Archived: AIG Aesthetic Care

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There remained significant gaps in governance, leadership, and organisational integrity. Governance systems had improved to a limited extent but did not provide evidence or assurance of safe standards of practice. Audits designed to introduce consistency to environmental and hygiene management had failed to do so. There was a fundamental absence of competent leadership.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The registered manager left the provider in February 2024 but neither they nor the provider cancelled their registration with CQC. This is a breach of Regulation 15 of the Care Quality Commission (Registration) Regulations 2009. The provider told us they had experienced difficulty in recruitment but there was limited evidence of progress at the time of our assessment.

Staff told us the managing director was leading the service until they recruited a new manager. However, the ongoing unmitigated risks in the environment and poor standards of medicines management reflected a lack of competent leadership or consistent presence of a manager.

Poor leadership was reflected in other aspects of the service, including in the misleading and factually inaccurate public website, and in the lack of transparency and openness afforded to patients about their treatment.

There was no evident leadership of staffing. The appointment booking system showed that 1 doctor regularly ran 2 patient lists in parallel. We spoke with the individual about this, and they said on such occasions, 2 patients underwent treatment at the same time, in separate rooms, and they supervised the delivery of care by technicians. The combination of reduced doctor contact, the lack of experience and training of the doctor, the limited assurance of technician competency, and the lack of safety measures in place for patient deterioration, meant this approach to care significantly increased the risk of harm to patients.

Leaders did not value training and competence. The clinic had an emergency oxygen cylinder and automatic emergency defibrillator, and staff completed basic life support (BLS) training. However, this was the highest level of training any member of staff completed, including doctors. As the use of some medicines during treatment increased the risk of cardiac emergencies in patients, BLS was a low level of training for staff carrying out surgery.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The new governance system had not resulted in improved standards in the clinic. Cleanliness, hygiene, and infection prevention and control remained poor, and staff did not recognise risks. They did not take action when the clinic was visibly dirty and daily checklists designed to improve this standard had failed to make an impact.

The managing director told us they had introduced regular team meetings. However, staff were uncertain about the meetings and could not discuss details or outcomes.

There was a lack of understanding of confidentiality. Doctors used personal mobile phones to communicate with patients, which included receipt of photographs of patients’ surgical site wounds. This was against the provider’s policy but there was no monitoring or oversight in place and the managing director was unaware this was common practice. This placed patients’ personal data and privacy at risk because there were no controls in place for the use, storage, or transmission of personal information.

In some clinical records we found entries had been made by the managing director. However, they were not a clinician or doctor and did not deliver care or treatment in the clinic. We raised this was staff during our onsite assessment. They told us it was common practice to use a shared log in to complete patient records. As the clinic had only 1 computer, staff said logging in and out could be time consuming and so sometimes they used the manager’s log in. This was problematic because it meant patient records were prepopulated with the managing director’s name and it was challenging to trace who made the clinical entries.

Governance systems for medicines management were not functioning. Staff had carried out care and treatment using medicines processes that placed patients at direct risk of harm without oversight or awareness from the managing director. There were no checks and balances in place for the practice of doctors because they worked autonomously without supervision.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had implemented improvements in the previous 6 months. These included auditing systems for infection control, an electronic patient records system, and a basic governance structure. However, they had not resulted in persistent, quantifiable improvements in outcomes, standards of practice, or patient safety. There was a fundamental lack of understanding of patient safety, evidence-based practice, and professional integrity that placed patients at risk of harm. There were no mechanisms in place to identify these areas and address them.

Staff told us they did not monitor patients’ vital signs during surgery. This is a national standard when administering adrenaline due to the risk of overdose. We discussed this with all 3 doctors, and they were not aware of national guidance or how to access this. While the provider had a policy for the safe use of adrenaline, it was based on out-of-date standards and staff were unfamiliar with it.

Medicines management processes outside of the clinical area were not fit for purpose. We found ten 60ml containers, labelled with abbreviations, on a cabinet in the unlocked, unsecured office. Staff were unable to tell us where the containers had come from or why they were left out. A member of staff said they had been “received in error” and were due to be “sent back”. None of the doctors on duty could tell us the name of the supplying pharmacy or why they had been received like this. The medicine contained in the bottles presented a risk of harm to pregnant women due to the potential risk of causing birth defects. In addition, we found a pharmacy bag marked with a patient’s name discarded between audit papers in the office. The bag contained a single antibiotic capsule. Staff were unable to explain. These poor practices presented a risk of harm to patients because staff had no assurance of accurate medicine labelling or dispensing practices, and unauthorised persons could also access medicines due to a lack of security.