Archived: Ziering London Clinic

Updated 18 September 2019

Ziering London Clinic is operated by Chiron Hospitals Ltd. The service opened in 2014, providing hair transplants, cosmetic surgery and non-surgical cosmetic interventions. In January 2017, the clinic began functioning as a cosmetic surgery provider, providing operations such as breast enlargement, hair transplant and liposuction. It is a private clinic in London. The clinic accepts referrals from GPs, lead referrals from third party companies and self-referrals from patients living in London and internationally. The service does not provide services to NHS-funded patients or patients under the age of 18.

At the time of the inspection, a new manager had recently been appointed and their application for registered manager with CQC had been submitted and was being processed.

Updated 18 September 2019

Ziering London Clinic is operated by Chiron Hospitals Ltd. The service has three overnight beds. Facilities include one main theatre, two clinic rooms used for hair transplant operations, consulting rooms, a two-bedded recovery area and a three- bedded ward.

The service provides cosmetic surgery such as breast enlargement and hair transplants, as well as non-surgical interventions.

We inspected this service using our comprehensive inspection methodology. The service was inspected once before in February and March 2018. We carried out an unannounced inspection on 12 June 2019 to see if the provider made the improvements we required them to make at the last inspection.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We did not rate this service last time. We rated it this time as Requires improvement overall.

We found the following issues that the service provider needs to improve:

• The service provided mandatory training in key skills to all staff but did not make sure everyone completed it.

• Staff understood how to recognise and report abuse. Staff had received training on safeguarding adults but it was out of date at the time of inspection. The safeguarding policy did not reflect the requirements of the Care Act 2014 (Chapter 14) statutory guidance.

• The centre did not control infection risk well. Though staff used some equipment and control measures to protect patients, themselves and others from infection, they did always not keep equipment and the premises visibly clean. The provider did not have effective systems in place for maintenance of facilities, premises and equipment to keep people safe. However, staff managed clinical waste adequately.

• Managers regularly reviewed staffing levels and skill mix, and gave bank and agency staff a full induction. However, the provider was unable to provide assurance that they were always compliant with( Association for Perioperative Practice (AfPP) guidance as they did not audit this. All staff had out of date basic life support training.

• The service did not use systems and processes to safely record and store medicines.

• The service did not manage patient safety incidents well. Staff recognised incidents and near misses but did not always report them or grade them appropriately. Managers investigated incidents but there was no robust system to share learning from incidents with staff. The service did not use monitoring results well to improve safety. Staff collected safety information, but this was not shared with staff, patients and visitors.

• A safer surgical checklist based on the World Health Organisation (WHO) guidance was used for cosmetic procedures only and the service did not use the WHO checklist for hair transplant procedures. Following inspection, the provider informed us that this had now been implemented for hair transplant procedures and provided a template they intended to use for this purpose going forward.

• The service did not consistently provide care and treatment based on national guidance and evidence-based practice. Some policies were not fit for purpose, and some practice was not in line with current best practice guidance. Staff did not always monitor the effectiveness of care and treatment. Since the last inspection, the provider had not sufficiently improved and widened audit activity undertaken to make improvements and achieve good outcomes for patients.

• The service did not always have adequate measures in place to make staff were competent for their roles. Managers appraised most staff’s work performance. However, we were not assured of the quality of these appraisals, and no clinical supervision meetings were taking place at the time of inspection. The provider did not follow their own policy on the review of practising privileges as they did not have a functioning medical advisory committee. They did not monitor every surgeon’s scope of practice or performance adequately.

• Managers in the service did not have the right skills and abilities to run a service providing high-quality sustainable care. Staff did not always feel supported by their managers and there had been frequent changes at the level of registered manager. The provider did not promote a universally positive culture that supported and valued all staff.

• Leaders did not ensure effective governance processes operated throughout the service. Staff at all levels were clear about their roles and accountabilities but did not have regular opportunities to meet, discuss and learn from the performance of the service. The centre lacked a robust risk management system and demonstrated limited engagement with staff regarding improving the service, as well as lacking a robust approach to quality improvement.

However, we also found the following areas of good practice:

• Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care. Staff completed and updated risk assessments for each patient and removed or minimised risks where possible. Staff identified and quickly acted upon patients at risk of deterioration.

• Managers ensured that actions from patient safety alerts were implemented and monitored.

• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They gave additional pain relief to ease pain. Staff gave patients enough food and drink to meet their needs and improve their health. Generally, doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Key services were available six days a week. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

• The service had a vision for what it wanted to achieve and a strategy to turn it into action. The centre collected information to support some of its activities.

We told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with two requirement notices and a warning notice that affected the Ziering London Clinic. Details are at the end of the report.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a warning notice under section 29A of the Health and Social Care Act 2008 and two requirement notices that affected the Ziering London Clinic. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

Updated 18 September 2019

Cosmetic surgery was the only activity carried out in the service.

We rated overall this service as requires improvement because safe, effective and well-led required improvement. We rated caring and responsive as good.