Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Satish C Pillarisetti on 30 June 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.

We undertook this focussed inspection on 1 March 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. You can read the report from our last comprehensive inspection by selecting ‘all reports’ link for Dr Satish C Pillarisetti on our website at www.cqc.org.uk.

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 of Dr Satish C Pillarisetti (also known as Chalk Surgery) on 30 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be good for providing caring, responsive and well-led services. It required improvement for providing safe and effective services.

Our key findings 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 and reviewed.
• Not all patients’ needs were assessed and care was not always planned and delivered in line with current legislation. Staff had received some training appropriate to their roles. However, not all training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. Staff treated patients with kindness and respect, and maintained confidentiality.
• Patients said they experienced few difficulties when making appointments and urgent appointments were available the same day.
• There was a leadership structure and staff felt supported by management. The practice took into account the views of patients and those close to them as well as engaging with staff when planning and delivering services.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must;

• Ensure physical health checks and medicine reviews are undertaken for patients with learning disabilities.
• Review medicine management to help ensure vaccines are stored in line with current guidance.
• Ensure the practice is able to respond to medical emergencies in line with national guidance.
• Ensure the practice responds to shortcomings in the quality of patient care identified by audit activity.

The provider should also;

• Review staff fire safety training.
• Review the system to monitor and record the hepatitis B status of all clinical staff.
• Revise governance processes and ensure that all documents used to govern activity are up to date and contain relevant contact details.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on 22 November 2013 found that care and treatment was not always planned and delivered in a way that was intended to ensure patients’ safety and welfare. Patients who used the service were not always protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Patients were not always protected from the risk of infection because appropriate guidance had not been followed. Patients were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Patients were not always cared for, or supported by, suitably qualified, skilled and experienced staff. The provider did not have an effective system to regularly assess and monitor the quality of service that patients received.

Compliance actions were set asking the provider to take action regarding these concerns. They wrote to inform us that they had taken action and put measures in place to rectify the areas of concern found at this inspection.

We followed up on our inspection of 22 November 2013 to check that action had been taken to meet the compliance actions set. We found that although some improvements had been made, the provider was not able to demonstrate that they were meeting all of the compliance actions set in order to rectify the areas of concern identified at that inspection. Patients were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Patients were not always cared for, or supported by, suitably qualified, skilled and experienced staff. The provider did not have an effective system in place to regularly assess and monitor the quality of service that patients received. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients and others. We found additionally that the provider did not have an effective system in place for dealing with complaints.

People told us that they were happy with the service they received. One person told us, "They are very good here". Another person told us, "I have been coming here for many years. I am happy with the service".

We checked the training records of staff at the practice and saw that clinical staff had received training for Basic Life Support however we noted that all staff except one had been due to attend a renewal course in September 2013.

We found that the practice had no clear defined process for staff to follow to report suspicions of abuse, or information about the types and signs of abuse to look out for.

We looked at the training records of staff and we saw that staff had not received any training in relation to decontamination and infection control. The service also had no policies and procedures in place to manage infection control.

We found there was no system in place to log the prescription pads received or to record the individual identifying numbers on them, which meant that there was no way of knowing whether any had gone missing or been stolen

The provider had employed staff without undertaking suitable pre-employment checks.

We saw that the service completed risk assessments for areas such as health and fire safety, lone working, manual handling, and the environment.

Patients and their representatives were not asked for their views about their care and treatment.