We carried out an announced comprehensive inspection at Brighton Skin Surgery on 8 December 2017. We found that the service was providing safe, effective, caring and responsive services. However, we found that the service did not always provide well-led services and a breach of regulation was identified. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Brighton Skin Surgery on our website at www.cqc.org.uk

Specifically, we said they must:

• Ensure systems and processes are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

After the previous inspection on 8 December 2017, the provider wrote to us to say what they would do to meet legal requirements. We undertook this focused inspection on 20 March 2018 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

Our key findings for this inspection were as follows:

• There were processes in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.
• Medicines were stored safely.
• Systems were in place to deal with medical emergencies and the provider had appropriate emergency medicines in place.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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.

Brighton Skin Surgery provides a minor surgery service for dermatology. Procedures offered include skin tag, cyst, mole, wart and cherry or blood spot removal. The service is based in a local NHS GP surgery on the outskirts of the city of Brighton and Hove.

Dr. Avni Patel 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.

We carried out an announced comprehensive inspection at Brighton Skin Surgery on 8 December 2017 to ask the service the following key questions; are services safe, effective, caring, responsive and well-led.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not always providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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.

Brighton Skin Surgery provides a minor surgery service in dermatology. Procedures offered include skin tag, cyst, mole, wart and cherry or blood spot removal. The service is based in a local NHS GP surgery on the outskirts of the city of Brighton and Hove.

Dr. Avni Patel 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.

Nine people provided feedback about the service via comment cards all of which were positive about the standard of care they received. The service was described as excellent, professional, helpful and caring.

Our key findings were:

• The clinic was supported by services provided by a GP practice on the same site including practice policies, protocols and non-clinical governance.
• The approach to safety of systems for reporting and recording incidents was in place. However, these systems were not always adhered to.
• Information about services and how to complain was available and easy to understand.
• The surgery room was well organised and equipped, with good light and ventilation.
• The provider assessed patients according to appropriate guidance and standards.
• Staff maintained the necessary skills and competence to support the needs of patients. Staff were up to date with current guidelines.
• Risks to patients were well managed. For example, there were effective systems in place to reduce the risk and spread of infection.
• Medicines were not always stored safely.
• Systems were in place to deal with medical emergencies, staff were trained in basic life support and the provider had appropriate emergency medicines in place. However these medicines were not checked in accordance with the provider’s policy and some had expired.
• Staff were kind, caring and put patients at their ease.
• Patients were provided with information about their health and with advice and guidance to support them to live healthier lives.
• The provider had a clear vision to provide a high quality service that put caring and patient safety at its heart.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

We identified regulations that were not being met and the provider must:

• Ensure systems and processes are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity.

You can see full details of the regulations not being met at the end of this report.

People were complimentary about the care and treatment they had received. The provider gave people enough information in order for them to make decisions about their treatment. The provider follows a robust consent procedure with patients signing written consent forms before commencing treatment.

People told us that they were extremely happy with their treatment and the professionalism of the provider. People had their individual needs assessed before commencing treatment and were given detailed information, including risks and benefits. We found that the general atmosphere of the surgery was warm and welcoming.

We looked around the premises and saw that it was safe, accessible, comfortable and clean. The treatment room was well equipped and maintained people's dignity and privacy. There were contingency plans in place for emergency situations.

The provider had the appropriate qualifications, skills and knowledge to undertake her role, supported by on-going professional development. Testimonials of people who had used the service commented on the provider's expertise such as, "The doctor provided an excellent service and was careful and competent".

The provider had effective systems in place to monitor the quality of service provision through audits and feedback. The provider had an awareness of how to deal with incidents, risks and complaints. People using the service felt confident to discuss any concerns with the provider.

During our inspection we spoke with the provider and a member of staff at the surgery. We also spoke with people who used the service and reviewed records, policies and cleaning schedules.

People were happy with the care that they received and told us, “I felt reassured all through my treatment. I would recommend the service”. We saw testimonials of people who had used the service where people had made comments such as, “I was delighted with my treatment” and “It was a quick and friendly service”.

People were given leaflets with information about their conditions and what the surgery provided. The provider also had a website with contact details and information about the prices for different procedures.

We looked at the room that was used for the surgery. We saw that it was clean and had adequate washing facilities. There were arrangements in place to ensure that the room was kept clean and free from infection.