The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: Roberts House

Overall: Inadequate read more about inspection ratings

2 Manor Road, Ruislip, Middlesex, HA4 7LB (01895) 630604

Provided and run by:
Perfect Image Consultants Limited

All Inspections

07 April 2022

During an inspection looking at part of the service

Roberts House is operated by Perfect Image Consultants. The service provides surgical procedures to adults only.

We inspected the service using our focused inspection methodology.

The service was previously inspected in January 2022. As a result of this inspection we took urgent action to extend the suspension of the registration of the provider, scheduled to end on 19 April 2022.

This inspection was a focused follow up inspection to review if all areas of concern had been resolved and the risk of harm to patients had been removed.

We did not rate the service at this inspection; we were following up on concerns raised at our last inspection.

We found that:

  • Not all policies reflected national best practice or were relevant to the service. Policies were not all identifiable as being related to the service, and some contained very little or poor detail.
  • The policy for monitoring a deteriorating patient was not service specific and did not outline what staff should do when recognising someone becoming unwell.
  • There were no clear processes in place for investigating incidents. It was not clear from the policy how investigations would be conducted or how learning would be shared with staff.

However:

  • Staff had completed training in key skills and how to protect vulnerable patients from abuse or the risk of abuse.
  • The service was able to provide a training matrix of staff’s mandatory training.
  • Clinical waste and rubbish bins were labelled appropriately with the correct colour bin liner.

25 January 2022

During an inspection looking at part of the service

Roberts House is operated by Perfect Image Consultants. The service provides surgical procedures to adults only. We inspected the service using our focused inspection methodology.

The service was previously inspected in November 2021. As a result of this inspection we took urgent action to extend the suspension of the registration of the provider, scheduled to end on 31 January 2022, for a period of a further 11 weeks.

This inspection was a focused follow up inspection to review if all areas of concern had been resolved and the risk of harm to patients had been removed.

We did not rate the service at this inspection; we were following up on concerns raised at our last inspection

We found that:

  • There was no training matrix to inform staff of the mandatory training they were expected to complete. Staff had not been provided with updated mandatory training.
  • Staff did not have training in key skills or how to protect vulnerable patients from abuse or the risk of abuse.
  • Managers did not monitor the effectiveness of the service.
  • Not all policies reflected national best practice or referenced the most recent national guidance and regulations.
  • There was a risk staff would be unable to care for deteriorating patients as the deteriorating patients’ policy was not fit for purpose.
  • The service was not clear about how to manage patient safety incidents.

However:

  • Equipment required in the event of a patient emergency was now functional.
  • All sharps bins were now set up correctly and labelled with the date they were started.

09 November 2021

During an inspection looking at part of the service

Roberts House is operated by Perfect Image Consultants. The service provides surgical procedures to adults only. We inspected the service using our focused inspection methodology.

The service was previously inspected in September 2021, as a result of this inspection we took urgent action to suspend the registration of the provider for a period of six weeks. The suspension period was scheduled to end on 12 November 2021.

This inspection was a focused follow up inspection to review if all areas of concern had been resolved and the risk of harm to patients had been removed.

We did not rate the service at this inspection; we were following up on concerns raised at our last inspection

We found that:

  • Staff did not have training in key skills or how to protect patients from abuse or the risk of abuse.
  • There was a risk staff would be unable to care for deteriorating patients as some equipment was not functional and policies were out of date.
  • Managers did not monitor the effectiveness of the service and had not provided staff with guidance or policies based on national best practice.
  • The maintenance and use of equipment did not work to keep people safe.
  • Clinical waste well was not always managed well by the provider. The clinical waste systems were not clearly designed.
  • The service was not clear about how to manage patient safety incidents.

However:

  • The service now managed infection risks in theatre. There was a system to identify surgical site infections.

As a result of this inspection, we took urgent action to extend the suspension of the registration of the provider for a further period of 12 weeks.

The service remains in 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.

14, 20 and 22 September 2021

During a routine inspection

Roberts House is operated by Perfect Image Consultants. The service provides surgical procedures to adults only. We inspected the service using our comprehensive inspection methodology. The service was previously inspected in April 2019 but was not rated at this time. 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?

We rated it as inadequate because:

  • Staff did not have training in key skills or how to protect patients from abuse or the risk of abuse. They were not able to demonstrate they provided safe care. The service was not controlling infection risk well in the theatre environment. Staff were potentially unable to care for deteriorating patients as some equipment was out of date or not functional. The service was not clear about how to manage safety incidents.
  • Managers did not monitor the effectiveness of the service and had not provided staff with guidance to provide care based on national guidance. Staff did not work with other healthcare professionals for the benefit of patients. Patients were not always given a 14-day cooling off period before cosmetic surgery was carried out.
  • The service did not work with others in the wider system to support patient care and did not provide translation services for patients with barriers to communication.
  • Leaders lacked insight into the problems identified at the service and there were no clear governance processes. The service had no clear vision or values for staff to work towards. The service did not engage well with patients, staff or wider health care providers to plan and manage services and staff were not committed to improving services continually.

However:

  • The service had enough staff to care for patients and the environment was visibly clean. They stored medicines safely.
  • There was the correct pain relief to give patients and key services were contactable seven days a week. Managers made sure staff were clinically competent to carry out their role.
  • Eligible patients could access care promptly and were able to make a complaint about the care they received if they were unhappy.

As a result of this inspection, we took urgent action to suspend the registration of the provider for an initial period of eight weeks. We are also placing the 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.

15 April to 16 April 2019

During a routine inspection

Roberts House is operated by Perfect Image Consultants. The service has one theatre bed.

The service provides a surgical procedures and diagnostic imaging service to adults only. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 April 2019. Surgical procedures undertaken by this provider happened very infrequently.

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

This service was Not rated.

  • Non-clinical staff working in the service, including the branch manager, assistant branch manager and the receptionist, had not completed any mandatory training for their roles at the time of our inspection.

  • The staff who were employed in the service, (the branch manager, assistant branch manager and receptionist), were not trained in safeguarding matters other than part of a one-day overall training package which occurred after our initial inspection.

  • On day one of our inspection we found that the temperature of the theatres was 30 degrees and on day two of our inspection, it was 21 degrees. There was no monitoring of temperatures within the theatres.

  • Medications were kept in a locked cupboard in the theatre room. There was no measurement of the temperature of the cabinet, which meant that there was no evidence that the temperature in the theatre room did not exceed the 25 degrees recommended for some of the medications kept in the cupboard.

  • We saw no evidence of an anaesthetic machine in use. However, there was an anesthetic machine in theatres that was no longer in use, having been decommissioned.

  • There were no incidents recorded in the service and we were shown no evidence of how the service would log a serious incident.

  • The service did not undertake any auditing.

  • The service did not monitor patient outcomes and we were told by the registered manager that the service did not compare results with other providers.

  • We did not see any leaflets specific to any health promotion that was encouraged for surgical procedures.

  • Whilst the service performed very few surgical cases over the preceding years, the service was not able to present us with a risk register that identified any risks, past, present or perceived.

    However;

  • There was a cooling off period between consent and procedure to ensure that patients had been given due consideration to the treatment they wished to receive, and that their expectations were realistic.

  • We observed that the service maintained clear and legible notes. Patient records were detailed and included observations taken during surgery, times in theatre, and when drugs were given.

  • In the records that we looked at for the two surgical procedures that took place in 2018, we saw that treatment options were discussed well in advance of the actual procedure being carried out. We also saw that discussions regarding treatment options happened over a series of consultations, with more than one health professional.

  • Staff were constantly with the patient during the consultation and procedure and staff checked patients’ comfort and anxiety levels throughout.

  • We observed in patient records that staff answered patients’ concerns and questions about treatments and procedures.

  • Surgical procedures were organised around patients’ availability.

  • A chaperone was available to any patient who requested one. This could have been a friend or family member. There was also the option for the doctor to ask for a colleague to sit in on consultations and procedures.

  • The total number of cancelled procedures for a non-clinical reason was zero in the reporting period.

  • The number of complaints recorded in the reporting period, was zero. In the two years prior of the reporting period, the service had received only one complaint.

  • The registered manager’s leadership was described as good, as well as being described as “one of the most approachable people”, who was also very good to work with.

  • The culture at Roberts House was very friendly. Staff got on with each other, and we were told that staff had good relationships with patients, especially repeat patients.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and the South East)

19, 28 June 2013

During a routine inspection

We previously inspected Roberts House on 6 February 2013 and 12 February 2013 and found the provider was not meeting the essential standards in respect of requirements relating to workers and supporting workers. The provider sent us an action plan on how they would improve. During our inspection on 19 June 2013 the provider had updated staff files with an employment history, written references and insurance certificates. The provider had obtained qualification certificates and professional development records for all medical staff.

People who use the service had their treatment needs assessed and a treatment plan was developed to ensure people received safe and effective treatment. Treatment was provided in a clean and hygienic environment and the provider had implemented infection control audits.

During our visit to Roberts House on 19 June and 26 June 2013 we did not talk with people who use the service. During our inspection there were no scheduled appointments. However, we looked at provider questionnaires which had been completed by people. These informed us that overall people had received a satisfactory treatment experience at Roberts House.

6, 12 February 2013

During a routine inspection

We visited the clinic as part of our planned scheduled inspection. We had also received information that the clinic might not be complying with essential standards of quality and safety. In particular concerns were raised about the recruitment practices of the provider, the training staff received, the quality assurances processes in the clinic and about the care and treatment people received.

We obtained the views of six people who use the service and two members of staff. We also met with the manager and a newly appointed practice manager to discuss the services provided by the clinic.

All the people spoken with confirmed their treatment was explained to them and they had signed consent forms. People also told us they were told about the side effects of their treatment and were happy with the way these were carried out. One person said 'If I was not happy I would go elsewhere'. People confirmed the clinic was always clean and the staff were easy to talk to. People told us they would complain and talk with the provider if they were unhappy with the service.

Suitable arrangements were not in place to demonstrate that staff received appropriate training, professional development, supervision and appraisal to make sure that they were competent to treat people.

The staff personnel files we looked at did not contain all the necessary recruitment checks to confirm that only suitable staff were chosen to work at the clinic.

6 March 2012

During an inspection looking at part of the service

We did not meet people who use the service during the visit. We viewed some of the satisfaction questionnaires that people had completed and found that all of the comments were positive.

Comments included '[the service is] always flexible and able to offer what I want' , 'Everyone took such good care of me' and 'I felt in control of what was going to happen'.

27 September 2011

During an inspection in response to concerns

We did not meet people who use the service during the visit. We viewed some of the satisfaction questionnaires that people had completed and all of the comments were positive.

People said the information provided to them about the service, the consultation and the monitoring treatment were 'very good'.

Other comments included people saying that they 'were able to explain their feelings' to the doctor and they had not felt 'rushed'.

We found during the visit that there was a lack of checks and audits on infection control, medication and the disposal of instruments used during procedures.

The provider had also not obtained detailed recruitment information on the staff working at the service.