We carried out an announced comprehensive inspection on 26 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. The impact of our concerns is minor for patients 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.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. The impact of our concerns is minor for patients 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.

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. The impact of our concerns is minor for patients 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 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.

The service was previously inspected by CQC on 13 February 2014 and found to be meeting the regulations that were inspected.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment for minor surgical procedures including circumcision to NHS and private (fee paying) patients.

The service had a registered manager since April 2012. 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 received 87 Care Quality Commission comment cards, of which 84 were positive. Feedback from people using the service included that the service was very good, staff had explained everything really well, staff were professional and caring.

During the inspection, we spoke with parents of children using the service. Parents commented positively about the service and expressed no concerns. They felt they had received sufficient information before and after the procedure.

Our key findings were:

• The clinic had policies and processes to keep patients safe. However, there were examples where policies and processes were not well embedded, for example the safeguarding, infection, prevention and control and significant event policy.
• The clinic checked patient’s and parent’s identification (where appropriate) before the procedure. However, the clinic did not record the legal status of children or ask if the child was on a safeguarding risk register.
• Staff told us they always gained consent from the child’s mother, and would try to get consent from the father, but they did not contact the father in every case, only if they suspected the father may not agree.
• The clinic audited post-operative complications. However, the process was not effective and did not give an accurate picture of post-operative complications.
• The provider did not give us evidence to show they obtained sufficient medical information prior to the procedure to avoid unnecessary cancellations.
• The clinic collected feedback from people using the service on the day of the procedure, from the data provided we saw all people that responded were satisfied with the service. The provider did not routinely contact people to obtain feedback about experience of aftercare or postoperative complications.
• Service users were sent an information pack before the procedure that informed them about the consent process, the procedure itself, the cancellation policy and the restraint policy (if applicable). Staff also gave patients appropriate aftercare advice.
• The lead clinician was experienced in circumcision and continued to access clinical support and supervision as needed.
• Data we viewed showed the clinic was mostly meeting its own targets for treatment times.
• The clinic had a clear leadership structure and staff were aware of their own roles and responsibilities.

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

• Ensure that care and treatment of patients is only provided with the consent of the relevant person.
• 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:

• Review and improve safeguarding processes to ensure they are service specific and that staff are following them as intended.
• Review and improve processes for collecting pre-operative information.
• Review processes for obtaining feedback from patients in relation to aftercare services, to allow them to continue to make improvements to the service.
• Review processes for recording verbal complaints, to give management oversight of all complaints.
• Consider communication processes to explain to patients that if the procedure was cancelled for medical reasons the impact on fees and deposit.
• Review their provision of written information to support patients whose first language is not English.
• Consider processes for appropriate liaison with the patients GP before the procedure to share any relevant information such as safeguarding concerns.

Procedures were offered to people of all ages at the service, including children. The procedures included minor surgical operations including circumcisions.

During our visit we spoke with the operations manager, the governance manager and the registered manager who was also a doctor. We spoke with an additional doctor who treated patients and a health care assistant.

Following our visit we spoke with four people whose children had recently received treatment at the service to seek their views about the service provided. People told us they were happy with the service they received. One person told us, ”Everything was just fine." Another person said, "The doctor was very professional and informative."

We examined four patient records. We saw a health assessment and medical history had been taken for each patient before treatment commenced. This meant the doctor was alerted to any medical conditions that may affect a patient's treatment.

People we spoke with told us they had been provided with full information about the procedures their relatives had before they attended the surgery for treatment. One person told us, "I received the paperwork via email before the visit so I was able to read everything beforehand. The doctor explained everything during our consultation."

The provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

At the time of our inspection, there were no people being treated so we were unable to speak with people using the service. Following our visit, we spoke with four people on the telephone who had received treatment at the clinic to seek their views about the service provided.they told us that all treatment was discussed with them at each stage of their treatment.

Vitality Medical Spa is part of Vitality Partnership. We spoke with the operational manager and governance manager who represented Medical Spa in the absence of the provider and staff.

People we spoke with told us they were provided with full information about the procedures they were having before they attended the clinic so consent to treatment was planned. One person told us, “I had the information before I came as I was referred by my GP’’.

At the time of our inspection, there were no people being treated so we were unable to speak with people using the service. Following our visit, we spoke with four people on the telephone who had received treatment at the clinic before our visit to seek their views about the service provided.

Vitality Medical Spa is part of Vitality Partnership. We spoke with the operational manager and governance manager who represented Medical Spa in the absence of the provider and staff.

People we spoke with told us they were provided with full information about the procedures they were having before they attended the clinic so consent to treatment was planned. One person told us, “I had the information before I came as I was referred by my GP’’.

Systems were in place to ensure that people’s treatment was planned. This meant that people were protected from receiving inappropriate treatments.

The provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

We found that the provider took steps to assess and monitor the quality of the service provided and the information was used to improve the service if required.