The Care Quality Commission
  • Doctor
  • GP practice

Dr Krishnan

Overall: Good read more about inspection ratings

Kent Elms Health Centre, 1 Rayleigh Road, Eastwood, Leigh On Sea, Essex, SS9 5UU (01702) 522012

Provided and run by:
Dr Krishnan

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Dr Krishnan 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 Krishnan, you can give feedback on this service.

6 September 2019

During an annual regulatory review

We reviewed the information available to us about Dr Krishnan on 6 September 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

1 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

On 6 January 2016 we carried out a comprehensive inspection at Dr Krishnan. Overall the practice was rated as inadequate and placed in special measures. The practice was found to be inadequate in safe and well-led, requires improvement in effective and good in responsive and caring.

As a result of that inspection we issued the practice with a requirement notice in relation to risks to patient safety not been assessed and managed appropriately, the governance at the practice, staff training and recruitment. The issues of concern related to the lack of health and safety risk assessments in place and clinical equipment that had not been calibrated since 2013. There was no system for ensuring staff were registered with their professional body and a lack of system for reviewing test results and recording appropriately in patient records. Not all staff had undertaken training in respect of their roles and responsibilities and appropriate checks had not been carried out when employing staff.

The practice submitted further information following the inspection that assured us that the risks identified at the practice on the day of the inspection had been considerably reduced.

We then carried out an announced comprehensive inspection at Dr Krishnan on 1 June 2017. Overall the practice is rated as good.

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

  • Risks to staff and patients had been assessed and managed appropriately. The practice had completed all actions from the inspection in January 2016.
  • Staff had received training that was specific to their roles and the practice manager had a matrix that showed the training completed and when it was due for renewal.
  • Appropriate checks were carried out as to the fitness of staff to practice and all staff had current and effective registrations with their professional body. All relevant staff had received a disclosure and barring service check prior to employment or had a risk assessment in place detailing the reasons why for the staff that had recently commenced employment.
  • There was an effective system for assessing and monitoring the quality and safety of services provided.
  • Staff carrying out chaperone duties had received training and a disclosure and barring service check was in place.
  • There was sufficient and appropriate equipment for use in the treatment of patients, including in the event of a medical emergency and the equipment was calibrated to ensure it was working correctly.
  • There was a comprehensive business continuity plan in place in the event of an emergency taking place that disrupted the services to patients.
  • There was an ongoing programme of clinical audit that demonstrated quality improvement.
  • Practice policies and procedures had been reviewed to ensure that they were up to date and practice specific.
  • Prescriptions were stored securely however on the day of inspection were not tracked through the practice. The practice said that they would ensure this was completed.
  • The practice held regular multi-disciplinary team meetings in addition to coordinated care through the patient record system.
  • Data from the national GP patient survey showed patients reported high levels of satisfaction with the practice nursing team and had trust and confidence in their GPs.
  • Carers were identified and supported to access services and receive appropriate vaccinations.
  • The practice had an effective patient participation group and meetings showed how the practice had listened and responded to patient feedback.
  • Staff were able to recognise and reported significant incidents. These were investigated and lessons learnt identified and shared during clinical and practice management meetings attended by all staff.
  • The practice was clean and tidy and staff had reviewed infection prevention control and cleaning policies.
  • The practice manager had a log of all risk assessments and other tasks such as calibration and electrical testing documented on a log. This was colour coded and as they approached the date due the colour changed from green, to amber, to red.
  • Medicines were appropriately stored and monitored and we saw evidence to support this.
  • Patient safety and medicine alerts were shared amongst the clinical team and consistently actioned and a record and log was maintained.

Actions the practice should take to improve:

  • Ensure all blank prescriptions are handled in accordance with national guidance and tracked accordingly.
  • Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

06 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Krishnan on 6 January 2016. Overall the practice is rated requires inadequate.

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

  • Risks to patients were not consistently assessed and well managed. There were some systems for assessing risks including risks associated with fire safety and infection control. However these were not robust and where areas for improvements had been identified these had not been actioned.
  • Infection control procedures in place were not robust. Some parts of the practice were visibly dirty and cleaning schedules and quality monitoring were not in place.
  • Medicines were not stored or checked in a consistent manner to reduce risks. Fridge temperatures were not being effectively monitored.
  • There was no detailed business continuity plan to deal with untoward incidents that may affect the day to day running of the practice.
  • The procedure for dealing with medical emergencies were not recorded and available for staff to refer to as needed and there was insufficient equipment to support patients in the event of a medical emergency.
  • The practice staff recruitment procedure included carrying out checks including proof of identity and employment references. However these procedures were not followed consistently and Disclosure and Barring Service (DBS) checks were not carried out and this was not supported by a risk assessment to determine that these checks were not needed. There were no processes for checking that clinical staff including the practice nurse had a current and effective registration with their professional body.
  • The practice ensured that significant safety events were investigated and learning was shared with staff.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. However patients test results were not handled consistently, stored within patients records and evidence that appropriate action was taken following tests was not recorded.

  • Clinical audits and reviews were carried out to make improvements to patient care and treatment. However these were infrequent and carried out only as part of GP appraisal rather than part of a continuous programme for improvement.

  • Staff told us that they were supported and there was a system for staff appraisal.
  • Staff had not received role specific training to meet the needs of patients. This included safeguarding, chaperoning and basic life support.
  • 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 readily available. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or they experienced poor care or services.
  • 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. However appropriate checks were not carried out to ensure that equipment was calibrated so that it was working properly.
  • Staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

There were areas of practice where the provider needs to make improvements.

Importantly the provider must:

  • Ensure that risks to staff and patients are assessed and managed appropriately. This includes risks associated with medicines, fire and infection control. It also includes assessing risks associated with treating patients routinely, taking action after receiving test results and in the event of a medical emergency.

  • Ensure that staff receive training that is specific to their roles.

  • Ensure that appropriate checks are carried out as to the fitness of staff to practice and that all staff have current and effective registrations with their professional body. Ensure that all relevant staff have received a disclosure and barring service check prior to employment.

  • Ensure that there is an effective system for assessing and monitoring the quality and safety of services provided.

  • Ensure that those staff carrying out chaperone duties have received training and a disclosure and barring service check or a risk assessment is in place as to why one is not necessary.

  • Ensure that there is sufficient and appropriate equipment for use in the treatment of patients, including in the event of a medical emergency and that this equipment is calibrated to ensure it is working correctly.

  • Ensure that there is a business continuity plan in place in the event of an emergency taking place that disrupts the services to patients.

  • Carry out regular reviews and clinical audits to support improvements in patient treatment.

Additionally the provider should:

  • Consider the needs of patients with sensory impairment and provide a hearing loop if needed.

  • Review the practice policies and procedures to ensure that they are up to date and practice specific.

  • Ensure that prescriptions are stored securely and tracked through the practice.

Due to the passage of time between the inspection and the publication of the report we asked the provider to outline any improvement action they have already made. They sent us further information that assured us that the risks identified at the practice on the day of the inspection have been considerably reduced. This has not resulted in a change of rating but has reduced the need to take enforcement action at this time, although requirement notices have been issued.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice