Archived: Dr Paramundayil Joseph Also known as Dill Hall Surgery

Updated 9 May 2024

Dr Paramundayil Joseph is based at:

6-8 Church Street

Church

Accrington Stanley

Lancashire

BB5 4LF

Tel: 01254 457 452

Website: www.dillhallsurgery.nhs.uk

The following information applied to the practice prior to de-registration with the CQC:

The practice opening times were Monday to Friday from 8am to 6.30pm.

The practice delivered services under a general medical services (GMC) contract with NHS England to 2730 patients and was part of the NHS East Lancashire Integrated Care Board (ICB).

The service was registered with the CQC to provide the following regulated activities: Diagnostic and Screening Procedures, Maternity and midwifery services and Treatment of disease, disorder or injury.

Information published by Office for Health Improvement and Disparities showed that deprivation within the practice population group was in the second lowest decile (two of 10). The lower the decile, the more deprived the practice population was relative to others. According to the latest available data, the ethnic make-up of the practice area was 86% White, 12% Asian, 2% Mixed.

Dr Paramundayil Joseph was a single-handed GP practice. Dr Joseph was not providing any clinical work at the time of the inspection. All clinical work was provided by locum GPs. The practice had a team of one practice nurse who provided nurse led clinics for a range of long-term conditions and a health care assistant. A pharmacist (provided by the Primary Care Network) also worked at the practice. The GPs and clinicians were supported at the practice by a team of reception/administration staff.

Out-of-hours emergency cover was provided by East Lancashire Medical Services Limited.

How we inspected this service

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This included:

• Reviewing information, we had from the other organisations.
• Conducting staff interviews on site and using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection. The evidence table gives a summary of our findings, but we were unable to gather sufficient evidence to rate the provider.

Updated 9 May 2024

This service is rated inadequate. We were able to gather sufficient evidence to make a judgement on safe, effective, responsive and well-led, which were all rated as inadequate. We carried over the previous rating of caring which was good.

We carried out an unannounced focused inspection at Dr Paramundayil Joseph on the 29 November 2023 in response to concerns raised about the safety of the service provided to patients.

We returned to the practice to gather further evidence on 12 December 2023 and found the provider had ceased delivering regulated activities and the patient list had been transferred to another registered provider. We were therefore unable to complete the inspection.

The provider has since cancelled their registration and is no longer registered with the CQC as a provider at this location .

The registered provider was the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• Safeguarding procedures had not been developed to ensure patients were protected from abuse and harm. It was not possible to establish whether all staff were trained in safeguarding procedures and the lead GP was unable to explain the safeguarding procedures.
• Health and safety was not well managed. There was no evidence of regular fire safety checks and fire safety training being carried out.
• There was minimal oversight and monitoring of patients on multiple medicines that can cause dependence.
• Clinical searches found areas where clinical care for patient with long term conditions had not been monitored and managed to ensure patients received safe care.
• There was no evidence of quality improvements for the ongoing development of the service.
• Additional nursing clinical hours were not provided when concerns were raised about patient access to services.
• The provider could not explain how the practice adjusted the delivery of its services to meet the needs of patients with a learning disability.
• There was no evidence that the outcome of patient complaints had been linked to the overall development and improvement of the service.
• The way the practice was led and managed did not always promote the delivery of high quality person centred care.
• There was no evidence of a leadership development programme practice.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care