We carried out an announced comprehensive inspection on 12 July 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with

the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection 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.

Nippon Club North Clinic is located within the Hospital of St John and St Elizabeth in St John’s Wood in West London. The clinic provides a primary care service for Japanese patients. The doctors are restricted by the terms of their licence to practice providing care to Japanese nationals only.

The clinic maintains a list of registered patients who can book appointments with a doctor or nurse at the clinic with onward referral to diagnostic and specialist services as appropriate.

We received 17 comment cards completed by patients in the days leading up to the inspection. These were positive about the service and described the service as accessible; the quality of care as excellent; and the staff as kind, caring and professional. The clinic had recently reduced its floorspace and several patients commented that they preferred the previous layout.  

Nippon Club North Clinic is registered to provide the regulated activities of:

• diagnostic and screening services; and

• treatment for disease, disorder or injury.  

The clinic has a registered manager in post.  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.

Our key findings were:

• Systems were in place to protect people from avoidable harm and abuse.

• When mistakes occurred, lessons were learned and action was taken to minimise the potential for reoccurrence. Staff understood their responsibilities to be open with patients.

• Clinical staff were aware of current evidence based guidance.

• Staff were qualified and had the skills, experience and knowledge to deliver effective care and treatment.

• Patient feedback indicated that patients were happy with the service they received.

• Information about services and how to complain was available.

• There was clear leadership and staff felt supported. The clinic team worked well together.

• There was a clear vision to provide a personalised and culturally familiar service to patients living away from their home country.

• The service had systems in place to monitor and improve the quality of service provision although there were some gaps in oversight.

 The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider could make improvements. The provider should:

• Review the clinic team’s approach to identifying and assessing sepsis to ensure this is fully in line with current guidelines.

• Review its use of clinical audit to monitor its clinical performance and drive improvement.

• Review whether there is scope to increase information sharing with NHS GPs with patients’ consent.

• Review and risk assess the range of emergency medicines held within the clinic.

We carried out our inspection of 4 March 2015 to follow up non-compliance with two regulations we identified at our previous inspection on 5 September 2014. In particular, the provider was not meeting the standards for safeguarding people who use services from abuse, and supporting workers.

At our latest inspection we found the provider was now meeting these standards. All three doctors employed at the clinic had now undertaken level three training in child protection, and nursing and administrative staff now received appraisal and group supervision.

We did not speak to people who used the service on this occasion as the focus of our inspection was on documentary evidence in relation to staff training and appraisal.

We carried out our inspection of 5 September 2014 to follow up non-compliance with the two regulations we identified at our previous inspection on 7 October 2013. In particular, the provider was not meeting the standards for safeguarding people who used services from abuse and supporting workers.

At out latest inspection we found the provider had made improvements in the standards for safeguarding people who used services from abuse. Appropriate and up to date policies and procedures for safeguarding children and vulnerable adults were now in place and staff had received further training in these areas. However, these improvements were not sufficient to meet the standard for safeguarding. The level of child protection training for the doctors employed at the clinic was not in accordance with national requirements.

The provider had made improvements in the arrangements for training, professional development, supervision and appraisal of staff and the majority of staff were positive about the support they received. However, these improvements were not sufficient to meet the standard for supporting workers. There were still no formal supervision arrangements in place for administrative staff. In addition, an appraisal system for these and nursing staff had not been introduced by 31 July 2014 as stated in the provider’s action plan.

We did not speak to people who used the service on this occasion as the focus of our inspection was in relation to staff training and support.

We spoke with people who use the service, clinic staff, and an interpreter during our visit.

People were provided with appropriate information and support in relation to their care or treatment. People had been asked for their opinion about the services provided and their views had been reasonably accommodated.

Overall people were satisfied with the service and found the staff kind, approachable, and knowledgeable. Communication with staff was perceived to be good and people felt that their cultural needs and preferences were understood and they were treated with dignity and respect.

There was a lack of suitable arrangements and information in place to ensure that people were safeguarded against abuse and the risk of abuse. Some staff were unclear about the aspects of the safeguarding processes relevant to them, particularly in relation to vulnerable adults.

There were no suitable arrangements in place to ensure that all staff received appropriate training, professional development, supervision and appraisal. This meant there were some inconsistencies in relation to staff support and development, and training was not always based upon the needs of the people who used the service.

There was an effective system in place for identifying, receiving, handling and responding appropriately to complaints.

People that used the service told us that they thought the staff were nice. They liked using the clinic as they spoke their own language, so they felt confident that they were understood and they also understood what was being said to them.