All inspections: Dr Poolo's Surgery - Rush Green Medical Centre

We carried out a review of the data available to us about Dr Poolo's Surgery - Rush Green Medical Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Dr Poolo's Surgery - Rush Green Medical Centre, you can give feedback on this service.

We carried out an announced focused inspection at Dr Poolo’s Surgery - Rush Green Medical Centre on 19 and 31 October 2022. Overall, the practice is rated as good.

Following our previous inspection on 30 September 2021, the practice was rated requires improvement overall and for key questions safe and well-led.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Poolo’s Surgery - Rush Green Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up on breaches of regulation from the September 2021, in line with our inspection priorities.

How we carried out the inspection.

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

This included:

Conducting staff interviews using video conferencing and telephone calls.
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.

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 found that:

The practice provided care in a way that kept patients safe and protected them from avoidable harm.
Patients received effective care and treatment that met their needs.
Staff were involved with the running of the practice and their views were sought by the practice GP partners.
The practice’s GP Patient Survey results was 10% higher than the national average for patients describing their overall experience at the practice as good.
Patients could access care and treatment in a timely way.
Clinical audits were used to improve levels of care provided to patients.
Significant events that occurred at the practice were analysed and improvements made to the service as a result.
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 with measures to improve the uptake of childhood immunisations at the practice.
Continue with measures to improve the uptake of cervical screening at the practice.
Identify a Freedom to Speak Up Guardian within the practice.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced comprehensive inspection of Dr Poolo’s Surgery – Rush Green Medical Centre on 30 September 2021.

Following our previous inspection on 22 February and 9 and 10 March 2021, the practice was rated as inadequate overall (inadequate for ‘Safe’, ‘Effective’ and ‘Well-led’, and ‘Caring’ and ‘Responsive’ were not inspected so the previous rating of good was carried over).

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Poolo’s Surgery – Rush Green Medical Centre on our website at www.cqc.org.uk.

Throughout the COVID-19 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 reduced 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 practice’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 by email; and
A site visit to the practice.

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.

At this inspection, we have rated the practice as requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

The practice did not have an induction checklist for clinical staff and there was no locum handbook for locum GPs to refer to.
No risk assessment had been completed to support the practice’s decision that basic life support training would not be completed annually, as per Resuscitation Council UK guidelines.
The practice was not able to provide a Patient Group Direction for a specific vaccine.
The significant events policy was not being followed consistently by staff, in terms of the formal reporting mechanisms.
The system to monitor cervical screening results was ineffective and required further oversight.
There was no system in place to monitor and track blank prescriptions throughout the practice.
We saw no evidence that the practice had warned patients about a medicine’s particular risks, as specified in a safety alert.
However, we found that the practice had addressed issues from our previous rated inspection, and we saw appropriate arrangements for monitoring and safeguarding patients at risk, structured and appropriately documented medication reviews, appropriate monitoring for patients prescribed high-risk medicines, and no prescribing of medicines contrary to safety alerts.

We rated the practice as requires improvement for providing well-led services because:

There was limited documented evidence of compliance with the duty of candour for the two most recent significant events.
Some policies were not specific to the practice, were missing some information, were not version-controlled or did not have a next review date.
The shared drive containing the practice’s policies and procedures was disorganised and required review, with some staff not able to locate certain policies or up to date versions of documents.
Some meeting minutes did not contain any detail of what was discussed, and there was no formal system to ensure actions were consistently followed up.
There were some gaps in monitoring and management systems, including oversight of cervical screening results, monitoring of blank prescriptions, authorisation of medicines, and COSHH.
However, leaders had taken action to address the risks we had identified at the previous CQC inspection, for example in relation to monitoring of patients, management of long-term conditions, clinical record keeping, safeguarding arrangements, oversight of healthcare staff, and recruitment checks.

We rated the practice as good for providing effective services because:

Our records review indicated that care and treatment was delivered in line with current standards and evidence-based guidance.
We did not see any instances of a failure to follow up on symptoms indicating possible serious illness.
The practice had carried out audits looking at its care of patients with specific long-term conditions, and this had improved since the previous inspection.
Clinical staff had completed role-specific training and staff had access to regular appraisals and clinical supervision.
We saw that record keeping had improved, with clear documented reviews and assessments by GPs. The practice had increased its use of clinical templates which helped to ensure that structured reviews and consultations were completed.
Do Not Attempt Cardiopulmonary Resuscitation decisions were made in line with relevant legislation and were appropriate.
These areas affected all population groups, so we rated all population groups as good for providing effective services, except for the population group ‘working age people’ which we rated requires improvement as the system to monitor cervical screening results was ineffective and required additional oversight.

We rated the practice as good for providing caring services because:

Staff treated patients with kindness, respect and compassion.
Feedback we received from the Patient Participation Group (PPG) advised that the practice meets the needs of and listens to its patients.
The practice’s GP patient survey results for 2021 were in line with national averages for questions relating to kindness, respect and compassion.
The practice respected patients’ privacy and dignity.

We rated the practice as good for providing responsive services because:

The practice’s GP patient survey results for 2021 were in line with national averages for questions relating to access to care and treatment, except for the question about telephone access which was better than the national average.
We checked the appointment system and saw there were routine and urgent GP appointments available quickly.
Feedback we received from the Patient Participation Group (PPG) and staff we spoke with said that patients were able to access appointments.
We saw evidence of compliance with the Accessible Information Standard and arrangements in place for patients’ particular needs.
Complaints were listened and responded to and used to improve the quality of care.
These areas affected all population groups, so we rated all population groups as good for providing responsive services.

The areas where the provider should make improvements are:

Review the necessity to carry out checks of clinicians’ registration on an ongoing basis throughout their employment.
Consider merging the checklist of emergency medicines, refrigerated vaccines and emergency equipment, to make the checking process easier and more efficient for staff members.

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.

(Please see the specific details on action required at the end of this report).

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We previously carried out a focused inspection of Dr Poolo's Surgery - Rush Green Medical Centre on 22 February 2021 and 9 to 10 March 2021. At the inspection, we found the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17: ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued Dr Poolo’s Surgery – Rush Green Medical Centre with an urgent notice to suspend their registration as a service provider in respect of regulated activities, under Section 31 of the Health and Social Care Act 2008. This notice of urgent suspension of the provider’s registration was given because we believed that a person will or may be exposed to the risk of harm if we did not take this action. The provider had the right to make an appeal to the First-tier Tribunal, but did not do so. The practice remained open during the suspension period, but under the leadership of a different provider.

Dr Poolo's Surgery - Rush Green Medical Centre is currently rated as inadequate overall (inadequate for the key questions of ‘Safe’, ‘Effective’ and ‘Well-led’, and good for ‘Caring’ and ‘Responsive’).

The full report of the practice’s previous inspection can be found by selecting the ‘all reports’ link for Dr Poolo’s Surgery – Rush Green Medical Centre on our website at www.cqc.org.uk.

We carried out this announced focused inspection on 10 June 2021 to check whether the practice had made improvements in relation to the issues we identified at the previous inspection. This report covers our findings in relation to those specific areas, is not rated, and does not change the current ratings held by the practice.

Throughout the COVID-19 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 reduced 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 practice’s patient records system and discussing findings with the provider;
Reviewing patient records to identify issues and clarify actions taken by the provider; and
A site visit to the practice.

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.

At the inspection on 10 June 2021 we found the provider had taken action to address the issues we identified at the previous inspection, although there were still some areas which remained in breach of the Regulations.

Our key findings were as follows:

We could not be assured that the practice had implemented an effective system to proactively monitor vulnerable patients.
Some of the clinical records we checked contained brief information and required further detail.
We found instances where medication reviews had been coded as having taken place without evidence in the record of an actual structured medication review.
There were some issues around management and checks of diabetes patients, specifically around referrals for eye screening and urine checks.
We checked a sample of staff training records and found staff had completed adult and child safeguarding training to the appropriate level.
Disclosure and Barring Service (DBS) checks were undertaken where required and appropriate recruitment checks were carried out.
The practice had addressed the issue we previously identified around inappropriate use of a clinical code for cervical screening.
The practice had a system to appropriately monitor patients prescribed high-risk medicines, and our records review did not identify any patients prescribed high-risk medicines without the required monitoring having been carried out and documented.
The practice had taken action to ensure prescribing was in line with safety alerts.
Appropriate asthma reviews were being carried out and documented.
Dementia and mental health care plan reviews had been clearly documented in the patients’ records.
Leaders had taken on board our previous findings and had made, or were in the process of making, changes to improve the practice. Although many of the changes had been made with external assistance, and therefore we were unable to fully assess whether leaders had the capacity to recognise and react appropriately to issues or risks going forward.
Systems had been put in place to ensure effective oversight of healthcare staff.
The overall governance arrangements had improved.

The areas where the provider should make improvements are:

Ensure that internal meetings and any meetings with external health and social care professionals are fully documented, with a framework to follow up on any agreed actions.

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.

(Please see the specific details on action required at the end of this report).

On 18 March 2021, we issued Dr Poolo’s Surgery – Rush Green Medical Centre with an urgent notice to suspend their registration as a service provider for three months in respect of regulated activities. As a result of our findings at this inspection, the suspension will be allowed to expire on 18 June 2021. However, Dr Poolo’s Surgery – Rush Green Medical Centre remains in special measures due to our ratings at the previous inspection in March 2021.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an unannounced focused inspection of Dr Poolo's Surgery - Rush Green Medical Centre on 22 February 2021 as a result of concerns raised with the CQC. As a result of our findings from this site visit, we expanded the scope of our inspection and engaged with the practice to arrange further inspection activity. We carried out a remote review of the practice’s record system on 9 March 2021 and remote interviews with staff on 10 March 2021.

The practice was last inspected on 23 September 2020 and 13 October 2020 when we carried out a remote records review with the consent of the provider, and this inspection was not rated. As a result of this remote records review in September and October 2020, we sent the provider a ‘Letter of serious concern’, detailing our concerns in relation to their record keeping, monitoring of patients, and coding of patient records, and requesting that the provider submit evidence of work completed on auditing and peer-reviewing clinicians’ record keeping and in relation to coding of patient records.

The practice is currently rated as good overall following a comprehensive inspection on 18 March 2015 and a focused inspection on 6 March 2017.

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.

At this inspection, we have rated the practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
We found appropriate recruitment checks were not always carried out.
We could not be assured that patient records were written and managed securely, in line with current guidance, or that staff had the information they needed to deliver safe care and treatment.
The practice was coding medication reviews as having taken place with no evidence in the record of a structured medication review having been carried out by a clinician.
We identified examples where patients had been prescribed high-risk medicines without evidence in the clinical record that appropriate monitoring had taken place or that test results had been checked by clinicians prior to prescribing to ensure patient safety.
The practice did not have an effective system to manage safety alerts and we found examples of prescribing contrary to safety alerts.

We rated the practice as inadequate for providing effective services because:

Care and treatment was not delivered in line with current legislation, standards and evidence-based guidance.
We identified examples where patients presenting with symptoms indicating possible serious illness were not followed up in a timely or appropriate way.
We found evidence of a clinician acting beyond their scope of practice in relation to clinical reviews and decision-making, with no evidence of escalation to or involvement of a GP.
There was poor monitoring and management of patients with long-term conditions, such as diabetes and asthma.
We were not assured that dementia and mental health care plan reviews were being carried out properly or being adequately documented.
The records we reviewed demonstrate significant record keeping issues, with a repeated failure to keep accurate, detailed and contemporaneous records in line with ‘Good medical practice’ (General Medical Council guidance).

These areas affected all population groups, so we rated all population groups as inadequate for providing effective services.

We rated the practice as inadequate for providing well-led services because:

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.
The practice did not have clear systems to support good governance and management, for example in relation to systems for managing safety alerts, processes to appropriately diagnose, monitor and manage patients, arrangements for supervision and record keeping checks, and safeguarding arrangements.
The practice did not have effective processes for managing risks, issues and performance. We identified several risks to patient safety which had not been identified or acted upon by the practice prior to our inspection activity.
We could not be assured that the practice had systems and processes to keep clinicians up to date with current evidence-based practice, given the concerns around care and treatment we identified in patient records.
We were not assured that the practice maintained accurate and reliable data or was able to use their data to effectively monitor and improve performance.

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.

(Please see the specific details on action required at the end of this report).

On 18 March 2021, Dr Poolo’s Surgery – Rush Green Medical Centre was issued with an urgent notice to suspend their registration as a service provider in respect of regulated activities, under Section 31 of the Health and Social Care Act 2008. This notice of urgent suspension of the provider’s registration was given because we believed that a person will or may be exposed to the risk of harm if we did not take this action. The provider had the right to make an appeal to the First-tier Tribunal. The practice remains open during the suspension period, but under the leadership of a different provider.

The provider will be inspected again prior to the expiry of the suspension to assess whether sufficient improvements have been made.

I am also placing this service in special measures. If insufficient improvements have been made at the next inspection, we will take action in line with our enforcement procedures. Special measures will give people who use the service the reassurance that the care they get should improve.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an GP focused inspection at Dr Poolo's Surgery - Rush Green Medical Centre on the 23 September 2020 and 13 October 2020 as part of our inspection programme.

This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, all information contained within this report was obtained remotely from the provider.

We previously inspected Dr Poolo's Surgery on 6 March 2017. At this time we rated the practice good in all key questions. Details of this report can be found by selecting the ‘all reports’ link for Dr Poolo's Surgery on our website at www.cqc.org.uk.

The focused inspection undertaken on 23 September and 13 October 2020 did not review the ratings for the key questions or for the practice overall as this was a focused inspection undertaken to assess whether the provider had taken action to address an area of serious risk highlighted to the Commission following the receipt of information from a coroner's report.

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.

At this focused inspection we found:

Clinical records were viewed not always completed in-depth, which meant the best treatment for patients was identified.
Medication reviews were not always undertaken in a timely manner.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P and S Poologanathan on 15 March 2015. The overall rating for the practice was good, however we rated the practice as requires improvement for providing safe services based on our findings which included lack of infection control training and legionella testing. The full comprehensive report on the 18 March 2015 inspection can be found by selecting the ‘all reports’ link for Dr P and S Poologanthan’s surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 March 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 15 March 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. At this inspection we found that the issues found during the previous inspection had been addressed. Therefore, the practice is now rated as good for providing safe services.

Our key findings across the areas we inspected for this focused inspection were as follows:

We found that the infection control lead had undertaken infection control training and audits were now carried out at six monthly intervals.
We saw that learning from significant events was shared with non-clinical staff during practice meetings.
Legionella testing was carried out by an external organisation and possible hazards identified had been actioned and appropriate records were maintained.
We found that all staff who acted as chaperones were suitably trained.
The practice nurse was aware of and could sufficiently articulate the Gillick competencies.
The practice had a fire risk assessment and carried out fire drills annually.
Clinical audits we looked at demonstrated that improvements had been made to ensure any negative results were addressed.

The area where the provider should make improvement is:

The practice should review their fire risk assessment to ensure it is detailed and reflective of the practice’s current arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P and S Poologanathan's practice on 18 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. The practice requires improvement for providing safe services. It was also good for providing services for older people, people with long term-conditions, families, children and young people, the working age (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
Risks to patients were assessed and well managed.
Patients’ needs were assessed and care was planned and delivered following best practice guidance.
Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
Information about services and how to complain was available and easy to understand.
Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
The practice had good facilities and was well equipped to treat patients and meet their needs.
There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvements are:

Ensure appropriate standards of cleanliness and hygiene in relation to the premises occupied for the purpose of carrying out the regulated activity are met. To ensure the leads for infection control undertake training in infection control and are able to provide advice on the practice infection control policy and carry out staff training. Undertake infection control audits at periodic intervals.

In addition the provider should:

Ensure learning is communicated to the wider reception team, not directly involved with a significant event and are given opportunities to raise an issue for consideration and share good practice at regular practice meetings.
Ensure non clinical staff who undertake formal chaperone activities are suitably trained.
Ensure a Legionella risk assessment is completed to reduce the risk of infection to staff and patients.
Ensure the monitoring of audit results to ensure any negative results are addressed.
Ensure a fire risk assessment is completed to maintain fire safety.
The practice nurse to be aware of the Gillick competencies.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Dr Poolo's Surgery - Rush Green Medical Centre

All Inspections

6 July 2023

During a monthly review of our data

19 & 31 October 2022

During an inspection looking at part of the service

30 September 2021

During a routine inspection

10 June 2021

During an inspection looking at part of the service

22 February 2021, 9 and 10 March 2021

During an inspection looking at part of the service

23 September 2020 and 13 October 2020

During an inspection looking at part of the service

6 March 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

18 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)