The Care Quality Commission
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  • GP practice

Archived: Dr Chandrika Ramu

Overall: Good read more about inspection ratings

95 High Street, Milton Regis, Sittingbourne, Kent, ME10 2AR (01795) 426640

Provided and run by:
Dr Chandrika Ramu

Important: The provider of this service changed. See new profile

All Inspections

13 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 Chandrika Ramu on 19 May 2015. Breaches of the legal requirements were found.

  • Staff did not have a common understanding of what constituted a significant event and all significant events that took place had not been appropriately reported and recorded.
  • Staff had not undertaken training in safeguarding children or vulnerable adults to the appropriate level.
  • The practice was unable to demonstrate checks on the medicines held in the practice had been carried out and blank prescription forms were not always kept securely or tracked through the practice.
  • The practice did not have a member of staff designated with lead responsibility of infection control. Staff had not been trained or undertaken audits to identify infection control risks at the practice. The practice had not considered the risks associated with legionella (a germ found in the environment which can contaminate water systems in buildings).
  • The practice had not always undertaken recruitment checks prior to the employment of staff. The practice was unable to demonstrate that a risk assessment had been undertaken to determine the roles required to have Disclosure and Barring Service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • The practice was unable to demonstrate that emergency equipment and emergency medicines were checked on a regular basis. We found emergency equipment that was out of date.
  • The practice was unable to demonstrate they had carried out a fire safety risk assessment and did not have a fire safety action plan. Staff had not received fire safety training and the practice was unable to demonstrate that regular fire drills were carried out.
  • The practice had undertaken some clinical audits. However, information from the clinical audits did not clearly identify the findings or any subsequent changes that had been implemented as a result.
  • The practice did not have a system to undertake other audits to monitor the quality and safety of the service.
  • The practice did not have an established system for managing and mitigating risks in relation to the premises.
  • The practice did not have an active patient participation group (PPG).
  • The practice was unable to demonstrate that appraisals had been carried out for any of their staff.

Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook a focussed inspection on 14 April 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. At or focussed inspection on 14 April 2016, the practice provided records and information to demonstrate that some of the requirements had been met. However, breaches of the legal requirements were found.

  • The practice had carried out a legionella risk assessment. However, were unable to demonstrate they were monitoring water temperatures from hot and cold water outlets or carrying out regular flushing of infrequently used water outlets.

  • All staff had received a DBS check. However, the practice had failed to carry out other recruitment checks prior to the employment of staff.

  • The practice was unable to demonstrate that all staff who acted as chaperones had received training for this role.

  • The practice was unable to demonstrate that all staff were up to date with fire safety training.

  • Records demonstrated emergency equipment and emergency medicines were checked on a regular basis. However, we found emergency equipment at the practice that was out of date.

  • The practice had carried out clinical audits but were unable to demonstrate that these had led to improvements in the quality of patient care.

  • The practice had undertaken risk assessments for fire safety and legionella. However, there were no formal arrangements for identifying, recording and managing risks or implementing mitigating actions.

Following the focussed inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focussed inspection on 13 December 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. At our focussed follow-up inspection on 13 December 2016, the practice provided records and information to demonstrate that the requirements had been met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Chandrika Ramu on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

14 April 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 Chandrika Ramu on 19 May 2015. Breaches of the legal requirements were found. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches. You can read the report from our last comprehensive inspection by selecting ‘all reports’ link for Dr Chandrika Ramu on our website at www.cqc.org.uk.

We undertook this focussed inspection on 14 April 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements.

Overall the practice is rated as requires improvement.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were not always assessed and well managed. For example, the practice had undertaken risk assessments for fire safety and legionella. However, they had not taken action to mitigate the risks identified.
  • All staff had been trained to the appropriate level in safeguarding and had Disclosure and Barring Service (DBS) checks. The practice maintained records of checks undertaken for locum staff working in the practice. However, we found that other recruitment checks had not been carried out prior to employing staff. All staff had had an appraisal in the last 12 months and these were recorded in their personnel files.
  • The practice kept records of checks of medication, and had a system for storing blank prescriptions securely.
  • The practice had a designated lead member of staff for infection prevention and control, and clinical staff had received infection control training.
  • Emergency equipment and medicines were stored together, checked regularly and the practice kept records of these checks. However, we found that an oxygen face mask which had been out of date at our inspection on 19 May 2015 was still out of date.
  • The practice had carried out clinical audits but could not demonstrate that these had led to improvements in the quality of care. The practice did not carry out regular quality audits to monitor the quality and safety of services.

The areas where the provider must make improvements are:

  • Ensure action plans to address identified risks are implemented in a timely manner.
  • Ensure staff receive fire safety training.
  • Ensure that completed clinical audit cycles and quality audits are driving quality improvement.
  • Ensure recruitment arrangements include all necessary employment checks for all staff.

In addition the provider should:

  • Ensure all equipment is fit for purpose and within manufacturers’ expiry dates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 May 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Chandrika Ramu on 19 May 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. The concerns which led to these ratings applied to all population groups. We therefore found that the practice required improvement for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), as well as people whose circumstances may make them vulnerable and people experiencing poor mental health (including dementia). We found the practice was good for providing effective, caring and responsive services.

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, although staff may not have been fully aware of the type of incident that should have been reported. Information about safety that was reported was recorded, appropriately reviewed and addressed.
  • Data showed that many patient outcomes were above average for the locality and there was evidence that the Quality and Outcomes Framework (QOF) was used by the practice to monitor performance and drive improvement.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • Information about services and how to complain was available and easy to understand.
  • The practice had a number of policies and procedures to govern activity and these had been reviewed and were in date.
  • The practice had not always undertaken audits to monitor quality and safety, including infection control, training, and completed clinical audits to help drive improvement.
  • The practice identified and addressed risks to patients, although a risk management process had not been fully developed to assess and record all risks, including those relating to recruitment checks, some areas of infection control and medicines management.

There were areas of practice where the provider must make improvements. Importantly, the provider must:

  • Ensure recruitment arrangements include all necessary employment checks for all staff, including appropriate checks for locum staff.
  • Ensure the safe management of medicines, medical equipment and security of prescription forms.
  • Ensure effective management of infection prevention and control.
  • Ensure the practice governance arrangements include audits to monitor quality and safety, including completed clinical audit cycles.
  • Ensure the practice governance arrangements include a system of risk assessment and management, including analysis of significant events and improved staff awareness of incidents that require reporting.

In addition the provider should:

  • Review the training requirements for staff in keeping mandatory training updated.
  • Review the arrangements for undertaking timely staff appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice