was similar or below national and local averages.

  • Not all patients’ records were complete. Significant omissions had been identified and although the practice had taken steps to remedy these, these were still outstanding. This included updating patient records following home visits to reflect attendances, prescriptions or reviews of care plans.

  • Staff at the practice told us they felt supported; however there was an ongoing dispute at the practice between the CQC registered GP and another GP at the practice which had negatively impacted on the way the practice was being managed, putting patients at risk.

  • There was a lack of vision and strategy in place and this was not being shared with staff. There was no system in place to ensure that all clinicians were keeping up to date with and implementing NICE guidelines.

Importantly, the provider must:

  • Review and monitor patients taking high risk medicines.

  • Ensure all significant events are promptly recorded and investigated and relevant action is taken in a timely manner to mitigate reoccurrence.

  • Put in place a robust system of quality improvement including clinical and non-clinical audit.

  • Take steps to act on patient feedback raised in the National GP Patient Survey.

  • Improve the systems to recall patients to their routine checks and appointments and put systems in place to encourage and advise patients on a healthy lifestyle.

  • Ensure all patient records represent a complete and accurate picture of their communications and consultations either at the practice or when visited in their homes.

  • Complete a legionella risk assessment.

  • Ensure staff who act as chaperones have a DBS check undertaken or conduct a risk assessment if one is not required.

  • Take positive action to resolve the dispute affecting the management of the practice to ensure that the safety of patients is treated as a priority.

  • Increase nursing provision so that more appointments are available to patients.

In addition the provider should:

  • Track and monitor the use of prescriptions.

  • Develop a vision and strategy and discuss and share this with staff.

  • Improve the recall system in relation to the national screening programme for cervical cancer.

  • Continue to improve the identification of carers and provide them with appropriate support and information.

  • Improve communication to check that clinicians are performing in line with NICE and other best practice guidance.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

10 September 2014

During an inspection looking at part of the service

We carried out this inspection to check on the improvements made to the practice following our last inspection visit in May 2014. At that time we found that the practice did not have adequate systems in place for assessing and minimising the risks of an outbreak of fire. The practice did not have suitable assessments to identify and minimise the risks to staff and patients associated with premises, fixtures and fittings.

We visited the practice on 10 September 2014. We found that the required improvements had been made to the service so as to minimise risks to the health and safety of staff and patients.

A fire risk assessment had been undertaken and improvements had been made to minimise the risk of fire. Checks had been carried out to fixed electrical wiring and portable electrical appliances to ensure that they were safe and fit for use.

The practice had a suitable fire safety policy, which set out staff roles and responsibilities for fire safety and evacuation procedures. Staff had undertaken fire safety training.

The practice had a suitable health and safety policy and procedure, which set out staff roles and responsibilities. Staff had undertaken health and safety training. An external environmental assessment of the premises, fixtures and fittings had been carried out and the practice was awaiting the report and recommendations. Where recommendations had been shared with the practice, these had been addressed.

19 May 2014

During an inspection looking at part of the service

We conducted this inspection to follow up on the compliance action made at our last inspection on 08 January 2014, when we found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the surgery and others. For example, there was no evidence of completed health and safety or fire risk assessments and there was no process in place for checking the refrigerator temperatures, medicines and emergency equipment used at the surgery.

During our inspection on 19 May 2014 we found that some improvements had been made. We saw that health and safety risk assessments had been completed for some areas of the surgery. We noted that a fire risk assessment and a fire safety policy had been written, however these were incomplete and did not identify clear responsibilities for fire safety. There were appropriate arrangements in place to manage the risks associated with medicines and emergency equipment kept at the surgery. One of the clinicians we spoke with about the emergency medicines and equipment told us, 'There has been a big improvement.'

8 January 2014

During a routine inspection

We found that people were involved in decisions regarding their care and treatment. One person told us, 'I am involved in the consultation.' Another person said, '(GP) listens to my views, there is mutual respect.'

People were kept informed of the care and support available from the surgery and the treatment choices available to them. One person told us, 'We (person and GP) discuss the symptoms and what could alleviate them. They (GP) explain what the medication is for.'

We found that people received training and support appropriate to their role. One staff member told us, 'You get training as you go along as there is so much to learn.' We spoke with five members of staff, most of whom said they felt supported. One member of staff told us they were, 'Totally supported.'

The provider did not have an effective system in place to identify, assess and manage risks to the health and welfare of people who used the surgery and others. There was no evidence of completed health and safety or fire risk assessments. There was no audit process in place for checking the refrigerator temperatures, medicines and emergency equipment used at the surgery.

We found that people's records were regularly updated to reflect the care, treatment and support provided and that people's records were kept securely and could be located promptly when needed. The staff we spoke with were aware of their responsibility in relation to information governance.