Face Perfect Clinic

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service since its registration with CQC. This key question has been rated as Inadequate.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider told us that they had processes in place to improve services, this included learning from complaints, audit findings, and patient feedback. However, we found that systems for identifying, acting on, and learning from incidents were not effective. At the time of the assessment there was no record of incidents so monitoring of themes, learning, and the progress of any investigation could not be carried out. We saw evidence of incidents that had occurred which had not been recognised and recorded as incidents. For example, it had been identified within the menopause service that patients should stop taking testosterone 72 hours prior to baseline bloods being taken, and that this had not been happening. However, this had not been raised as an incident. Only 1 incident had been identified during the last 12 months; this formed part of a formal complaint, and was therefore appropriately investigated and acted upon. However, it had not been logged and investigated as an incident in its own right. In addition, minor events or near misses were not routinely recorded. There was a policy and defined process in place for incident reporting, and the provider told us it planned to address incident reporting at the next team meeting, to ensure staff followed this process consistently going forward.

There was a programme of audits in place which included record keeping, medicines management, and hand washing, however these did not effectively drive safety or quality improvement. For example, audits were not comprehensive, did not always identify issues, and did not contain information on actions taken where issues had been identified, including sharing of outcomes with other staff. After the assessment the provider told us they were reviewing the record keeping audit and would carry this audit out monthly until they were satisfied that it was effective, after which this would be completed every 6 months.

Staff told us they were confident to raise any concerns, and that they felt appropriate action would be taken if they did.

Processes to identify and manage risks to patients as they moved between care providers were not effective. There was no collaborative approach to safety as information about assessments, treatments and aftercare was not shared with the patient’s other healthcare providers. There was no evidence within clinical records that the provider itself communicated with the patient’s GP. The provider told us that patients were provided with a letter to take to their GP, however, there was no evidence that this was completed. The clinical record system did not contain information to demonstrate that patients had been asked to consent to sharing of their information. In addition, there was no evidence that the provider took further steps to explain to patients why sharing this information was important. After the assessment the provider made amendments to policies to reflect the need for staff to lead correspondence with the patient’s GP.

There were systems in place for processing information relating to new patients. This included details of past medical history, current medications, allergies, and expected treatment outcomes.

There were some procedures and measures in place to safeguard patients, and protect them from harassment, abuse, discrimination, avoidable harm and neglect.

There was a designated safeguarding lead at the service. Safeguarding policies contained relevant contact details and escalation processes.

However, we found that some staff were not trained to appropriate levels in safeguarding. During the assessment the provider reviewed this and arranged higher levels of safeguarding training for staff where required. Although safeguarding formed part of the agenda at monthly staff meetings, during the assessment we saw that the provider had arranged an additional meeting to go through potential safeguarding scenarios and processes, in order to ensure that staff had a thorough understanding of this area.

The provider offered chaperones for patients who required one; however, we found that staff had not completed training for this role. During the assessment we saw that the provider had arranged for this training to be undertaken by all staff.

Services were not provided to patients under 18 years of age.

Staff did not work effectively with patients to understand and manage risks. Our searches of clinical records showed that patients were not informed about specific risks in relation to their treatment and medication, and how to keep themselves safe. Although we saw some information was captured in some of the consent forms, the information was not always accurate. For example, 1 consent form detailed a patient may be prescribed a specific antibiotic, however the provider told us it would never actually prescribe this.

If required, patients were able to bring friends, family or others to support them with their language needs, however the provider could also access an interpretation service to enable more effective communication.

There were some processes in place for health and safety risk management. For example, risk assessments had been undertaken, and fire alarm testing and evacuation drills had been carried out on a regular basis. We saw there was appropriate signage in place, such as for fire escape routes. Electrical equipment had been safety tested. Staff we spoke with told us that they had no concerns related to health and safety at the service. The service was delivered from a premises shared with other businesses. All consultation and treatment rooms for this service were based on ground level.

Leaders told us about the ways in which they ensured staff were qualified and skilled to carry out their roles, and the support that they offered them. For example, staff regularly attended training courses and received yearly appraisals. However, due to the issues identified during the clinical records review, it was not clear whether staff delivering some services had the necessary training, knowledge, and experience to do so safely and effectively. In addition, there were no appropriate clinical supervision process in place.

In addition, there were no audits of individual prescribing carried out. During the assessment the provider told us it would initiate prescribing audits and that it planned to carry these out 6-monthly.

At the time of the assessment most staff were up to date with required training. There were however some training gaps identified, for example staff available for chaperoning had not received specific training for this role, safeguarding training was not to appropriate levels for all staff, and some staff had not completed data security training. During the assessment we saw that the provider had booked all necessary training. The provider had also recently introduced a new platform to support effective oversight of training compliance.

There was an infection prevention and control (IPC) policy in place and staff received IPC training. Audits of handwashing and cleaning records were carried out, and during the assessment the provider had initiated a general IPC audit which it planned to do yearly. The provider requested immunisation histories for all clinical staff.

We found the premises and equipment to be clean and tidy when we visited. We saw that waste bins were dated and signed and that they were not filled above the recommended line. Appropriate personal protective equipment was available to staff. Clinical waste was appropriately managed by an external company.

We had concerns about the process for purchasing and supplying medicines. We found that medicines had been ordered for some patients, however there was no information within their clinical records to show they had received a consultation for the medicines prescribed. In addition, some patients’ clinical records showed that medicines had been advised, however there was no prescription recorded to show these had been prescribed and issued to the patient.

There was no system in place to track which medicines had been ordered to check against clinical records. In the records we looked at, not all had prescriptions attached. It was therefore not clear from clinical records and pharmacy ordering systems if medicines ordered had actually been provided to the patients.

At the time of the assessment the policies for weight loss management and menopause lacked sufficient information for prescribers to follow safely. However, following the assessment changes were made to both policies to ensure safe prescribing could take place.

The medicines policy was in date and indicated that other than Botulinum toxin, no other medicines were stored at the clinic. On the day of the assessment was saw that the only medicine available was Botulinum toxin. This medicine was stored in line with manufacturer’s guidelines, and the provider had introduced a new monitoring system for refrigerators, to ensure guidelines were followed.

Medicines were stored securely and at appropriate temperatures. Refrigerators used to store medicines were regularly cleaned, and temperatures were monitored and logged. However, we found that refrigerators had not been serviced. During the assessment we saw that the provider had arranged for this servicing to be carried out and told us it would ensure this was carried out yearly.