This service is rated as Good overall. (Previous inspection July 2018- rated as not meeting the requirements for safe, effective and well-led).

At the last inspection in July 2018, we found there were breaches of regulations 12 (safe care and treatment) and 17 (good governance). CQC inspected the service in July 2018 and asked the provider to make improvements regarding safe care and treatment and good governance. We checked these areas as part of this comprehensive inspection and found the issues identified had been resolved.

The key questions are rated as:

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 comprehensive inspection at Health Counts on 30 April 2019. This inspection was to follow up on the breaches of regulation identified at the last inspection, and to rate the service.

Health Counts is a medical skin laser and aesthetic clinic. They offer laser hair, thread vein and tattoo removal, dermal fillers, acne treatments and Botulinum Toxin (Botox) treatments for cosmetic purposes and for migraine pain, Bell’s Palsy (temporary facial paralysis) and Hyperhidrosis (excessive sweating).

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some general exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment of clients suffering with migraines or Bell’s Palsy with the use of Botulinum Toxin and for the treatment of Hyperhidrosis. The treatment of clients with Botulinum Toxin was undertaken solely by a registered nurse prescriber, which included the prescribing of medicines. At Health Counts the aesthetic cosmetic treatments, including the use of laser treatments, that are also provided, are exempt by law from CQC regulation and were therefore not inspected.

The service is registered with the CQC under the Health and Social Care Act 2008 to provide the following regulated activities:

• Surgical procedures
• Treatment of disease, disorder or injury.

The Managing Director 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.

As part of our inspection we asked for CQC comment cards to be completed by clients prior to our inspection visit. We received 37 comment cards, 36 of which were wholly positive about the service and one was negative. The cards reflected the kind and caring nature of staff, how informative staff were, the pleasant environment and the positive effects of the treatment received. Other forms of feedback, including patient surveys and social media feedback was consistently positive.

Our key findings were:

• We saw there was leadership within the service and the team worked together in a cohesive, supported, and open manner.
• There was an effective system in place for reporting and recording significant events.
• Information about services and how to complain was available and easy to understand.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• Risks to patients were assessed and monitored.
• The service held a range of policies and procedures which were in place to govern activity; staff were able to access these policies easily and staff had signed each one.
• To ensure and monitor the quality of the service and their record keeping, the service undertook regular audits of patient records.
• Staff assessed patients’ needs and delivered care in line with current evidence-based guidance.
• Staff had the skills, knowledge, and experience to deliver effective care and treatment.
• All patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• The service proactively sought feedback from staff and patients, which it acted on. Regular surveys were undertaken, and reports collated from the findings and action taken where required.

The areas where the provider should make improvements are:

• Embed the system for the monitoring of fridge temperatures to ensure this is consistently managed.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection on 19 July 2018 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not 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 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.

Health Counts is a medical skin laser and aesthetic clinic. They offer laser hair, thread vein and tattoo removal, dermal fillers, acne treatments and Botulinum Toxin (Botox) treatments for cosmetic purposes and for migraine pain, Bell’s Palsy (temporary facial paralysis) and Hyperhidrosis (excessive sweating).

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment of clients suffering with migraines or Bell’s Palsy with the use of Botulinum Toxin and for the treatment of Hyperhidrosis. The treatment of clients with Botulinum Toxin was undertaken solely by a registered nurse prescriber, which included the prescribing of medicines. At Health Counts the aesthetic cosmetic treatments, including the use of laser treatments, that are also provided, are exempt by law from CQC regulation and were therefore not inspected.

The service is registered with the CQC under the Health and Social Care Act 2008 to provide the following regulated activities:

• Surgical procedures
• Treatment of disease, disorder or injury.

The Managing Director 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.

As part of our inspection we asked for CQC comment cards to be completed by clients prior to our inspection visit. We received 26 comment cards from clients who provided feedback about all aspects of the service. They were all very positive about the standard of care received. Comments included that the service provided brilliant aftercare and that the staff were professional, kind and caring. One card had mixed comments and included an issue with a payment plan.

Our key findings were:

• There was an effective system in place for reporting and recording significant events and these were monitored to completion. There was a process for sharing the learning within the service, when appropriate.
• Information about the service and how to complain was available and easy to understand. There was an effective system for responding to and learning from complaints.
• The service had systems in place for the receiving of and acting on, safety alerts regarding the monitoring of medicines or devices.
• Systems were in place to ensure that all client information was stored and kept confidential. We saw all paper client records were securely held within a locked cupboard.
• The service carried out fire drills and fire equipment checks were up to date; however, they did not have a current fire risk assessment available to us on the day of inspection or formal fire awareness training. Following the inspection, we were provided with a fire risk assessment.
• Staff acted as chaperones, however the service did not have a policy or procedure for this role and had not offered training to staff undertaking this role. Staff members who acted as chaperones were not checked under the Disclosure and Barring Service (DBS) and a risk assessment had not been completed to determine why DBS checks were not 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). Following the inspection, the Provider took some action in relation to this finding and applied for all relevant DBS checks.
• The service did not carry out appropriate recruitment checks on newly appointed staff, including, references, eligibility to work within the UK, DBS checks where relevant, and photographic identification. Following the inspection, the Provider took some action in relation to this finding and implemented a recruitment policy, an annual staff declaration form, updated staff files and applied for the relevant DBS checks.
• The service did not have a clear policy or procedure for the safeguarding of children. The service provided safeguarding training for staff in November 2017, however new staff had started after this date and had not completed any safeguarding training. There was no record of safeguarding training for the nurse prescriber. Checks were not carried out on adults accompanying children to confirm identity prior to providing consent to treatment. Following our inspection, the nurse prescriber undertook safeguarding training.
• The service had not conducted the appropriate risk assessments for the necessity of an automatic external defibrillator (AED) and oxygen available for use in medical emergencies and emergency medicines were limited to a measured dose of adrenaline to treat an anaphylactic reaction and Hyalase (helps break down dermal fillers where necessary). Staff had not undertaken basic life support training. We were informed the Provider took some action in relation to this finding following our inspection. We saw evidence that the provider had requested first aid at work training for a number of staff within the service for a future date.
• The service did not document any clinical audits or non-clinical audits to monitor quality as part of an improvement programme, there were no audits in relation to the efficacy of treatments, for example; prescribing audits or infection prevention and control audits.
• The Legionella risk assessment required review to include how and when water temperatures were checked and recorded, and what the level of risk was for the water cooled equipment. We were informed the Provider took some action in relation to this finding following our inspection. The provider amended the risk assessment to include the relevant information and implemented monthly testing.
• The service completed a temperature check list weekly for one fridge out of two in use for the storage of medicines. A separate freezer held stocks of Botulinum Toxin (Botox), and there were no documented checks. The appliances were domestic and not specific for medicines storage, did not have locks on and were in a room accessible by the public and therefore were not secure. We were informed the Provider took some action in relation to this finding following our inspection. Daily temperature checks were implemented for all fridges and the freezer, with actions to take if the temperatures fell outside of range and the appliances were moved into a secure room.
• The service did not have an awareness or adequate training for infection prevention and control (IPC) and had not completed any audits. We were informed the Provider took some action in relation to this finding following our inspection. We saw evidence that the nurse prescriber undertook infection prevention and control training and the provider had requested additional advice from an appropriate source regarding training for staff on IPC.

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

• Ensure care and treatment is provided in a safe way to clients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

There were areas where the provider could make improvements and should:

• Improve checks on adults accompanying children to confirm identity prior to providing consent to treatment.
• Embed the new process for medicines kept in cold storage within the service.
• Embed the new recruitment processes and procedures within the service.
• Ensure all members of staff have received fire awareness training.

The impact of our concerns is minor for clients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right. We have told the provider to take action (see full details of this action in the Requirement Notices 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 followed a robust consent procedure with people signing written consent forms before commencing treatment and reviewing their treatment and consent after each treatment session.

People had their individual needs assessed before commencing treatment and were given detailed information, including risks and side-effects.

The provider had procedures in place to ensure that the clinic was clean and hygienic.

People who used the service understood the care and treatment choices available to them. Throughout the service, in the treatment rooms and waiting areas there were information leaflets relating to different types of treatments offered. Peoples’ needs were assessed, care and treatment was planned and delivered in line with their individual care plan.

We looked at satisfaction survey documentation that showed that the service encouraged feedback. We saw that ‘satisfaction surveys’ were undertaken following each procedure and feedback about the service provided was positive.

The manager told us that there were sufficient staff to meet the needs of the people who used the service. The manager told us that the service was open four days a week and sufficient staff were on duty each day to cover laser treatment days, consultation sessions, treatment sessions and follow-up sessions.

There were insufficient policies and practices in place for the management of identified risks of abuse and a quality assurance process to ensure a good quality of service was given.