Dr Chidambaram Balachander

We carried out an announced comprehensive inspection at Dr Chidambaram Balachander on 04 December 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Dr Chidambaram Balachander on our website at www.cqc.org.uk.

After our inspection in December 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

We carried out an announced comprehensive follow-up inspection on 31 October 2019 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 04 December 2018. At this inspection we found that the practice had met the requirements. This report and accompanying evidence table covers the findings in relation to those requirements.

We have rated this practice as good overall and good for all population groups.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

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 found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Risk assessments had been completed and acted on in a way that helped keep patients safe.
• Security risks had been resolved and risk assessment action plans contained time frames.
• Alerts were now flagged up on the records of household members of children on the child protection register.
• There had been improvements to the arrangements for medicines management in the practice. All issues identified at the previous inspection had been resolved and patients were now being kept safe as a result.
• All staff that were assessed as requiring a DBS check had received one.
• Quality improvement activity had been effective and was ongoing.
• Staff had completed the essential training identified as incomplete at the previous inspection.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Care records were now available at the practice and to staff when visiting patients in their place of residence.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Governance arrangements had been improved and were effective. Governance documents were signed and dated appropriately.
• The practice had established a patient participation group.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Continue to monitor the temperature of water from all taps using the revised template.
• Ensure that discussions with patients as part of the practice’s duty of candour are always recorded.
• Continue to monitor and record staff training to ensure that all staff remain up to date with essential training.
• Ensure that recruitment procedures and protocols are applied to all staff.
• Investigate ways of increasing the number of carers identified.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Requires Improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Dr Chidambaram Balachander on 4 December 2018 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was an effective system for reporting and recording significant events.
• The practice’s systems, processes and practices did not always help to keep people safe.
• Risks to patients, staff and visitors were not always assessed, monitored and managed in an effective manner.
• Staff did not always have the information they needed to deliver safe care and treatment to patients.
• The arrangements for managing medicines in the practice did not always keep patients safe.
• The practice learned and made improvements when things went wrong.
• Performance for diabetes and hypertension related indicators for 2017 / 2018 was significantly below local and national averages. However, the practice was taking action to make improvements.
• Published results showed the childhood immunisation uptake rates for the vaccines given exceeded World Health Organisation targets of 95%.
• Published QOF data from 2017 / 2018 showed that the practice’s exception reporting for some indicators was higher than local and national averages, significantly so in some cases.
• Staff had the skills, knowledge and experience to carry out their roles. However, not all staff were up to date with essential training.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was higher than local and national averages, significantly so in some cases.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.
• Governance arrangements were not always effective.
• Some processes to manage current and future performance were not yet sufficiently effective.
• The practice involved patients, the public, staff and external partners to support high-quality sustainable services.

The areas where the provider must make improvements are:

• 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.

The areas where the provider should make improvements are:

• Continue with plans to set up a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.