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Dr Victoria Cosmetic Dermatology and Anti-Ageing Medicine Clinic Good

Inspection Summary


Overall summary & rating

Good

Updated 21 July 2021

This service is rated as

Good

overall. (Previous inspection July 2019 – rated Requires improvement)

The key questions are rated as follows, with the ratings of Good for caring and responsive carried over from the previous inspection:

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 focused inspection at Dr Victoria Cosmetic Dermatology and Anti-Ageing Medicine Clinic to follow up on a breach of regulations and areas identified for improvement from the previous inspection. When we previously inspected in July 2019, we rated the key questions Safe and Well led as Requires improvement. For this inspection in June 2021, we inspected Safe, Effective and Well led. The ratings of Good for caring and responsive were carried over from the previous inspection.

At the last inspection there was a breach of Regulation 17 of the Health and Social Care Act Regulations 2014, which relates to Good governance. The provider’s systems and processes were not in place or working effectively to enable the registered person to assess, monitor and improve the quality and safety of the services. The Care Quality Commission (CQC) inspected the service on 2 June 2021 and checked the areas identified in the last report and found the breach had been resolved.

One of the two directors of the company is the registered manager. A registered manager is a person who is registered with the CQC 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.

In advance of the inspection, the provider had collected feedback from patients using comment cards. All 18 comment cards provided highly positive feedback, with patients describing the team as welcoming, professional, caring and informative. People wrote that staff ensured patients were well informed about the procedures and options, and there was an emphasis on individual care and safety. People also said the additional infection control measures in place during COVID-19 were evident and reassuring.

Our key findings were:

  • The service provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • The practice was led and managed to promote high-quality, person-centred care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Good

Updated 21 July 2021

We rated safe as Good because:

At our last inspection we rated Safe as Requires improvement. This was because systems and processes to maintain safety for staff and clients were not always in place, or when they were, they were not consistently embedded or in line with the clinics own policies or best practice guidelines. This inspection in June 2021 showed the service had reviewed policies and procedures and had could evidence they had implemented safe processes.

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 had been reviewed and shared with staff. The polices outlined 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 vulnerable adults from abuse. The service’s safeguarding vulnerable adults policy included contact details for other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.
  • 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.
  • At the last inspection, we found not all staff had completed safeguarding training or chaperone training as appropriate. At this inspection, we found all staff had received up-to-date safeguarding training, and were trained to level 3 to gain in-depth understanding of how to identify different types of abuse, how to respond and the law. Staff knew the registered manager was the safeguarding lead.
  • Staff who acted as chaperones were trained for the role and had received a DBS check. The clinic displayed signage inviting patients to request a chaperone if they wished.
  • There was an effective system to manage infection prevention and control. At the last inspection we found that some of the infection prevention and control measures were not embedded, and there was neither a risk assessment nor management procedures to minimise the risk of Legionella. Legionella is a bacterial infection which can cause respiratory problems. Since the last inspection, the service had implemented a systematic approach to defining and monitoring the cleaning carried out by the contracted cleaner. This included requiring the contractor to confirm they had completed the required daily, weekly and monthly cleaning tasks, using appropriate methods and materials. Clinic staff were also tasked with checking on the quality of cleaning daily and carrying out monthly audits. The registered manager, who was also the infection prevention and control lead, had completed a Legionella risk assessment and carried out weekly water temperature checks. They had commissioned a Legionella inspection in December 2020, which had identified no additional actions.
  • Since the COVID-19 pandemic, the service had developed an enhanced infection control policy, and implemented a range of measures to promote patient and staff safety. This included reducing the range and number of procedures offered during different phases of the pandemic, making changes to the premises to promote social distancing, screening patients before seeing them on site, providing guidance and hand sanitiser and wearing appropriate PPE. The doctors used respirators for additional protection.
  • The provider ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions. Portable appliances had been safety checked and calibrated, and this was completed under contract. At the previous inspection, we found a lack of documentation of equipment checks. During this inspection, we found systems were in place to monitor and record safety checks, equipment calibration and routine maintenance.
  • There were systems for safely managing healthcare waste. This was removed under contract and appropriately segregated.
  • The provider leased the premises and the landlord had commissioned a fire risk assessment of the entire building in October 2020. As a result of this, the landlord had arranged the installation of a new fire alarm system. The provider carried out their own local fire risk assessment and tested the fire alarms each week.

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. The clinic had recruited a receptionist since the last inspection, who was training to take on additional managerial duties. As well as the two doctors who were the directors of the company, the clinic also employed an experienced aesthetic therapist.
  • There was an effective induction system for staff tailored to their role. The induction training was included in the staff files.
  • Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. They knew how to identify and manage patients with severe infections.
  • There were suitable medicines and equipment to deal with medical emergencies which were stored appropriately and checked regularly and overseen by the registered manager. This included an automated external defibrillator. The emergency equipment was kept in a room secured by keypad entry. This had been improved since the last inspection, where we found that checks had not been documented.
  • There were appropriate indemnity arrangements in place for the two doctors.

Information to deliver safe care and treatment

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

  • The records were written and managed in a way that kept patients safe. Individual care records were maintained on the clinic’s cloud-based records management system. The records management system was tailored by the clinicians to reflect the care pathways for the different treatments offered. The care records we saw showed that information needed to deliver safe care and treatment was available to relevant staff in an accessible way. The system was password protected and there was controlled access to different parts of the patient record, so only clinicians had permission to access the medical record.
  • The service had systems for sharing relevant information with staff and other agencies to enable them to deliver safe care and treatment. This included with the patient’s GP, with their consent, if assessed as necessary.
  • Staff completed training in information governance and signed confidentiality agreements.
  • 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.
  • Clinicians made appropriate and timely referrals in line with protocols and up to date evidence-based guidance.

Safe and appropriate use of medicines

The service had reliable systems for appropriate and safe handling of medicines.

  • At the last inspection we found the service did not have a safe system for managing medicines. Since the last inspection, the registered manager had set up systems to review the stocks and expiry dates of emergency medicines. The clinic had also improved the process for monitoring the storage of medicines that required refrigeration. There was a dedicated medicines fridge, recently purchased, and staff monitored and noted the temperature three times a day. The fridge was alarmed should it go out of range and the data logger provided automatic monitoring. The records showed the temperature had not been out of range.
  • The doctors rarely prescribed antibiotics, but when necessary, did so on their own headed paper and in line with their policy. Details of any items prescribed were included in patient records. The doctors only prescribed Roaccutane, a medicine used to treat severe acne, after appropriate screening tests and issued a prescription for a four week treatment course only. Antibiotics were only prescribed after a risk assessment of the patient’s treatment.
  • There were effective protocols for verifying the identity of patients, which was understood and applied by all staff.
  • Some of the medicines this service prescribed were 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 not recommended by the National Institute for Health and Care Excellence (NICE) or the British Menopause Society. NICE Guidance NG23 states that clinicians must explain this risk to women. The provider confirmed the risk of prescribing bioidentical hormones was explained to patients and they were asked to sign their consent to proceed. The prescriptions were emailed directly to the specialist issuing pharmacy, which then arranged delivery to the patient. The prescribing of bioidentical hormones was included in the provider’s medicine prescribing policy.

Track record on safety and incidents

The service had a good safety record.

  • There were risk assessments in relation to safety issues. These included risks associated with the premises, fire and equipment.
  • The provider had routine maintenance contracts with equipment suppliers. In some cases, the contractors had delayed their servicing visits due to the COVID-19 pandemic and travel restrictions, but the provider monitored this and had made arrangements to book these as soon as possible.
  • The service monitored and reviewed activity which had reduced considerably during the COVID-19 pandemic. The providers understood the various risks associated with the pandemic and communicated these clearly to patients and staff. There had been no recorded incidents since the last inspection.

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. There had been no incidents in the past year, but we saw the standard meeting agenda prompted the provider to raise and discuss incidents should they occur, for reflection and learning.
  • 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
  • The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional and agency staff.

Effective

Good

Updated 21 July 2021

We rated effective as Good because:

At the previous inspection we found the clinic was providing effective care in accordance with the relevant regulations.

We inspected Effective again during this inspection, in line with our methodology for re-inspecting services with an overall rating of Requires Improvement.

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. This included their clinical needs and their mental and physical wellbeing. The clinic had developed their own screening process to assess the patients who might have body dysmorphia; a mental health condition where a person worries about their appearance. Records showed clinicians assessed patients’ medical history, previous procedures and side effects and expectations in detail.
  • Clinicians had enough information to make or confirm a diagnosis or to recommend alternative treatments or no treatment. As part of the assessment process the clinicians determined a patient’s views on treatments and ensured they understood the various treatment risks, options and benefits.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • Staff assessed and managed patients’ pain where appropriate. For example, the clinic used radiofrequency micro-needling equipment, where the patient could control the application of chilled air to reduce pain. The clinic used topical anaesthetics for some treatments and advised patients to take pain relief in advance of their treatment, where this would be of benefit.
  • The clinicians ensured they kept up to date with developments within the aesthetic cosmetic sector and related evidence-based practices. This was through membership of the British College of Aesthetic Medicine and the British Medical Association, as well as ongoing professional development.

Monitoring care and treatment

The service was involved in quality improvement activity.

  • The service used information about care and treatment to make improvements. For example, the clinic completed annual audits for the British College of Aesthetic Medicine (BCAM) and compared performances and complication rates across different clinics. The results for the Botulinum toxin treatment from 20 patients showed there had been no complications. Further audits were planned as the clinic resumed normal services. An audit of lesion removal procedures showed no infections.
  • The clinical staff also presented audit activity as part of their appraisal and revalidation activities.

Effective staffing

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

  • All staff were appropriately skilled and qualified. The provider had an induction programme for all newly appointed staff. We saw that staff files were maintained showing staff induction and training records. At the last inspection, we found staff completed training but this was not routinely logged. During this inspection we found the provider had arrangements for logging and monitoring when training was completed.
  • Practitioners completed and logged training on the use of the different types of specialist equipment.
  • Relevant professionals were registered with the General Medical Council (GMC) and were up to date with revalidation.
  • The provider supported staff to gain skills and complete training. Staff had protected time to complete training and this included on-line as well as face to face training. Up-to-date records of skills, qualifications and training were maintained. Staff told us they were encouraged and given opportunities to develop and were always supported to achieve competency and confidence before applying new skills. They said they were encouraged to develop their training within the clinic.

Coordinating patient care and information sharing

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

  • Patients received person-centred care. Before providing treatment, doctors at the service ensured they had adequate knowledge of the patient’s health, their medicines, family history and any previous history of cosmetic procedures. The doctors provided examples of when they had advised patients against treatment, for example due to their medical history.
  • The doctors advised patients to seek medical treatment from their GP where this was clinically appropriate, for example in relation to concerns identified when assessing lesion removal.
  • The provider had risk assessed the treatments they offered and patient feedback showed they participated in assessments and were fully informed of the risks and benefits of different treatments.
  • There were clear and effective arrangements for following up on people who had been referred to other services.

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. This included advice on protection against sun damage to the skin as well as clear after-care advice following treatments.
  • Risk factors were identified and highlighted to patients.
  • 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. The electronic record system was set up to prompt informed consent for each treatment.
  • Staff supported patients to make decisions. Patient feedback showed clinicians explained procedures carefully and gave time for questions. Patients commented on having comprehensive consultations about any treatment and receiving professional person-centred advice. Where appropriate, staff advised against treatments requested by patients, and gave clear reasons and explanations for this opinion.

Caring

Good

Updated 21 July 2021

Responsive

Good

Updated 21 July 2021

Well-led

Good

Updated 21 July 2021