The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: Refresh SouthWest Limited

1 Emma Place Ope, Stonehouse, Plymouth, Devon, PL1 3FD (01752) 228107

Provided and run by:
Refresh South West Limited

All Inspections

27 March 2018

During a routine inspection

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)

20 March 2014

During an inspection looking at part of the service

We visited the service in November 2013 and found that recruitment records were not complete. This posed a risk as safety checks for all staff had not been completed. The acting manager sent CQC an action plan in December 2013 which outlined the actions being taken to ensure all the checks had been put in place.

We visited the service 20 March 2014 and saw that the recruitment checks needed to ensure that all staff were safe and competent had been completed. People were cared for and supported by, suitably qualified, skilled and experienced staff.

26, 28 November 2013

During a routine inspection

The clinic was not open every day and so we had telephoned the clinic previously to advise of our visit. The clinic provided a wide variety of treatments, however not all of these treatments were regulated by the Care Quality Commission. This report relates to the treatments regulated under the Health and Social Care Act 2008.

We spoke with three people who used the service. They told us they were happy with the information supplied and the service provided. They told us that their consent was always requested and that they felt informed and involved enough to sign their agreement to treatment.

One doctor and two staff provided all laser treatment and trained nurses were available when some treatment was being provided. All medical checks were undertaken prior to treatment and care records included any discussions between the doctor and person using the service about any identified risks.

Not all staff had received training to recognise and act appropriately to any signs of abuse. This training was planned for the near future.

The records of recruitment checks for staff were being maintained since our last inspection, but further checks were needed to ensure the registered provider had a clear record of who was employed by them. Processes were in place to supervise and support staff but records of this were not maintained.

Records of care provided had improved since our last inspection and provided an audit of treatment and care provided. Records were orderly and well managed and stored securely.

4 March 2013

During a routine inspection

The clinic was not open everyday and we had phoned the clinic previously so as to know when it would be open. The clinic provided a wide variety of treatments, however not all of these treatments were regulated by the Care Quality Commission. This report relates to the treatments regulated under the Health and Social Care Act 2008.

We spoke with one person who used the service and saw advice being given to another person. They told us that the information they received about the clinic provided them with what they needed to know.

Medical cover was provided by two visiting doctors. Trained nurses were available when some laser treatment was being provided. We spoke to a receptionist and one staff member who was providing treatment. Some treatments were provided by staff who had the specific training for those laser treatments. The service did not open each day and only opened for planned clinics and treatments.

Records of care provided were not well managed and did not provide an audit trail of which doctor had confirmed each procedure and what post treatment care had been provided.

The records of recruitment checks for staff and how staff were appraised were not maintained.

We saw questionnaires completed about the treatment people received. Some responses noted that they were not aware of the complaints procedure should they be unhappy with the service provided. Most comments were positive about people's experience of the service.