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Inspection Summary


Overall summary & rating

Updated 15 February 2018

We carried out an announced comprehensive inspection at Brighton Skin Surgery on 8 December 2017 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 always 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.

Brighton Skin Surgery provides a minor surgery service in dermatology. Procedures offered include skin tag, cyst, mole, wart and cherry or blood spot removal. The service is based in a local NHS GP surgery on the outskirts of the city of Brighton and Hove.

Dr. Avni Patel is 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.

Nine people provided feedback about the service via comment cards all of which were positive about the standard of care they received. The service was described as excellent, professional, helpful and caring.

Our key findings were:

  • The clinic was supported by services provided by a GP practice on the same site including practice policies, protocols and non-clinical governance.
  • The approach to safety of systems for reporting and recording incidents was in place. However, these systems were not always adhered to.
  • Information about services and how to complain was available and easy to understand.
  • The surgery room was well organised and equipped, with good light and ventilation.
  • The provider assessed patients according to appropriate guidance and standards.
  • Staff maintained the necessary skills and competence to support the needs of patients. Staff were up to date with current guidelines.
  • Risks to patients were well managed. For example, there were effective systems in place to reduce the risk and spread of infection.
  • Medicines were not always stored safely.
  • Systems were in place to deal with medical emergencies, staff were trained in basic life support and the provider had appropriate emergency medicines in place. However these medicines were not checked in accordance with the provider’s policy and some had expired.
  • Staff were kind, caring and put patients at their ease.
  • Patients were provided with information about their health and with advice and guidance to support them to live healthier lives.
  • The provider had a clear vision to provide a high quality service that put caring and patient safety at its heart.
  • The provider was aware of, and complied with, the requirements of the Duty of Candour.

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

  • Ensure systems and processes are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

You can see full details of the regulations not being met at the end of this report.

Inspection areas

Safe

Updated 15 February 2018

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

  • The service had systems, processes and risk assessments in place to keep staff and patients safe with the exception of medicines for use in emergencies were not regularly checked in accordance with their protocol.

  • Staff had the information they needed to provide safe care and treatment and shared information as appropriate with other services.

  • The provider had a good track record of safety and had a learning culture, using safety incidents as an opportunity for learning and improvement.

  • The staffing levels were appropriate for the provision of care provided.

  • We found the equipment and premises were well maintained with a planned programme of maintenance.

  • Emergency equipment and medicines had not been regularly checked and some equipment and medicines had expired or were missing.

  • Fridge temperatures, for medicines storage, had not been recorded on a daily basis and we noted one fridge had a recorded temperature which was outside of specified parameters and no action had been taken as a result.

Effective

Updated 15 February 2018

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

  • The provider had the skills, knowledge and experience to deliver effective care and treatment.

  • The provider used current guidelines such as National Institute for Health and Care Excellence and NHS guidance and competences for the provision of services for GPs with special interest in dermatology and skin surgery to assess health needs.

  • Patients received a comprehensive assessment of their health needs, which included their medical history.

  • The provider encouraged and supported patients to be involved in monitoring and managing their health.

  • The provider had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.

Caring

Updated 15 February 2018

We found that this service was providing caring services in accordance with the relevant regulations.

  • We did not speak to patients directly on the day of the inspection. However, we reviewed the provider’s patient survey information. This showed that patients were happy with the care and treatment they had received.

  • The provider treated patients courteously and ensured that their dignity was respected.

  • The provider involved patients fully in decisions about their care and provided reports detailing the outcome of their health assessment.

Responsive

Updated 15 February 2018

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

  • The provider was responsive to patient needs and patients could contact the GP to further discuss results of their treatment.

  • The provider proactively asked for patient feedback and identified and resolved any concerns.

  • There was an accessible complaints system both in the surgery room and on the provider’s website.

  • Patient feedback was closely monitored and responded to.

  • The provider had good facilities and was well equipped to meet the needs of the patient.

  • The provider was able to accommodate patients with a disability or impaired mobility. All patients were seen on the ground floor.

Well-led

Updated 15 February 2018

We found that this service did not always provide well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices).

  • The provider had a clear vision and strategy for the service and the knowledge, experience and skills to deliver high quality care and treatment.

  • There was a suite of policies, systems and processes in place to identify and manage risks. However, the provider did not always follow their own policies and processes.

  • The provider actively engaged with staff and patients to support improvement and had a culture of learning.

  • There was a management structure in place.

  • The culture of the service was open and transparent.