Dr Alexandra Chambers Medical and Aesthetics Practice is a small independent hospital offering cosmetic surgery services to privately funded adult patients. The service has been registered with the commission since 2011.

The hospital was previously inspected by the Care Quality Commission (CQC) in April 2013. When the report was published in May 2013 we had concluded the location had met all of the standards inspected. On this occasion we inspected the hospital on 6 October 2016 as part of our independent hospital inspection programme. The inspection was conducted using CQC’s comprehensive inspection methodology and was a routine planned inspection. The inspection focussed on the regulated activities of surgical procedures and diagnostic and screening. Procedures not currently subject to regulation were not part of the inspection.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The services provided by this hospital were cosmetic surgery and treatments.

We have not published a rating for this service. CQC does not currently have a legal duty to award ratings for those hospitals that provide solely or mainly cosmetic surgery services.

Our key findings were as follows:

• There were adequate systems to keep people safe and to learn from adverse events or incidents.

• The environment was visibly clean and well maintained and there were measures to prevent and control the spread of infection.

• There were adequate numbers of suitably qualified, skilled and experienced staff to meet patients’ needs, and staff had access to training and development, which ensured they were competent to do their jobs.

• There were arrangements to ensure patients had access to suitable refreshments, including drinks.

• Treatment and care was delivered in line with national guidance and the outcomes for patients were good.

• Patient consent for treatment and care met legal requirements and national guidance.

• Patients could access care in a timely way, and had choices regarding their treatment day.

• Staff ensured patients privacy and the dignity of patients was upheld.

• The leadership team were visible and appropriate governance arrangements meant the service continually reviewed the quality of services provided.

However, there were also areas of where the provider needs to make improvements. The provider should:

• Make arrangements to store clinical equipment more appropriately.
• Check staff comply with the hospital policy and the infection prevention and control (IPC) requirement regarding the wearing of jewellery and nail polish.
• Consider attaching secure tags to checked resuscitation trolleys
• Consider further training for staff around drug cabinet security and checking for out of date medication.
• Consider how to improve staff knowledge of mental capacity, dementia awareness and deprivation of liberty safeguards.
• Consider introducing a formal hospital risk register.

Professor Sir Mike Richards

Chief Inspector of Hospitals

It was not possible to speak to people who used the service as no one attended an appointment during our inspection. However, we looked at feedback forms that had been completed in the three months preceding our inspection. People were positive about the care and treatment they had received. One person said that the procedure had been fully explained and they knew what to expect. Another person described the aftercare as "first class". People were given information on how to make a complaint and we saw that complaints were investigated and responded to.

Care was planned in a way to ensure a people's safety. People were assessed to determine whether the treatment requested would be suitable for them. People were provided with post-operative advice and had at least four follow-up appointments following their surgery. Written consent had been obtained by the surgeon on the day of the person's procedure. People were given written information on the risks associated with the procedure prior to their consent being obtained, but the consent forms also outlined the risks.

There was emergency equipment and procedures in place to deal with a medical emergency. People were cared for in a clean and hygienic environment and there were systems in place to reduce the risk of infection. There were daily cleaning checklists in place and the provider had appointed an external consultancy to undertake annual infection control audits.

People we spoke with were positive about their experience at the clinic. They felt that they were given sufficient information to make an informed decision about their treatment options and did not feel pressurised to proceed. They found staff to be helpful and polite.