Archived: Sk:n - Esher High Street

This service is rated as Good overall.

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 an announced comprehensive inspection of Sk:n - Esher High Street between 11 and 18 November 2021 under Section 60 of the Health and Social Care Act 2008. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. This was the provider’s first inspection of the service since it registered with the Care Quality Commission (CQC).

Throughout the COVID-19 pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Speaking with staff in person, on the telephone and using video conferencing.
• Requesting documentary evidence from the provider.
• A site visit.

We carried out an announced site visit to the service on 15 November 2021. Prior to our visit we requested documentary evidence electronically from the provider. We spoke to staff on the telephone and using video conferencing prior to and following our site visit, between 11 and 18 November 2021.

The provider specialises in a combination of medical aesthetic treatments and anti-ageing medicine, as well as offering rejuvenation and dermatology treatments. This service provides independent doctor-led dermatology services, offering a mix of regulated skin treatments and minor surgical procedures, as well as other non-regulated aesthetic treatments.

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 regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Sk:n – Esher High Street provides a wide range of non-surgical aesthetic interventions, for example, cosmetic Botox injections, dermal fillers and thread vein treatments, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

Sk:n – Esher High Street is registered with the Care Quality Commission to provide the following regulated activities: Treatment of disease, disorder or injury, Diagnostic and screening procedures and Surgical procedures.

The clinic manager 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.

Our key findings were:

• Staff had received training in key areas. There was a clear plan of training for staff. There was some monitoring of training undertaken by clinical staff employed on a sessional basis, but some current gaps in training had not been identified.
• There were processes in place for performance review and monitoring/oversight of clinical staff employed on a sessional basis. Staff employed by the service had undergone appraisal and regular one to one review.
• There were effective systems and processes to assess the risk of, and prevent, detect and control the spread of infection. There were processes for auditing of infection prevention control arrangements.
• The monitoring of staff immunisations did not reflect current Public Health England guidance.
• There were safeguarding systems and processes to keep people safe. Staff were clear who the safeguarding lead was and what procedures they would follow if they had a safeguarding concern. Staff had received training in the safeguarding of adults and children.
• Arrangements for chaperoning were effectively managed. Staff had received chaperone training and had been subject to Disclosure and Barring Service checks.
• There were appropriate arrangements to manage medical emergencies and suitable emergency medicines and equipment in place.
• Fire safety processes were in place. Staff had participated in fire drills and had received fire safety training.
• There were comprehensive health and safety and premises risk assessments in place.
• Clinical record keeping was clear, comprehensive and complete.
• There was evidence of clinical audit and regular auditing of clinical record keeping processes.
• There were clear and effective governance and monitoring processes to provide assurance to leaders that systems were operating as intended. Risks were promptly identified and responded to.
• Best practice guidance was followed in providing treatment to patients. For example, excised lesions were routinely sent for histological review.
• There were records to demonstrate that recruitment checks had been carried out in accordance with regulations, including for staff employed on a sessional basis. However, local managers did not always have oversight of those assurance checks.
• Policies and procedures were monitored, reviewed and kept up to date with relevant and sufficient information, to provide effective guidance to staff.

The areas where the provider should make improvements are:

• Review processes for the monitoring of staff immunisation status to reflect current Public Health England guidance.
• Review processes for the monitoring of staff training to ensure clinical staff working under practising privileges have received up to date training in all required areas.
• Review arrangements for the storage of staff recruitment and personnel records, to facilitate ease of access and monitoring of compliance with organisational requirements by local managers.
• Store syringes and dosage instructions with needles and ampoules in emergency medicine packs, to promote ease of access.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care