Skin and Follicle Birmingham

Updated 12 May 2021

Skin and Follicle Birmingham is operated by Surgen Ltd. It provides services for privately paying patients.

The service is registered for the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder or injury

The service provides several cosmetic surgery procedures for adults over 18 years at this location. These include hair restoration, earfold surgery and blepharoplasty (eyelid surgery). These types of surgery are performed under local anaesthetic on a day case basis.

The service undertakes outpatient work including mole, skin tag and cyst removal. If required, tissue removed from patients may be sent for testing. Consultants at this service share the results with patients.

Patients can receive consultations for procedures which require general anaesthetic such as breast augmentations at the clinic. However, the procedures are performed at local private hospitals which have the equipment and additional staff to support patients undergoing a general anaesthetic.

The service has a registered manager who has been in this position since the service first registered with CQC in December 2016.

The service has four business partners, three of whom work as consultant plastic surgeons at the clinic. In addition, the service employs two non-clinical support staff; a receptionist and a clinic manager. Additional staff such as clinical staff to support procedures were available through a bank staff arrangement. One surgeon was employed under practicing privileges at the time of our inspection, with two more due to start in 2021; one at the end of April and one later in the year.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 12 April 2021.

The service has a dedicated surgical suite with a waiting area and three treatment rooms on the ground floor. The first floor has six consultation rooms, a waiting area and back office. The service has no overnight beds. There is a small car park at the front of the premises.

The service provides two core services: surgery and outpatients.

The main service provided by this clinic was cosmetic surgery. Where our findings on surgery for example, management arrangements also apply to outpatients, we do not repeat the information but cross-refer to the surgery service report.

The service also offers a range of other aesthetic procedures such as anti-wrinkle injections and laser hair removal. We did not inspect these as aesthetic procedures do not form part of CQC regulated activities.

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. The main service provided by this service was cosmetic surgery.

We have inspected this service previously on one occasion. We last inspected on 11 September 2019. During this inspection we found breaches of the following Health and Social Care Act (Regulated Activities) Regulations 2014:

• Regulation 12: Safe Care and Treatment
• Regulation 13: Safeguarding service users from abuse and improper treatment
• Regulation 16: Receiving and acting on complaints
• Regulation 17: Good Governance
• Regulation 18: Staffing
• Regulation 19: Fit and proper persons employed

Following the inspection in 2019, we issued a warning notice and five requirement notices to the provider.

We conducted a desk top review in February 2021 which demonstrated that the warning notice had been complied with. We saw during our inspection that requirement notices were now compliant.

Updated 12 May 2021

Our rating of this location improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and mostly made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available Monday to Saturday from 10am till 6pm.
• Staff treated patients with compassion and kindness, took account of their individual needs, and helped them understand their choices. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for procedures.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• Leaders and teams did not always identify and escalate relevant risks and issues and identify actions to reduce their impact. Flammable substances were not stored appropriately, and the risk assessments were not reflective of the storage need.
• The storage and management of medicines was not in line with national guidelines.
• Staff did not total up early warning scores when monitoring patients during procedures. This meant that there was a risk of not detecting a deteriorating patient.

Outpatient services is a small proportion of clinic activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery core service report below.

Updated 12 May 2021

The outpatients core service was not previously reported on or rated. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available Monday to Saturday from 10am till 6pm.
• Staff treated patients with compassion and kindness, took account of their individual needs, and helped them understand their choices. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for procedures.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually. Leaders and teams did not always identify and escalate relevant risks and issues and identify actions to reduce their impact.

However, we also found:

• Leaders and teams did not always identify and escalate relevant risks and issues and identify actions to reduce their impact.
• Flammable substances were not stored appropriately, and the risk assessments were not reflective of the storage need and the storage and management of medicines was not in line with national guidelines.
• Formal appraisals were not completed for non-clinical permanent staff.
• Storage of emergency medicines was not consistently in line with best practice guidance.

Outpatient services is a small proportion of clinic activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery.

Updated 12 May 2021

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available Monday to Saturday from 10am till 6pm.
• Staff treated patients with compassion and kindness, took account of their individual needs, and helped them understand their choices. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for procedures.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However, we also found:

• Leaders and teams did not always identify and escalate relevant risks and issues and identify actions to reduce their impact.
• Flammable substances were not stored appropriately, and the risk assessments were not reflective of the storage need.
• The storage and management of medicines was not in line with national guidelines.
• Staff did not calculate early warning scores when monitoring patients during procedures. This meant that there was a risk of not detecting a deteriorating patient.

Outpatient services is a small proportion of clinic activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery.

We rated this service as good overall because it was safe, effective, caring and responsive, and well led.