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London Centre for Aesthetic Surgery

Inspection Summary


Overall summary & rating

Updated 22 August 2017

The London Centre for Aesthetic Surgery is operated by 'London Centre for Aesthetic Surgery’

and is a small independent clinic, which has been registered since April 2002. The clinic provides

cosmetic surgery services for private adult patients over the age of 18 years. Patients

are admitted for planned day case surgery procedures. The service does not provide overnight

accommodation for patients. Facilities include one treatment room, two recovery rooms and two

consultation rooms.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 21 March 2017.

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?

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 do not rate

The clinic’s main service is cosmetic surgery. We regulate cosmetic surgery service, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Staffing levels and skills mix were sufficient to meet patient needs and staff assessed and responded to patient risks.
  • Medicines were safely, administered, stored, and given to patients in a timely manner.
  • Patient records were detailed with clear plans of the patient’s pathway of care.
  • Patient consent was obtained prior to commencing treatment. Patients were provided with information to enable them to make an informed decision.
  • A cooling off period was observed for patients undergoing cosmetic surgery procedures. This was in line with cosmetic surgery guidelines.
  • We spoke to two patients. They were positive about the care and treatment they had received.
  • Staff treated patients with dignity and respect and patients were kept involved in their care.
  • Equipment we checked had been tested for electrical safety and serviced as required.
  • There were arrangements to ensure patients received adequate food and drink that met their needs and preferences.
  • There were processes to audit patient and clinical outcomes on a quarterly basis and these were discussed in the Medical Advisory Committee (MAC) meetings.
  • There was appropriate management of quality and governance and mangers were aware of the risks and challenges they needed to address.
  • There was clear visible leadership within the services. Staff were positive about the culture within the service and the level of support they received.

However, we also found the following issues that the service provider needs to improve:

  • The treatment room was cluttered and disorganised. There were no clearly defined separate clean and dirty zones within the treatment room. The Department of Health Building Note (HBN) 00-09: Infection control in the built environment states that clean and dirty areas should be kept separate and the workflow patterns of each area should be clearly defined. Maintaining separate clean treatment and contaminated zones, helps reduce the risk of infection.
  • The World Health Organisation (WHO) surgical safety checklist was not routinely used for all patients and there were no audit arrangements to test staff practice and adherence to the WHO checklist.
  • The provider had no processes to collect performance measures and supply these to the Private Healthcare Information Network (PHIN). This is a requirement of the Private Healthcare Market Investigation Order (2014).
  • The safeguarding policy did not reflect national guidelines, for example, there was no reference made to female genital mutilation (FGM), slavery, sexual exploitation and PREVENT.
  • We were told there were routine checks to ensure anaesthetic equipment was working correctly, but these were not recorded.
  • The practice manager had not received the appropriate training for their role as the accountable officer for controlled drugs.
  • The controlled drugs register did not contain entries for supply, administered, and destroyed, which is recommended and regarded as good practice.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Updated 22 August 2017

We found the following areas of good practice:

  • Staff knew how to report incidents of all severities.
  • Medicines were stored safely and staff administered medicines to patients in accordance with the clinics policy.
  • All staff had completed or were booked for mandatory safety training.
  • Staff had a good understanding of safeguarding and knew of the steps to take if reporting a safeguarding concern.
  • Patients were appropriately risk assessed, their condition was monitored, and there were procedures in place to respond to any deteriorating condition.
  • Equipment was serviced regularly and all electrical testing had been completed and was in date.
  • There was an agreement with a local larger independent hospital to transfer patients who unexpectedly required an overnight stay.
  • There were sufficient competent staff to deal with patient’s care and treatment.

However, we also found the following issues that the service provider needs to improve:

  • The treatment room was cluttered and did not allow for effective infection prevention and control techniques and was not in line with the Department of Health, Health Building Note (HBN) 00-09: Infection control in the environment.
  • The WHO surgical safety checklist was not used for all patients having minor surgical treatment. The checklist was only used for patients who had conscious sedation.
  • The safeguarding policy did not reflect up-to-date guidelines. There was no reference to female genital mutilation and sexual exploitation.
  • The Mental Capacity Act 2005 was not included as part of mandatory training.
  • Anaesthetists did not record their daily check of equipment.
  • The controlled drugs register did not contain entries for supply, administered, and destroyed, which is recommended and regarded as good practice.

Effective

Updated 22 August 2017

We found the following areas of good practice:

  • Patients received care according to national guidelines, such as National Institute For Health and Clinical Excellence (NICE) and The Royal College of Surgeons.
  • Patients were prescribed pain relief and their pain symptoms were managed effectively.
  • There were systems, which ensured anaesthetists were compliant with the revalidation requirements of their professional bodies.
  • Staff sought consent from patients prior to treatment and allowed the two-week ‘cooling-off’, period to ensure patients had sufficient time to make decisions on treatment of care.
  • The clinic audited patient outcomes on a quarterly basis and these were discussed in MAC meetings.

However, we also found the following issues that the service provider needs to improve:

  • The provider had no processes to supply performance measures to the Private Healthcare Information Network (PHIN).
  • The practice manager who was the responsible officer for controlled drugs had not received the necessary training.

Caring

Updated 22 August 2017

  • Staff were caring and treated patients with dignity and respect.

  • Patients were involved in their treatment of care.
  • Feedback from patients was positive.
  • Clear information was provided about the costs of treatment and procedures.
  • The clinic provided information on alternative therapies if patients wished to access them.

Responsive

Updated 22 August 2017

  • Services were planned to meet the needs of patients.
  • Patients were offered follow up appointments to ensure they had received the right level of care.
  • Complaints about the clinic were dealt with in a timely manner and information relating to complaints was shared with staff.

Well-led

Updated 22 August 2017

  • The was a clear governance structure in place with Medical Advisory Committee (MAC) meetings, which monitored the quality of the service.
  • There was effective teamwork and good leadership, which created a positive culture