Archived: Refresh SouthWest Limited

Updated 13 July 2018

Refresh South West Limited is a private clinic in Plymouth, Devon providing various cosmetic procedures for private patients, for example the bodytight/facetight procedure. The clinic is owned and operated by Nicola Trathen, who is also the registered manager. The clinic primarily serves the communities of Devon though also accepts patient referrals from outside this area.

The clinic has an operating theatre, two treatment rooms, and a reception area. There are also consulting and administration rooms. There are no inpatient beds at the clinic. No surgical procedures are carried out on young people under the age of 18.

The regulated activity, the body tight/ face tight procedure forms only a small proportion of activity through the clinic. At the time of inspection we were told the clinic had performed 10 procedures in the last year. The clinic also offers cosmetic procedures such as dermal fillers, laser hair removal, and complementary therapies. We did not inspect these services as these procedures do not fall under our scope of registration.

The clinic has had a registered manager in post since 2010. The provider is registered to provide the following regulated activity:

Treatment of disease disorder or injury

Surgical procedures

Diagnostic and screening procedures

Updated 13 July 2018

Refresh South West Limited is a private clininc in Plymouth, Devon providing various cosmetic proceedures for private patitents, for example the bodytight/facetight procedure. The clinic is owned and operated by Nicola Trathen, who is also the registered manager. The clinic primarily serves the communities of Devon though also accepts patient referrals from outside this area.

We carried out an unannounced focused inspection in response to concerns raised. We inspected this service as a focussed, unannounced inspection on 27 March 2018. We looked at the domains of safe and well-led in response to concerns raised and arising from our ongoing monitoring/intelligence about the service

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. As this was an unannounced inspection responding to concerns we focussed on two domains, safe and well led.

At the inspection, we reviewed five patient records, three personel files, observed premises, interviewed two staff, and spoke with the registered manager.

Services we do not rate

We regulate cosmetic surgery services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

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

• The registered manager was unfamiliar with the requirements and their responsibilities with regards to the Health and Social Care Act 2008 (Regulated Activities) 2014.
• There was no mandatory training undertaken by staff working at the clinic.
• There were no procedures or processes to make sure people were protected from abuse. There was no scrutiny or oversight of safeguarding and staff had not received any safeguarding training.
• Infection prevention and control risks had not been considered. There was no routine of decontamination or cleaning.
• There were no systems to monitor infection, prevention and control to ensure the premesis, including the operating theatre was clean and safe for use.
• The emergency equipment was not fit for purpose. There was no evidence that checks or servicing had been carried out for the anaphylaxis kit or defibrillator. The defibrillator was found to be indicating a battery replacement was required which meant we could not be assured it would work effectively.
• There were no systems or processes to enable the registered manager to monitor the safety, quality or performance of the service. The registered manager could not provide any assurance that the Health and Social Care Act was being adhered to.
• Risk assessments and associated management plans were not documented to give an account of the decision making process to safely manage the risk to patients.
• There were no processes to assess, monitor and mitigate the risks relating to the service.
• The service did not have adequate governance systems to protect patients attending the clinic. There was no formal governance framework to evidence and support the delivery of good quality care.
• There was a lack of oversight, audit, and assessment of the service provided. The lack of governance structure, systems or processes meant concerns and issues were not routinely identified and services could not be improved as a result. The lack of regard for following policy and procedure put both patients and staff at risk.
• There was no evidence to demonstrate the clinic assessed all patients to ensure their psychological wellbeing was considered in line with the Royal College of Surgeons recommendations for cosmetic surgery.
• Systems and processes did not ensure staff received appropriate pre-employment checks. There were no references or declarations under the rehabilitation of offenders act.
• There was no evidence to assure the registered manager that staff practice complied with policies.
• There was no system to provide assurance of staff competency.
• Patient records containing sensitive patient identifiable information were not stored securely.

However,

• Patient records were legible, concise and in order. We found completed consent forms, procedural notes and discharge summaries.

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 to help the service improve. Full information about our regulatory response to the concerns we have described will be added to a final version of this report, which we will publish in due course.  

Amanda Stanford

Deputy Chief Inspector of Hospitals (South West)

Updated 13 July 2018

We do not currently have a legal duty to rate cosmetic surgery services.

Surgical services at the clinic did not keep people safe from avoidable harm.

There was no risk register or risk management system to identify, record, manage or mitigate risks.

There were no systems and processes to keep patients safe from abuse or avoidable harm. There was an assumption safeguarding training was completed as part of other employment by staff coming to work with Refresh South West.

We found issues with cleanliness and there were no systems or processes to prevent the spread of infection. The theatre scrub room was visibly dirty and had cleaning products on the walls and floor. We asked how the provider was assured that the cleaning was taking place and they were unable to tell us.

Staff employed by the service did not have the right skills or qualifications to undertake to roles expected of them. A safe recruitment procedure was not in place to safeguard patients against unsuitable staff

During the inspection we had concerns the registered manager did not understand her role and responsibilities in relation to the Health and Social Care Act 2008 (Regulated Activities) 2014. There was no evidence to demonstrate how the requirements of the act were being met by the provider.

There was no evidence to demonstrate the clinic assessed all patients to ensure their psychological wellbeing was considered in line with the Royal College of Surgeons recommendations for cosmetic surgery.

There was no governance framework to evidence and support the delivery of good quality care. There were no systems or processes which enabled the registered manager to monitor the safety, quality or performance of the service and identify areas which required improvement.

There was a lack of oversight, audit, and assessment of the service provided. The lack of governance structure, systems or processes meant concerns and issues were not routinely identified and services could not be improved as a result. The lack of regard for following policy and procedure put both patients and staff at risk which would usually identified through a detailed assessment and monitoring processes.

All three personel files reviewed were incomplete and we could not be assured of an effective recruitment and selection procedure. For staff working for Refresh South West and for the regulated activity, the provider could not assure themselves that all checks were complete and satisfactory.

We reviewed three staff files and there were no processes to ensure staff were ‘fit and proper’ to provide care and treatment appropriate to their role and to enable them to provide the regulated activity. There were no effective recruitment procedures or ongoing monitoring of staff.