The Care Quality Commission
  • Doctor
  • Independent doctor

Royal Tunbridge Wells Skin Clinic Ltd

Overall: Good read more about inspection ratings

Cobden House, 25 London Road, Tunbridge Wells, Kent, TN1 1DA (01892) 535577

Provided and run by:
Royal Tunbridge Wells Skin Clinic Ltd

All Inspections

15 March 2022

During a routine inspection

Royal Tunbridge Wells Skin Clinic Ltd was last inspected in January 2020, but it was not rated. This inspection was undertaken to provide a rating for this service.

We carried out an announced comprehensive inspection at Royal Tunbridge Wells Skin Clinic Ltd on 15 March 2022. Overall, the service is rated as Good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out a focused inspection at Royal Tunbridge Wells Skin Clinic Ltd on 15 and 17 July 2020, in response to concerns about the safe care and treatment of patients and governance arrangements. We found breaches against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued Warning Notices to the provider.

We carried out a further focused inspection on 11 September 2020, to confirm whether the service had met the legal requirements in relation to those breaches of regulations. We found that the provider had made improvements to meet Regulation 17. However, they had not made sufficient improvement in providing safe services. A further Warning Notice was issued against Regulation 12(1) Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our inspection on 11 September 2020, the provider submitted assurance information and evidence to us electronically to demonstrate improvements they had made. We carried out a remote review of this information to confirm whether the service had taken sufficient action to comply with the regulations. We found that the provider had made improvements since our last inspection and was compliant with the Warning Notice issued.

Royal Tunbridge Wells Skin Clinic Ltd is an independent provider of doctor-led dermatology services and the use of botulinum toxin (Botox) injections to treat a range of medical conditions.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by the Care Quality Commission (CQC) which relate to particular types of regulated activities and services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Royal Tunbridge Wells Skin Clinic Ltd provides a wide range of non-surgical cosmetic interventions. For example, cosmetic Botox injections, facial fillers and cosmetic laser treatments, which are not within CQC’s scope of registration. Therefore, we did not inspect or report on those services.

The practice is registered with CQC to provide the following regulated activity: Treatment of disease, disorder or injury.

The company chairman and director is the registered manager. A registered manager is a person who is registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • Care records contained full information on what medicines and treatment had been provided.
  • Policies and procedures were comprehensive, up to date and relevant to the service.
  • All staff had the appropriate level of training for safeguarding adults and children, relevant to their role.
  • Staff training was effective. However, not all staff had received training in recognising the signs of sepsis.
  • The service had reliable systems for appropriate and safe handling of medicines. However, some risk assessments for emergency medicines not held at the service required implementing.
  • Consent was recorded for appropriately for each procedure.
  • Patient feedback was positive about clinical care and treatment experience.
  • The service was supportive of patients’ needs and patients were able to access the service.
  • There was clear leadership and leaders had the capacity and skills to deliver high-quality, sustainable care.
  • The provider had effective processes for planning of the future leadership of the service. For example, appointing a new service manager, who had applied to become the CQC registered manager.
  • Governance arrangements were implemented effectively.

The areas where the provider should make improvements are:

  • Continue to monitor and implement their schedule to ensure all staff receive training in recognising the signs of sepsis.
  • Ensure risk assessments for emergency medicines not required by the service are completed, in line with their action plan.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

04 January 2021

During an inspection looking at part of the service

We carried out a focused inspection at Royal Tunbridge Wells Skin Clinic Ltd on 15 and 17 July 2020, in response to concerns about the safe care and treatment of patients and governance arrangements. We found breaches against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued warning notices to the provider.

We carried out a further focused inspection of Royal Tunbridge Wells Skin Clinic Ltd, on 11 September 2020, to confirm whether the service had met the legal requirements in relation to those breaches of regulations. We found that the provider had not made sufficient improvement in providing safe services. A further warning notice was issued against Regulation 12(1) Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our inspection on 11 September 2020, the provider submitted assurance information and evidence to us electronically to demonstrate improvements they had made. We carried out a remote review of this information to confirm whether the service had taken sufficient action to comply with the regulations. This report only covers our findings in relation to our review of that information. The service was not rated as a result of this review.

Royal Tunbridge Wells Skin Clinic Ltd is an independent provider of doctor-led dermatology services and the use of botulinum toxin (Botox) injections to treat a range of medical conditions. Services are provided from dedicated premises within the centre of Royal Tunbridge Wells.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by the Care Quality Commission (CQC) which relate to particular types of regulated activities and services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Royal Tunbridge Wells Skin Clinic Ltd provides a wide range of non-surgical cosmetic interventions, for example Botox injections, facial fillers and cosmetic laser treatments, which are not within CQC’s scope of registration. Therefore, we did not inspect or report on those services.

The practice is registered with CQC to provide the following regulated activity: Treatment of disease, disorder or injury.

The company chairman and director is the registered manager. A registered manager is a person who is registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that the provider had made improvements since our last inspection and was compliant with the warning notice issued.

Our key findings were:

  • Medicines which required refrigeration were appropriately monitored to ensure their safe storage and use.
  • Arrangements to support the administration of emergency medicines had been improved. There was a risk assessment, guidance and training for staff in the administration of emergency medicines.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 September 2020

During an inspection looking at part of the service

We previously carried out a focused inspection at Royal Tunbridge Wells Skin Clinic Ltd on 15 and 17 July 2020, in response to information we had received with regard to concerns about the safe care and treatment of patients and governance arrangements within the service. We found breaches against Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued warning notices to the provider.

We carried out this inspection of Royal Tunbridge Wells Skin Clinic Ltd, on 11 September 2020, at short notice to the provider, to confirm that the clinic was meeting the legal requirements in relation to those breaches of regulations. This report only covers findings in relation to those requirements. The service was not rated as a consequence of this inspection.

Royal Tunbridge Wells Skin Clinic Ltd is an independent provider of doctor-led dermatology services and the use of Botulinum toxin (Botox) injections to treat a range of medical conditions. Services are provided from dedicated premises within the centre of Royal Tunbridge Wells.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by the Care Quality Commission (CQC) which relate to particular types of regulated activities and services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Royal Tunbridge Wells Skin Clinic Ltd provides a wide range of non-surgical cosmetic interventions, for example Botox injections, facial fillers and cosmetic laser treatments, which are not within CQC’s scope of registration. Therefore, we did not inspect or report on those services.

The practice is registered with CQC to provide the following regulated activity: Treatment of disease, disorder or injury.

The company chairman and director is the registered manager. A registered manager is a person who is registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found the practice had made some improvements including:

  • Patients treated for medical conditions were treated by, or with the clinical oversight of, a GMC registered doctor.
  • Revised prescribing processes promoted the safe care of patients requiring treatment involving prescription only medicines.
  • There was improved oversight of the ordering and use of prescription only medicines within the clinic.
  • There were safe and secure arrangements for the storage of emergency medicines.
  • Processes to prevent, detect and control the spread of infection had been reviewed. Staff had undergone training in infection prevention and control.
  • There were improved arrangements for managing healthcare waste, including sharps items.
  • Recruitment checks were undertaken as required and in a timely manner.

We found the provider had not made sufficient improvement in providing safe services, in particular:

  • Medicines which required refrigeration were not appropriately monitored to ensure their safe storage and use.
  • There was a lack of risk assessment, guidance and training for staff in the administration of emergency medicines. Staff with the appropriate training were not always present within the clinic.

We took enforcement action and issued a warning notice against the provider in relation to Regulation 12(1) Safe care and treatment.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Arrange a clinical review of the patients treated by an unregistered doctor, by the General Medical Council (GMC) registered doctor, at their next clinic attendance.
  • Document courtesy calls made, to identify any patient concerns arising from treatment by the unregistered doctor, within the patients’ clinical record.

We are mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

15 July to 17 July 2020

During an inspection looking at part of the service

We carried out an unannounced focused inspection at Royal Tunbridge Wells Skin Clinic Ltd on 15 July 2020 under Section 60 of the Health and Social Care Act 2008. We returned to the practice on 17 July 2020 to complete our review of records.

The service was previously inspected in November 2018, when the practice was not rated but was found to be meeting all regulations. We carried out an unannounced, focused inspection on 15 July 2020, followed by a short notice announced inspection visit on 17 July 2020, in response to information we had received with regards to concerns about the safe care and treatment of patients and governance arrangements within the service. This report covers our findings in relation to those concerns.

Royal Tunbridge Wells Skin Clinic Ltd is an independent provider of doctor-led dermatology services and the use of Botulinum toxin (Botox) injections to treat a range of medical conditions. Services are provided from dedicated premises within the centre of Royal Tunbridge Wells.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by the Care Quality Commission (CQC) which relate to particular types of regulated activities and services and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Royal Tunbridge Wells Skin Clinic Ltd provides a wide range of non-surgical cosmetic interventions, for example Botox injections, facial fillers and cosmetic laser treatments, which are not within CQC’s scope of registration. Therefore, we did not inspect or report on those services.

The practice is registered with CQC to provide the following regulated activity: Treatment of disease, disorder or injury.

The company chairman and director is the registered manager. A registered manager is a person who is registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • The clinic had good facilities and was equipped to treat clients and meet their needs.
  • Services were offered on a private, fee paying basis only.
  • Care and treatment was not always provided in a safe way for service users.
  • Treatments had been carried out by a non-registered doctor, without the required clinical oversight or authorisation by a General Medical Council (GMC)registered doctor.
  • Medicines were not always prescribed, administered and supplied to patients in line with legal requirements. Some patients received treatment with no valid prescription in place to support the treatment administered.
  • The service did not always ensure the proper and safe storage and management of medicines.
  • The provider had not undertaken an audit of infection prevention and control procedures and some infection prevention arrangements required review. Staff had not received recent training in infection prevention and control.
  • Organisational policies were not always specific to the clinic and did not clearly reflect some of the processes taking place within the service.
  • Clinical record keeping and consenting processes did not always clearly document treatments received.
  • Staff recruitment processes were not sufficiently robust to mitigate the risks to service users and the organisation as a whole.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Ensure that labels on all sharps bins are fully completed at the start of use and include a date and signature.
  • Provide clear opportunities for staff to regularly contribute to the review of service processes and to feel supported in raising concerns.

We are mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

12 November 2018

During a routine inspection

We carried out an announced comprehensive inspection on 12 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services caring?

We found that this service was providing caring services care in accordance with the relevant regulations

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations of the Health and Social Care Act 2008.

Royal Tunbridge Well Skin Clinic is a doctor led dermatology service. It is in detached premises in Royal Tunbridge Wells. It treats private patients. There is car parking on site. The staff comprise, a doctor specialising in dermatology, an ascetic doctor, nursing staff, administration, reception staff and cleaning staff.

The clinic is open during a range of hours including some evening and Saturday opening. The hours are advertised on the service's website.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Therefore, at Royal Tunbridge Well Skin Clinic Ltd, we were only able to inspect the services which were subject to regulation.

The registered provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 23 comment cards all of which were very positive about the standard of care received. There was praise for all the staff, from the helpfulness of those on reception to the communication skill of clinicians.

Our key findings were:

  • The care provided was safe. There was a culture of placing safety at the core of activity. Staff told us they were encouraged to contribute to the organisation as a whole whether on safety or any other matters.
  • The provider put the patients’ needs before other considerations with patients being advised that no treatment or a “wait and see” approach were the favoured options if that was clinically in the patients’ best interests.
  • The provider was technically innovative, adopting, after suitable research and trials, new medical and information technology.
  • The was a strong emphasis on continuous learning for staff. The provider recognised consultation skills were central to patient’s care as well as satisfaction and had worked hard to maintain and improve this.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

18 October 2012

During a routine inspection

We were only able to speak with a limited number of people about the treatments they had received, and that were under the remit of the Care Quality Commission. However, the people we spoke with were positive about the treatment and service they had received.

There were information leaflets about a number of the treatments in the waiting area. There was more detailed information available in a clinic information book, which also included the cost of treatments. The people we spoke with told us that they had had the procedures they received explained to them. We saw that people had signed a consent form before they received treatment.

The interactions we saw between staff and people using the service were positive. The people we spoke with said the staff were generally very helpful, and were 'always courteous and helpful' and another that they 'go out of their way to put you at ease.'

People were invited to complete an electronic patient survey that was hosted on a website by an external company. The feedback was anonymised and mostly positive.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

We saw that routine servicing and testing had been carried out of equipment in the clinic which included the lasers, fire equipment and portable electrical equipment.

28 July 2011

During a routine inspection

We were only able to speak to one person who was receiving treatment from the Royal Tunbridge Wells Skin & Laser Clinic as there were not many customers receiving treatments on this occasion under the registered activity and when they were in the clinic they were receiving treatment. One person we did speak with was entirely satisfied with the treatment they had received so far. They said the service was 'efficient, reliable and friendly'.