Farjo Hair Institute

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service delivered care that made people feel safe, supported, involved, and listened to. Safety events were reported and thoroughly investigated, with lessons learned to embed good practices. The environment and equipment were clean, tidy, and well-maintained. The service collaborated with people to maintain safe care systems, ensuring continuity of services. The service had a mandatory training assurance framework covering a range of modules that included learning disability and autism. Person-centred risk assessments were proportionate and regularly reviewed, prioritising individual needs and safety. The service provided care that followed best practice and national guidance and had processes in place to identify and manage risk.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice

Staff consistently recognised and reported incidents and near misses, supported by a culture that encouraged raising safety concerns. We saw that incidents were logged via an electronic system, enabling oversight, action tracking, and monitoring through clinical reviews and weekly meetings. The system also helped identify recurring themes and trends.

Leaders conducted thorough investigations and shared lessons learned transparently. One staff member said, “We’re kept informed of everything through daily handovers. The team is small, meaning we can disseminate information easily.” Inspectors saw evidence of case studies on new equipment and safety measures presented at international hair restoration conferences to promote sector-wide learning.

All incidents were reported to the surgery manager and documented electronically. No never events or serious incidents occurred in the 12 months prior to inspection. Nine non-patient safety incidents and 1 staff needle-stick injury were reported; managers investigated appropriately, took corrective action, and shared learning. For example, a contaminated magnifying glass was taken into the surgical area but not used. Preventative actions were implemented immediately, including labelling, dating, and staff signatures.

Managers shared learning via staff information boards, emails, and team meetings. Staff described a no-blame culture and demonstrated clear understanding of the duty of candour, being open and honest when things went wrong.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

We saw the service had clear operational policies guiding booking, admission, and discharge. Patients attended an initial consultation with the operating surgeon to assess needs, preferences, and surgical eligibility. Consent was sought to contact GPs if concerns arose, and records confirmed appropriate GP correspondence. Staff provided examples of when this had occurred.

Patient notes were comprehensive, electronic from consultation stage, password protected and securely stored. All reviewed records showed completed assessments, signed by doctors and verified by a director.

On surgery day, patients had a second consultation to review risks, plans, and consent. Doctors led both consultations and procedures, briefing technicians during theatre handovers. Staff re-confirmed medical history and used the WHO surgical safety checklist. We observed staff completing the checklist during the inspection and found all elements performed effectively.

Policies were in place for managing patient deterioration. All clinical staff had adult resuscitation and basic life support training. Staff monitored patients throughout procedures and they told us they would call 999 for emergency hospital transfer if needed. There had been no instances of emergency hospital transfers in the 12 months prior to the inspection.

Discharge summaries included anticipatory medications and were coordinated with the on-site patient manager. Patients received aftercare guidance and could contact their surgeon directly. One patient reported an infection concern; the surgeon contacted the GP, who arranged a face-to-face review.

Two surgeons were available 24/7 for post-discharge concerns. Staff followed up with patients at 8 and 14 months, typically in person for detailed reviews and photographic comparisons. A mobile technician team ensured continuity of care between London and Manchester sites.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

We found that the service had a comprehensive safeguarding policy with clear guidance for identifying and reporting concerns. All staff completed safeguarding training, with 100% compliance at Level 3 for vulnerable adults. Training included the Mental Capacity Act, deprivation of liberty safeguards (DoLS), modern slavery, and female genital mutilation (FGM), integrated into adult and children’s safeguarding modules.

Staff showed strong understanding of protecting people from harassment and discrimination, including those with protected characteristics under the Equality Act 2010. Although no referrals had been made, staff clearly explained and understood the referral process and identified appropriate contacts.

Managers described how the service promoted inclusion and protected people with protected characteristics. People using the service told us they felt safe and confident raising concerns.

The safeguarding policy included a referral flowchart, making it easy for staff to identify contacts and refer to local authorities if needed. All staff had Enhanced Disclosure and Barring Service (DBS) checks completed at the start of employment.

There had been no safeguarding incidents reported by the service in the 12 months prior to the inspection.

We scored the service as 3. The evidence showed a good standard. The service effectively involved people in managing risks, ensuring risk assessments were person-centred, proportionate, and regularly reviewed. Risks to peoples’ health and well-being, including mobility and skin care, were thoroughly assessed and managed throughout the patient journey. People reported feeling safe and listened to, with their concerns addressed promptly and managed effectively.

Administrative staff conducted initial telephone assessments to support triage, identify risks, needs and preference and arrange face-to-face appointments. Any discrepancies or complex medical conditions were escalated to doctors for review. Staff clearly described exclusion risks. Patients told us they underwent thorough initial assessments, with risks explained before treatment.

Inspectors found comprehensive risk assessments in care plans. Staff completed the five-point surgical checklist and documented surgical instruments used before and after procedures. Operation notes were signed, dated, and timed by 2 staff members. The service also used the British Association of Hair Restoration Surgery (BAHRS) surgical safety checklist to enhance safety.

During inspection, we saw staff attentively monitored vital signs, alertness, and pain, pausing procedures if patients experienced anxiety or discomfort.

Staff received training in sepsis awareness, and we found evidence that this training was current and complete. Staff assessed the risk of Venous Thromboembolism (VTE) and supported patients to mobilise during treatment to reduce this risk. We reviewed the VTE risk assessment and confirmed it was up to date and aligned with National Institute for Health and Care Excellence (NICE) guidelines

Staff had access to senior doctors and ensured a doctor was always available post-surgery. One patient reported receiving prompt out-of-hours support from their surgeon with an immediate advice and reassurance given.

Post-operative reviews assessed outcomes and infection risks. Patients received leaflets on infection prevention and symptom recognition The Emergency Procedures and Equipment Protocol aligned with guidelines set out by the Cosmetic Practice Standards Authority (CPSA), the body responsible for setting practice standards in the non-surgical sector. Staff had access to adrenaline, oxygen, a defibrillator, and first aid kits.

Staff demonstrated strong understanding of patient needs and risks, enabling timely interventions and personalised care planning.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The main reception area was clean, well-maintained, and offered secure access via controlled doors. Closed-circuit television (CCTV) was in operation, and reception staff maintained a clear line of sight. The patient waiting area provided privacy and was equipped with a television and magazines for people awaiting consultations or surgery. Staff had access to suitable changing facilities, which were locked, clean and tidy.

The service operated robust security systems, including key fob access to restricted areas such as theatres and the records archive room. Key fobs were programmable, ensuring only staff with appropriate clearance could access designated areas.

An up-to-date fire safety audit had been completed by a local fire protection service, and we saw evidence that the service complied with fire safety standards. A third-party contractor conducted annual safety tests on electrical equipment, and records confirmed testing was current. Fire safety measures were comprehensive, with signposted and serviced fire extinguishers, clear fire exits and corridors, and a documented fire evacuation plan.

Personal Protective Equipment (PPE) and hand gels were readily available throughout the premises. Staff carried out daily cleaning checks; although complete, dated, and signed cleaning records were not available, we observed housekeeping staff maintaining communal areas, which were clean and well-presented.

We reviewed a selection of consumables, including dressings, syringes, and needles, and found all items were in date. Staff disposed of clinical waste safely and correctly segregated clinical and domestic waste. Waste bins were enclosed and foot-operated, and sharps bins were properly assembled and remained below the fill line. The management and disposal of sharps and waste followed service policy. Inspectors saw that the service maintained records of all waste collections to ensure compliance with relevant legislation.

The service had multiple storage rooms for stock, cleaning equipment, medicines, and sharps bins. All rooms, except toilets, were secured with keypad entry locks. Inspectors found that stock and cleaning equipment were stored appropriately and were in date.

Theatres and treatment rooms were spacious, well-lit, and provided ample workspace for technicians. Theatres contained specialist equipment, and management confirmed that staff equipment was regularly reviewed to support staff wellbeing.

Theatre rooms were equipped with adjustable surgical beds that met recommended standards and were clean and well-maintained. As advised, mirrors and wall clocks were present to help patients track their procedure. Patients could watch their choice of television programmes on large screens during surgery and had access to individual rest rooms adjacent to each theatre.

The service had a business continuity plan in place, which provided staff with guidance on managing key risks that could affect care delivery, such as power outages.

People who used the service told us they had not experienced any issues with equipment. They reported that the premises, equipment, and facilities were safe, well-maintained, and provided a suitable environment for their care and treatment.

The service was not registered to receive patient safety alerts from the Central Alerting System (CAS), which includes important safety information from the Medicines and Healthcare products Regulatory Agency (MHRA). Services are expected to use these alerts to learn from safety incidents and improve practice. The provider explained that they had not registered for CAS alerts because they were confident that all medical staff working within the service received relevant alerts through their membership of professional bodies such as the British Association of Hair Restoration Surgery (BAHRS) and the General Medical Council (GMC).

We were told of a recent alert regarding a post-operative medication with potentially detrimental side effects. In response, medical staff contacted all patients who had received the medication and conducted welfare checks. No adverse effects were reported, and staff were aware of escalation procedures should any adverse reactions occur.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We found staffing allocation considered skill mix, ratios, and procedure complexity. Business continuity plans supported staffing resilience. The service had developed business continuity plans to address potential staff shortages, which managers could refer to when needed.

The service had sufficient staff to keep people safe, with daily requirements calculated by the clinical manager and reviewed in advance. Senior technicians were delegated planning responsibilities to support development.

All doctors were registered with the General Medical Council (GMC), had up-to-date appraisals through the Independent Doctors Federation, and were current with their revalidation. Doctors also had 360 feedback surveys as part of their revalidation. The team had a strong skill mix, including experience in burns surgery, general practice, and cosmetic disciplines.

Recruitment processes included background checks, verification of professional registration, and competency assessments. Clear job descriptions outlined roles and expectations. All eligible staff had completed annual appraisals, and managers addressed poor performance appropriately. Training was managed via an online system and tailored to individual roles, covering mandatory topics and professional interests. We saw evidence of a structured induction process for new staff, which included both corporate and clinical skills training.

All staff completed mandatory training in the past 12 months, including infection control, life support, health and safety, and information governance. Training records were up to date.

Ongoing supervision included reflective practice, care discussions, and personal development. Regular team meetings supported communication and improvement.

Staff sickness and turnover were low calculated at 10% over 12 months, with no vacancies or use of agency staff at the time of inspection.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas of the service were visibly clean, well-maintained, and equipped with appropriate furnishings. Handwashing sinks and sanitising gels were readily available, and staff followed hand hygiene protocols and ‘bare below the elbow’ guidance. Personal protective equipment (PPE) was accessible and used appropriately.

People who used the service told us the premises were clean and tidy, and they had no concerns regarding the cleanliness of the environment or equipment.

Staff followed the infection prevention and control (IPC) policy, completed mandatory training, and demonstrated strong understanding of how to manage IPC risks.

The IPC policy referenced guidance from NICE, the Department of Health, and the NHS, and identified an IPC team comprising a clinical lead and clinic manager.

IPC was continuously monitored through peer observation. Post-operative infections were audited annually. While formal hand hygiene audits weren’t routine, documentary evidence confirmed monitoring, and staff adhered to hygiene principles. Housekeeping staff maintained cleanliness throughout the inspection.

Before surgery, patients’ hair was cleaned with antiseptic wash. Surgical areas had hand wash facilities and easy-to-clean flooring. Most equipment was single-use and disposed of after procedures. Clinical waste was managed by a third-party provider under a service level agreement referencing relevant regulations.

Staff cleaned equipment after use, labelled it with cleaning dates, and used a tagging system to identify clean items. Staff described decontamination procedures, including deep cleaning when needed. Suitable arrangements were in place for the safe handling, storage, and disposal of clinical waste, including sharps.

Patients with known infections were assessed during consultation for admission suitability. No healthcare-acquired infections or outbreaks were reported in the 12 months prior to inspection.

The service operated a bench-top steriliser, with trained staff conducting regular quality checks. Staff complied with relevant Health Technical Memorandums (HTMs), including HTM 01-01 (management and decontamination of surgical equipment in acute care) and HTM 01-05 (decontamination in primary care dental practice). Although the service primarily used single-use items for hair transplant procedures, staff routinely sterilised these items prior to use to minimise infection risk.

Steriliser use was audited, with daily validations and weekly helix tests. We saw evidence of regular maintenance was by an accredited engineer. Autoclave records were complete, signed, and compliant. Any issues were documented and resolved without impact on safety. Autoclave cycles were verified as satisfactory, and audits confirmed that all records were appropriately signed and dated.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

All medications used were standardised and administered daily as part of routine procedures. We saw evidence that medication errors were rare and considered low risk. The service conducted twice-yearly audits led by the accountable officer or senior lead, with independent audits by an external pharmacist every 2–3 years. The pharmacist remained available for consultation and advice.

Patients received clear information about their medicines, and staff ensured understanding through explanation. Standardised drug charts included risk assessments, consent, infusions, and emergency prescribing, aligning with best practice.

Daily stock checks ensured accurate reconciliation. Medicines and prescribing documents were stored securely, and we observed controlled drug procedures were followed. Fridge temperatures were recorded daily, with no anomalies found during inspection.

A comprehensive medicines policy covered prescribed drugs, supplements, and alternative treatments. Staff followed safe prescribing and administration systems. Post-inspection data confirmed that all staff had completed mandatory medicines management training relevant to their roles. People using the service reported no issues with medicine-related support.

We reviewed a recent medication audit, which showed no incidents or adverse events related to medicines used in the service.