Archived: The Monteiro Clinic Limited

Updated 16 October 2019

The Monteiro Clinic Limited is an independent provider of medical services. The service provides a full range of General Practice services. The service is provided primarily for patients for whom Spanish or Portuguese are their first language who make up 70% of the services list. Services are provided at 2 Clapham Road, Oval, London, SW9 0JG in the London borough of Lambeth. All patients attending the service referred themselves for treatment; none are referred from NHS services. The patients seen at the service attend sometimes just for one appointment, while many patients attend for follow up of long term conditions. The majority of patients who use the service are adults, but some children are also seen. The provider also provides services at three other sites providing dental care and beauty and skin care services.

The service is open Monday to Friday from 8:30am to 7pm and Saturday 8:30am to 4pm. The service does not offer elective care outside of these hours.

The premise is located on two floors. The property is leased by the provider and the premises consist of a patient reception area, five consulting rooms and a dispensary.

The service is operated by a general practitioner who works at the service. The service also employs three nurses, a service manager and four receptionists. There are six other GPs who work at the service, they are not employed by the service, working on a contract basis. The nursing service had been suspended at a provider level prior to this inspection, meaning the nurses were not providing clinical care at the time of this inspection.

The lead clinician is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

The service is registered with the CQC to provide treatment of disease, disorder or injury and diagnostic and screening procedures.

During the inspection we used a number of methods to support our judgement of the services provided. For example, we interviewed staff, and reviewed documents relating to the service.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Our inspection team was led by a CQC lead inspector. The team included a member of the CQC medicines team and a General Practitioner specialist advisor.

Updated 16 October 2019

This service is rated as Inadequate overall. (Previous inspection September 2018, at which point the service was unrated. At that time the service was found not to be providing safe, effective or well led care.)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out this announced comprehensive inspection at The Monteiro Clinic on 9 May 2019. We had previously carried out an announced comprehensive inspection on 4 September 2018. At that time the service was judged to be meeting the standards for providing caring and responsive care and treatment but not to be providing safe, effective or well led care.

The areas where we said that the provider must make improvement were:

• Ensure care and treatment is provided in a safe way to patients. This should include ensuring systems are in place to assure medicines management, infection control and equipment to manage emergencies and full infection control processes.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties. This should include ensuring staff are trained in relevant areas, supervision of the nurses working at the service, and completion of appraisals.

The area where we said the provider should make improvements was:

• Review privacy arrangements in clinical rooms.

At this inspection we found that the practice had addressed some of the issues from the last inspection. However, we noted that there were other breaches in the safe, effective and well led domains.

We found that:

• The service did not provide care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs in some areas, but there were inadequate systems to ensure that staff were fit for the role they were undertaking and the management of consent.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The service organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed did not promote the delivery of high-quality, person-centre care. There was a lack of governance systems, protocols and systems to provide safe and effective care.

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 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