We carried out an announced comprehensive inspection on 17 April 2019 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

This service is rated as Inadequate

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced inspection at the Monteiro Clinic North under Section 60 of the

Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Following the inspection, we took action immediately regarding the practice nurses and imposed an urgent condition on the provider by issuing a s.31 notice under the Health and Social Care Act 2008. This condition prevented the practice nurses from operating until they were appropriately trained and competency checked to carry out the roles they were employed to perform.

We issued the provider with two Warning Notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

•Regulation 12 Safe care and treatment.

•Regulation 17 Good governance.

The Monteiro Clinic Limited is an independent provider of medical services and offers a full range of private general practice services predominantly to the Brazilian, Portuguese and Spanish communities. This is the first inspection of the service. The service has a sister practice in Clapham, South London.

Dr Monteiro is the lead clinician and the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection, we asked for CQC comment cards to be completed by patients prior to our inspection. We received 13 completed CQC comment cards which were all positive about the level of service and the care provided, and patients felt that they were treated with dignity and respect. We did not speak with patients directly at the inspection.

Our key findings were:

•Practices nurses did not have the required training, knowledge and experience to carry out the roles they were undertaking.

•There was limited evidence of system and processes in place regarding safeguarding children and vulnerable adults.

•Not all GPs’ had undertaken safeguarding training at an appropriate level.

•The service did not have a system or policy in place to safely manage patients who had been prescribed high risk medicines.

•Staff had not undertaken training to enable them to screen patients for red flag signs.

•The service did not have an Import Licence for medicines imported from Portugal.

•Yellow Fever vaccines had been administered to patients but the service was not registered as a Yellow Fever Centre.

•There was a lack of clinical governance and oversight for patient care.

•The service did not recognise or record all significant events.

•The service did not have an adequate clinical audit system in place to ensure quality improvement.

•The provider was aware of their responsibility to respect people’s diversity and human rights.

•Patients could access care and treatment from the clinic within an appropriate timescale for their needs and information leaflets were available in Spanish, Portuguese and English.

•Staff told us the service offers new patients a free health check consultation.

We identified regulations that were not being met and the provider must make improvements regarding:

•Care and treatment must be provided in a safe way for service users.

•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 placing this service in special measures. Services 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 service 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 remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care