The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Kandasamy Sundaram Also known as Roding Lane Surgery

Overall: Inadequate read more about inspection ratings

2 Roding Lane North, Woodford Bridge, Woodford Green, Essex, IG8 8NR (020) 8559 0280

Provided and run by:
Dr Kandasamy Sundaram

Important: We are carrying out a review of quality at Dr Kandasamy Sundaram. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

6 December 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kandasamy Sundaram on 1 July 2016. The overall rating for the practice was inadequate. The full comprehensive report on the 1 July 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kandasamy Sundaram on our website at www.cqc.org.uk. Following that inspection Warning Notices were served in relation to breaches of the regulations we identified. These breaches related to issues around safety (Regulation 12), governance (Regulation 17) and staffing (Regulation 19).

The specific issues we identified at that inspection were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. Areas of concern were found in relation to significant events, staff training, chaperoning, infection control, medicines management, recruitment checks, health and safety, fire safety, management of unforeseen circumstances in relation to the business continuity plans and dealing with emergencies.

  • The practice systems to keep patients safe and safeguarded from abuse were inadequate.

  • The arrangements for seeking consent to care and treatment in line with legislation and guidance were inadequate.

  • There was no effective programme of quality improvement to monitor and improve clinical outcomes.

  • GP satisfaction scores were lower than average and no action had been taken to address this.

  • There were no curtains in consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments.

  • There were limited facilities to help patients become involved in decisions about their care, such as interpreting services.

  • The practice had inadequate formal governance arrangements and the leadership arrangements in place were not effective enough to ensure safe and high quality care.

This inspection was an announced focused inspection carried out on 6 December 2016 to follow up on the concerns identified in the Warning Notices and confirm that the practice was now meeting the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 1 July 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection. Other areas of non-compliance found during the inspection undertaken on 1 July 2016 will be checked by us for compliance at a later date.

Following the inspection on 6 December 2016 the practice remains rated as inadequate. We found the provider had made improvements in some areas of Regulations 12 and 17 as set out in the Warning Notice. However, there were still areas relating to the Warning Notice that required improvement. The ratings for the provider will remain in place until a comprehensive inspection is undertaken.

Our key findings were as follows:

  • Areas of concern remained in relation to chaperoning, infection control, health and safety, fire safety, medicines management, dealing with emergencies and some aspects of infection control.

  • Processes around risk management were inadequate for example there was no evidence of electrical safety testing, fire safety training or legionella safety.

  • There was limited evidence of clinical audit. There was no evidence of completed audits where the improvements made were implemented and monitored

  • Some policies had been reviewed however, a number of policies remained out of date or requiring review.

  • Awareness of the Duty of Candour was limited.

  • Steps had been taken to address concerns around the leadership of the practice. However, these were yet to be formalised.

The other key lines of enquiry will be reassessed by us at another inspection when the provider has had sufficient time to meet the outstanding issues. At that time a new rating will be assessed for the provider.

The outstanding issues that the practice must address are:

  • Review the system for reporting, recording and sharing learning from significant events to ensure it was effective and that it supports the recording of notifiable incidents under the duty of candour.

  • Ensure staff have a suitable understanding of significant events and how to handle them.

  • Ensure documents related to the management of regulated activities (practice policies) are created and amended appropriately.

  • Ensure patient group directions (PGDs) are completed appropriately.

  • Assess the risks to the health and safety of service users of receiving the care or treatment and do all that is reasonably practicable to mitigate any such risks. This specifically relates to health and safety, fire safety, electrical safety and legionella testing.

  • Ensure a programme of quality improvement, including audit, to improve patient clinical outcomes.

    The areas where the provider should make improvement are:

  • Include staff contact numbers in the business continuity plan.

    Following the inspection on 1 July 2016 the practice was placed into special measures for a period of six months following the publishing of that report. We will inspect the practice again within six months of that publishing date to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

1 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kandasamy Sundaram, based at Roding Lane Surgery, on 1 July 2016. Overall, the practice is rated as Inadequate.

Our key findings across all the areas we inspected were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. Areas of concern were found in relation to significant events, staff training, chaperoning, infection control, medicines management, recruitment checks, health and safety, fire safety, management of unforeseen circumstances in relation to the business continuity plans and dealing with emergencies.
  • The practice systems to keep patients safe and safeguarded from abuse were inadequate.
  • The arrangements for seeking consent to care and treatment in line with legislation and guidance were inadequate.
  • There was no effective programme of quality improvement to monitor and improve clinical outcomes.
  • On the day of the inspection patients were positive about their interactions with nurses and reception staff and told us that they were treated with compassion and dignity. However, GP satisfaction scores were lower than average and no action had been taken to address this.
  • There were no curtains in consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments.
  • There were limited facilities to help patients become involved in decisions about their care, such as interpreting services.
  • Patients said they found it easy to make an appointment with a named GP and urgent appointments were available the same day.
  • The practice had inadequate formal governance arrangements and the leadership arrangements in place were not effective enough to ensure safe and high quality care.

The areas where the provider must make improvements are:

  • Care and treatment must be provided in a safe way for patients. This includes introducing processes for significant events, incidents and near misses, staff training, safeguarding children and vulnerable adults, addressing concerns with medicines management. 
  • Systems must be put in place to ensure all clinicians are kept up to date with national guidance and guidelines and provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.
  • The provider must ensure recruitment arrangements include all necessary employment checks for all staff, for example, Disclosure and Barring Service (DBS) checks, or risk assessments for all staff providing a chaperone service for patients.
  • The practice must ensure there is a comprehensive, business continuity plan in place.
  • The provider must ensure systems or processes are established and operated effectively to carry out quality improvement activity to monitor improvement and implement formal governance arrangements to assess, monitor and mitigate risk and to ensure the quality and safety of services are provided and to take appropriate action where progress is not achieved as expected.
  • The provider must establish an effective system for identifying, handling and responding to complaints from people who use the service.
  • The provider must ensure compliance with the requirements of the Mental Capacity Act (MCA) 2005.
  • The provider must ensure interpreting services are available for patients with communication difficulties.

The areas where the provider should make improvement are:

  • The provider should proactively identify and support patients who are carers.
  • The provider should review the national GP patient survey scores with the aim of improving patient satisfaction scores on GPs involvement in care.

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