We carried out an announced comprehensive inspection on 1 February 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 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.

Medizen Limited is a clinic that provides non-surgical aesthetic treatments that are minimally invasive to help people with general complexion problems, excessive sweating or hair problems and migraines.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of treatment of migraines and excessive sweating. At Medizen Limited the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for migraines and excessive sweating but not the aesthetic cosmetic services.

One of the directors of Medizen Limited 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.

24 people provided feedback about the service. All feedback was positive. People commented they felt welcomed and respected, and they felt staff were friendly and caring. Eight of these people commented they had been attending the clinic for over five years and were happy with the outcome. This feedback was provided by all people attending the clinic, not only those attending for treatment for migraines or excessive sweating.

Our key findings were:

• Not all policies or processes were available such as chaperoning, safeguarding, or checking patient identification.
• Policies that were available were not well embedded such as risk management or had not all been reviewed and updated regularly.
• Not all staff had received relevant training for example safeguarding adults and children or chaperone training.
• The clinic did not routinely share information with the patients GP.
• The staff did not routinely check with patients if they had any difficulties with accessing the service for example mobility difficulties or if they required an interpreter.
• There was effective management of infection prevention and control.
• Staff had received appropriate training and told us what they would do in the event of an emergency.
• Patient records were stored securely.
• There was appropriate management of medicines.
• The clinic was open with staff about performance, complaints and incidents.
• The clinic collected feedback from patients in various ways.
• All feedback we received from patients was positive about the clinic.
• Patients received appropriate pre-treatment and aftercare advice.
• Staff told us they felt respected, supported and valued. They were proud to work in the clinic.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure patients are protected from abuse and improper treatment.

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:

• Review their process for identifying if people have any communication or mobility difficulties.
• Review their process for sharing information with patients’ GPs where appropriate.

During our visit we spoke with the clinic manager and two staff. We looked at the records of five people who had received a service. After our visit we telephoned ten people and were able to speak with four people who told us they were happy with the service provided.

People told us they were given information about the treatments they were considering including the benefits and any associated risk. One person told us, "They are informative. You get both written and verbal information."

Records showed that consent for treatment was taken at each treatment session. Treatment plans were comprehensive and showed the treatments given. All the people spoken with told us they were given choices about treatments, told about any possible risks and received follow up calls to ensure they were happy with the treatment.

People were prevented from the risks of cross infections because there were systems in place to prevent them. Everyone we spoke with told us the clinic was always clean.

Staff were supported to gain and develop skills and knowledge so that people were provided with a safe service.

There were systems in place to monitor the quality of the service. Complaints and comments from people were used to assess if they were happy with the service. One person told us, "They are a fantastic place, make you feel very welcome."

During our visit we spoke with two doctors, two nurses, the clinic manager and looked at records. After our visit we spoke with four people who had received treatments at the clinic. We did this over the telephone.

People told us they were given information about the treatments they were considering including the benefits and any associated risk. Information was given verbally and in writing so that they could make an informed decision about whether to have the treatment or not. Once people had made the decision to go ahead with their treatment written consent was obtained to ensure people understood the information given to them.

Treatment plans were comprehensive and showed the treatments given. Photographic evidence was kept of the outcome meaning that people could see the results of the treatments they had received. There were follow up appointments to ensure that no complications had developed.

There were systems in place to ensure that people were kept safe from harm. These included recruitment processes, infection control process and maintenance of equipment.

The management of medicines had not ensured that medicines were locked away and used within expiry dates.

There were systems in place to monitor the quality of the service. Complaints and comments from people were used to assess if they were happy with the service. Comments made by people included: "extremely happy with the service" and "always been delighted with the level of care".