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The Bodyline Clinic Limited Birkenhead Good

Inspection Summary


Overall summary & rating

Good

Updated 19 February 2020

We carried out an announced comprehensive inspection at The Bodyline Clinic Limited Birkenhead to follow up on a breach of regulations and to rate the service.

CQC inspected the service on 21 November 2018 and asked the provider to make improvements regarding safe provision of treatment, to protect patients from the risks of supplying more than one medicine with the same action. We checked these areas as part of this comprehensive inspection and found this had been resolved.

Bodyline Birkenhead is a private clinic which provides medical treatment for weight loss for adults over the age of 18.

One of the nurses 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.

20 people provided feedback about the service. All the feedback was positive. Patients told us that staff were professional, helpful and listened. The environment was always clean and organised.

Our key findings were

:

  • Patients felt supported and staff were helpful.
  • The provider had good governance in place, audit outcomes and lessons learnt were shared at the monthly clinical meeting.
  • The provider was developing its ongoing support for patients using online solutions.
  • The provider supplied medicines that required refrigeration, but we were not assured of the monitoring. This is because the minimum and maximum temperatures had not been recorded.

The areas where the provider should make improvements are:

  • Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
  • Review and update policies for medicines that require refrigeration so that appropriate temperature monitoring is carried out.

Dr Rosie Benneyworth BM BS BMedSci MRCGP


Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Good

Updated 19 February 2020

Safety systems and processes

The service

had

clear systems to keep people safe and safeguarded from abuse.

  • The provider conducted safety risk assessments. It had appropriate safety policies, which were regularly reviewed and communicated to staff. They outlined clearly who to go to for further guidance. Staff received safety information from the service as part of their induction and refresher training. The service had systems to safeguard children and vulnerable adults from abuse. The medical director was the safeguarding lead, all staff were aware of local escalation processes if needed.
  • The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse.
  • The provider carried out staff checks at the time of recruitment and on an ongoing basis where appropriate. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. Staff who acted as chaperones were trained for the role and had received a DBS check.
  • There was an effective system to manage infection prevention and control. A Legionella risk assessment had been carried out. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
  • The provider ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste.
  • The provider carried out appropriate environmental risk assessments, which took into account the profile of people using the service and those who may be accompanying them.

Risks to patients

There

were systems to assess, monitor and manage risks to patient safety.

  • There were arrangements for planning and monitoring the number and mix of staff needed.
  • Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention.
  • A risk assessment had been carried out to determine suitable medicines and equipment to deal with medical emergencies. These were stored appropriately and checked regularly.
  • When there were changes to services or staff the service assessed and monitored the impact on safety.
  • There were appropriate indemnity arrangements in place.

Information to deliver safe care and treatment

Staff

had

the information they needed to deliver safe care and treatment to patients.

  • Individual care records were written and managed in a way that kept patients safe. The care records template used to document patient information had recently been modified in conjunction with nursing staff to ensure review dates were clear.
  • We looked at 13 medical records and they showed that information needed to deliver safe care and treatment was available to relevant staff in an accessible way.
  • A new records cabinet had been built to ensure records were stored safely and securely
  • The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. There was a monthly clinical management meeting.
  • The service had a system in place to retain medical records in line with Department of Health and Social Care (DHSC) guidance in the event that they cease trading.

Safe and appropriate use of medicines

The service

had

reliable systems for appropriate and safe handling of medicines most of the time.

  • The systems and arrangements for managing medicines, including controlled drugs, emergency medicines and equipment minimised risks. One of the medicines supplied required fridge storage. The thermometer being used had not been reset and the temperature recorded did not document the minimum and maximum. This meant we were not assured that the medicines had been stored in line with manufactures guidance. The provider addressed this immediately and identified there had been no risk to patients.
  • The service carried out regular medicines audit to ensure prescribing was in line with best practice guidelines for safe prescribing. Where audit identified records that were outside the service’s prescribing policy we saw evidence of this being investigated. Lessons learnt were shared across the organisation at the monthly clinical meeting and appropriate feedback was given to staff.
  • The service did prescribe Schedule 3 controlled drugs (medicines that have additional levels of control due to their risk of misuse and dependence).
  • Staff prescribed, administered or supplied medicines to patients and gave advice on medicines in line with legal requirements and current national guidance. Processes were in place for checking medicines and staff kept accurate records of medicines.
  • There were effective protocols for verifying the identity and age of patients.
  • Some of the medicines this service prescribes for weight loss are unlicensed. Treating patients with unlicensed medicines is higher risk than treating patients with licensed medicines, because unlicensed medicines may not have been assessed for safety, quality and efficacy. These medicines are no longer recommended by the National Institute for Health and Care Excellence (NICE) or the Royal College of Physicians for the treatment of obesity. The British National Formulary states that ‘Drug treatment should never be used as the sole element of treatment (for obesity) and should be used as part of an overall weight management plan’.

Track record on safety and incidents

The service

had

a good safety record.

  • There were comprehensive risk assessments in relation to safety issues.
  • The service monitored and reviewed activity. This helped it to understand risks and gave a clear, accurate and current picture that led to safety improvements.

Lessons learned and improvements made

The service learned and made improvements when things went wrong.

  • There was a system for recording and acting on significant events. Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so.
  • There were adequate systems for reviewing and investigating when things went wrong. The service learned and shared lessons identified themes and took action to improve safety in the service. For example, the temperature documentation for the fridge was highlighted to the provider on inspection and this was logged as a significant event. The provider completed a full investigation and planned to share lessons identified across the organisation at the monthly clinical meeting.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The provider encouraged a culture of openness and honesty. The service had systems in place for knowing about notifiable safety incidents.
  • Duty of candour was considered when carrying out the significant event investigation considered impact to patients and identified that there had been no risk.
  • The service acted on and learned from external safety events as well as patient and medicine safety alerts. The service had an effective mechanism in place to disseminate alerts to all members of the team.

Effective

Good

Updated 19 February 2020

Effective needs assessment, care and treatment

The provider had systems to keep clinicians up to date with current evidence based practice. We saw evidence that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance (relevant to their service)

  • Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs, height, weight and body mass index and physical wellbeing.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • Arrangements were in place to deal with repeat patients. The policy ensured that people were reviewed at appropriate time intervals.
  • A new digital system had been launched to support patients when away from the clinic. The service had changed how people signed up to this as a result of patient feedback.

Monitoring care and treatment

The service was actively involved in quality improvement activity.

  • The service used information about care and treatment to make improvements. For example, the service reviewed a selection of records monthly to monitor the effectiveness of treatment by monitoring weight loss.

  • The service made improvements through the use of completed audits. Clinical audit had a positive impact on quality of care and outcomes for patients. For example, the service had completed a 12 weekly review clinical audit. The audit identified that 11 out of 30 patients had lost weight. For those who had not lost weight the reason was considered, most commonly a break in treatment had occurred.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

  • All staff were appropriately qualified. The provider had an induction programme for all newly appointed staff.
  • Relevant professionals were registered with the Nursing and Midwifery Council and were up to date with revalidation.
  • The provider understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff were encouraged and given opportunities to develop.
  • The service had launched its digital support for patients and staff were supported to use this.
  • Audits had identified inconsistency for measuring waist circumference and a training video had been prepared for staff to complete.

Coordinating patient care and information sharing

Staff worked together, and worked well with other organisations, to deliver effective care and treatment.

  • Patients received coordinated and person-centred care.
  • Before providing treatment, nurses at the service ensured they had adequate knowledge of the patient’s health, any relevant test results and their medicines history. We saw examples of patients being signposted to more suitable sources of treatment where this information was not available to ensure safe care and treatment.
  • All patients were asked for consent to share details of their consultation and any medicines prescribed with their registered GP when they joined the service, and at periodic reviews.

Supporting patients to live healthier lives

Staff were consistent and proactive in empowering patients, and supporting them to manage their own health and maximise their independence.

  • Where appropriate, staff gave people advice so they could self-care.
  • The new digital support for patients contained information to support patients to live healthier lifestyles. This included diet advice, exercise and fitness and support from a lifestyle coach.
  • Where patients needs could not be met by the service, staff redirected them to the appropriate service for their needs.

Consent to care and treatment

The service obtained consent to care and treatment in line with legislation and guidance

.

  • Staff understood the requirements of legislation and guidance when considering consent and decision making.
  • Staff supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.
  • The service monitored the process for seeking consent appropriately.

Caring

Good

Updated 19 February 2020

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

  • The service sought feedback on the quality of clinical care patients received.
  • Feedback from patients was positive about the way staff treat people. Analysis of a recent survey of 50 patients showed 79% of people were very satisfied with the service; and 92% of people said they got sufficient information about their treatment.
  • Staff understood patients’ personal, cultural, social and religious needs. They displayed an understanding and non-judgmental attitude to all patients.
  • The service gave patients timely support and information.

Involvement in decisions about care and treatment

Staff helped patients to be involved in decisions about care and treatment.

  • Interpretation services would be made available, if requested for patients who did not have English as a first language.
  • We received 20 comment cards. Patients told us they felt comfortable using the service and staff were supportive. Patients felt listened to and had sufficient time during consultations to make an informed decision about the choice of treatment available to them.

Privacy and Dignity

The service respected patients’ privacy and dignity.

  • Staff recognised the importance of people’s dignity and respect.
  • Staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs.

Responsive

Good

Updated 19 February 2020

Responding to and meeting people’s needs

The service organised and delivered services to meet patients’ needs.

It took account of patient needs and preferences.

  • The provider understood the needs of their patients and improved services in response to those needs. The clinic had reviewed its opening times and had allocated extra clinics on a Saturday during busy periods in response to patient feedback.
  • The facilities and premises were appropriate for the services delivered. The clinic was due to expand to improve the waiting area size and accessibility for patients.

Timely access to the service

Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

  • Patients had timely access to initial assessment and treatment.
  • Waiting times, delays and cancellations were minimal and managed appropriately.
  • Patients reported that the appointment system was easy to use, the service was reviewing this to allow people to book online.

Listening and learning from concerns and complaints

The service took complaints and concerns seriously and responded/ to them appropriately to improve the quality of care.

  • Information about how to make a complaint or raise concerns was available.
  • Staff were able to describe how they would deal with complaints compassionately.
  • The service had a complaints policy and procedures in place. The service had identified a concern and had supported the patient to complain. A faulty blood pressure machine had caused bruising on the patients arm. The registered manager immediately removed the machine from use and reported it to the manufacturer.
  • The service shared any learned lessons from individual concerns, complaints and from analysis of trends at other locations at the clinical managers meeting.

Well-led

Good

Updated 19 February 2020

Leadership capacity and capability;

Leaders had the capacity and skills to deliver high-quality, sustainable care.

  • Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
  • Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
  • The provider had effective processes to develop leadership capacity and skills, including planning for the future leadership of the service.

Vision and strategy

The service had a clear vision and credible strategy to deliver high quality care and promote good outcomes for patients.

  • There was a clear vision and set of values. The service had a realistic strategy and supporting business plans to achieve priorities.
  • The service developed its vision, values and strategy jointly with staff and external partners.
  • Staff were aware of and understood the vision, values and strategy and their role in achieving them.
  • The service monitored progress against delivery of the strategy.

Culture

The service had a culture of high-quality sustainable care.

  • Staff felt respected, supported and valued. They were proud to work for the service.
  • The service focused on the needs of patients.
  • Leaders and managers acted on behaviour and performance inconsistent with the vision and values.
  • Openness, honesty and transparency were demonstrated when responding to incidents and complaints. This was demonstrated when investigating the temperature monitoring incident where possible impact for patients was considered. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.
  • Staff told us they could raise concerns and were encouraged to do so. They had confidence that these would be addressed. Staff had identified processes that could be improved and these had been reviewed and changes made.
  • There were processes for providing all staff with the development they need. This included appraisal and career development conversations. All staff received annual appraisals in the last year. Staff were supported to meet the requirements of professional revalidation where necessary. Clinical staff, including nurses, were considered valued members of the team. They were given protected time for professional time for professional development and evaluation of their clinical work.
  • There was a strong emphasis on the safety and well-being of all staff.
  • The service actively promoted equality and diversity. It identified and addressed the causes of any workforce inequality. Staff had received equality and diversity training. Staff felt they were treated equally.
  • There were positive relationships between staff and teams.

Governance arrangements

There were clear responsibilities, roles and systems of accountability to support good governance and management.

  • Structures, processes and systems to support good governance and management were clearly set out, understood and effective.
  • Staff were clear on their roles and accountabilities
  • Leaders had established proper policies, procedures and activities to ensure safety and assured themselves that they were operating as intended.

Managing risks, issues and performance

There were clear and effective processes for managing risks, issues and performance.

  • There was an effective, process to identify, understand, monitor and address current and future risks including risks to patient safety.
  • The service had processes to manage current and future performance. Performance of clinical staff could be demonstrated through audit of their consultations, prescribing and referral decisions. Leaders had oversight of safety alerts, incidents, and complaints.
  • Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to change services to improve quality.
  • Results of audits were discussed monthly at the clinical meeting ensuring leaders had oversight. As a result of audits, a training video had been developed to clarify how to complete waist measurement.
  • The provider had plans in place and had trained staff for major incidents.

Appropriate and accurate information

The service acted on appropriate and accurate information.

  • Quality and operational information was used to ensure and improve performance. Performance information was combined with the views of patients.
  • Quality and sustainability were discussed in relevant meetings where all staff had sufficient access to information.
  • The service used performance information which was reported and monitored and management and staff were held to account.
  • The information used to monitor performance and the delivery of quality care was accurate and useful. There were plans to address any identified weaknesses.
  • The service submitted data or notifications to external organisations as required.
  • There were robust arrangements in line with data security standards for the availability, integrity and confidentiality of patient identifiable data, records and data management systems.

Engagement with patients, the public, staff and external partners

The service involved patients, the public, staff and external partners to support high-quality sustainable services.

  • The service encouraged and heard views and concerns from the public, patients, and staff and acted on them to shape services and culture. For example, the clinic was due to be extended. Increasing the size of the waiting area.
  • Staff could describe to us the systems in place to give feedback. We saw evidence of feedback opportunities for staff and how the findings were fed back to staff. We also saw staff engagement in responding to these findings. For example, staff had responded positively to the training video for waist circumference measurement. This had been prepared in response to feedback and engagement.
  • The service was transparent, collaborative and open with stakeholders about performance.

Continuous improvement and innovation

There were systems and processes for learning, continuous improvement and innovation.

  • There was a focus on continuous learning and improvement.
  • The service made use of internal and external reviews of incidents and complaints. Learning was shared and used to make improvements. All incidents and complaints from across the organisation were shared at the monthly clinical management meeting.
  • Registered managers shared information locally with their teams.
  • Leaders and managers encouraged staff to take time out to review individual and team objectives, processes and performance.
  • There were systems to support improvement and innovation work. Staff had identified an app that could be used to support calculation of body mass index and the system had been reviewed. We saw the recent implementation of the digital platform to support patients outside of clinic hours.