Archived: Cedar House Clinic

Updated 22 August 2019

Cedar House Clinic is operated by Cedar House Clinic Limited. The service has been regulated by CQC since 2011. The last inspection took place in February 2019 when it did not meet all the standards inspected.

The unannounced, focussed inspection took place on 28 May 2019.

Facilities on the ground floor included a waiting room, three treatment rooms, toilets, staff room, filing room and two offices. The upstairs of the building housed a theatre, clean and dirty utility rooms, four treatment rooms a toilet and shower and changing facilities. The provider rented rooms out to other practitioners.

The clinic has had a registered manager in post since March 2011. The current manager was appointed and registered with the CQC in June 2018.

Additionally, the clinic offered cosmetic procedures such as dermal fillers and laser hair removal. Dermal fillers and laser hair removal are not within our scope of regulation and we do not inspect these services.

Updated 22 August 2019

Cedar House Clinic is operated by Cedar House Clinic Limited. The service saw patients on a day care basis, there were no overnight facilities.

The service provided cosmetic surgery for patients over the age of 18: data showed that one person between the ages of 16-18 had been treated at the clinic. We inspected surgery as a core service.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 5 February 2019.

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.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We rated it as Inadequate overall.

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

• The service did not have enough staff with the right training, skills and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• The provider did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and the unexpected.

• There were some controlled drugs on site which were out of date, with some since 2015.

• The service did not always control infection risk well. However, staff kept themselves, equipment and the premises clean. They used some control measures to prevent the spread of infection.

• The service reported they had not had any patient safety incidents. However, effective processes were not in place to carry out investigations that were clinical.

• Systems and processes to protect patients from abuse were not effective.

• The service did not always make sure staff were competent for their roles. Managers did not appraise staff’s work performance or hold supervision meetings with them to provide support and monitor the effectiveness of the service.

• The service did not provide mandatory training in key skills to all staff and make sure everyone completed it.

• Systems and processes for assessing and responding to risk were not always effective.

• The service had suitable premises and equipment; however, the resuscitation trolley was not tamperproof. This was important as it contained emergency medicines and was in a public area.

• The service did not always provide care and treatment based on national guidance and evidence of its effectiveness. Managers did not check to make sure staff followed guidance.

• Managers did not monitor the effectiveness of care and treatment and use the findings to improve the service. They did not compare local results with those of other services to learn from them.

• Staff did not always understand their roles and responsibilities under the Mental Capacity Act 2005.

• There was no specific support available for people living with a learning disability, but staff told us they would be happy for someone to come along with them to provide support.

• Staff told us if a patient had a translation need they would ask the patient to bring a relative who could translate; this was not good practice.

• The service did not always take account of patient’s individual needs.

• The provider did not use a systematic approach to continually improve its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

• Staff did not routinely collect safety information and share it with staff, patients and visitors.

• The service had a vision statement, however not all staff were aware of this.

• The provider did not always engage well with patients to plan and manage appropriate services.

• There were no leaflets available in different languages.

However, we also found the following areas of good practice.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available for all staff providing care.

• The service was supported by an external pharmacist on a six-weekly basis, fridges containing medications were regularly checked and kept secure.

• Staff gave patients enough fluids to meet their needs and improve their health.

• Staff worked together as a team to benefit patients.

• Staff provided patients with health advice before and after cosmetic procedures.

• Staff assessed and monitored patients regularly to see if they were in pain.

• Staff cared for patients with compassion.

• Staff provided emotional support to patients to minimise their distress.

• Staff involved patients in decisions about their care and treatment.

• The consultant surgeon and registered manager were looking at ways they could improve the service.

• The service planned and provided services in a way that met the needs of most local people.

• Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• There was an established leadership team in place. Staff regardless of seniority felt able to approach and challenge each other.

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, even though a regulation had not been breached, to help the service improve. We issued the provider with three requirement notices that affected surgery. We also issued the provider with a warning notice. Details are at the end of the report.

Following this inspection, we sent the provider a warning notice raising concerns. I am also placing this service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 15 July 2019

Surgery was the main activity of the clinic. We rated this service as inadequate overall because it was inadequate for safe, effective and well led. It required improvement for responsive although it was good for being caring.