We undertook a desk top focused review of National Slimming and Cosmetic Centre (Salisbury) on 09 March 2018. This review was carried out to check that improvements to meet legal requirements planned by the service after our comprehensive inspection on 26 January 2016 had been made. We reviewed the service against three of the five questions we ask about services: is the service safe, responsive and well-led? This is because the service was not previously meeting some legal requirements.

Our findings were:

Are services safe?

We found that this service was providing safe care 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 providing well-led care in accordance with the relevant regulations

Background

We carried out an announced comprehensive inspection of this service on 26 January 2016. Breaches of legal requirements were found. After the comprehensive inspection, the service wrote to us to say what they would do to meet legal requirements in relation to safeguarding service users from abuse and improper treatment, and good governance

We undertook this focused review 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. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for National Slimming and Cosmetic Clinics (Salisbury) on our website at www.cqc.org.uk

The National Slimming and Cosmetic Clinics (Salisbury) provides weight loss treatment and services, including medicines and dietary advice to people accessing the service. The clinic is on the first floor of a shared building in a city centre location. The clinic is open for half a day on Tuesdays and Fridays.

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 weight reduction. At the National Slimming and Cosmetic Clinics (Salisbury) 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 weight reduction but not the aesthetic cosmetic services.

Our key findings were:

• Changes have been made at the service to meet its legal requirements in relation to safeguarding service users from abuse and improper treatment, and good governance

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

• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available
• Review the ordering process for controlled drugs in line with changes in legislation

We carried out an announced comprehensive inspection on 26 January 2016 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 providing well-led care in accordance with the relevant regulations.

Background

The National Slimming and Cosmetic Centres (Salisbury) provides weight loss treatment and services, including medicines and dietary advice to people accessing the service. The clinic is on the first floor of a shared building in a city centre location. The clinic is open for half a day on Tuesdays and Fridays.

The clinic is run by doctors and a clinic manager who is also 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 received feedback about the clinic from three completed Care Quality Commission comment cards. The observations made on the comment cards were all positive and reflected that people found staff to be helpful, respectful and caring. On the day of the inspection we spoke with one person that used the service.

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 weight reduction. At the National Slimming and Cosmetic Centre (Salisbury) 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 weight reduction but not the aesthetic cosmetic services.

Our key findings were:

We found the service to have good governance arrangements and quality assurance processes in place.

• Feedback from patients was consistently positive about the care they received.
• The provider did not have clearly defined and embedded systems, procedures and processes to keep people protected and safeguarded from abuse.
• The provider did not always supply medicines in line with evidence based practice.
• There were appropriately qualified staff in the clinic and staff felt supported to carry out their roles and responsibilities.

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

• Have robust systems and processes in place to prevent abuse of service users.
• Make sure there are effective arrangements in place to manage any medical emergency and that staff are trained to carry out the process.

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:

• Ensure all staff have an understanding of the duty of candour and how it would be applied in the service if things went wrong.
• Review the policies and procedures to ensure they are up-to-date, reflect current practice and legislation, and encourage continuous improvement.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
• Review the ordering process for controlled drugs in line with changes in legislation.
• Ensure that medicines are supplied in accordance with recognised clinical guidance and best practice.
• Assess how they will make their services accessible to non-English speaking and disabled people to ensure that they are not disadvantaged compared with English speaking and non-disabled people.
• Have a process to manage the risk of Legionella infection in the water supply.
• Have a robust system in place for regular and appropriate inspection, calibration, maintenance and replacement of equipment.

People received an organised, well managed service. Staff were friendly, approachable and accommodating.

Staff felt well supported and could readily discuss issues with the provider at any time.

Systems such as staff appraisal were in place.

Staff felt they were kept up to date with current practice and received sufficient training to perform their role effectively.

People told us they were very happy with the service they received at the slimming clinic. They said they were well supported and fully informed about all aspects of their treatment. People told us they saw the same doctor which assured consistency. They said they discussed the importance of a healthy lifestyle, as well as information about their prescribed medicines. People told us their weight was monitored at each consultation and their blood pressure was taken. They said the doctor had asked them for written consent before any medication was prescribed. They had also consented to the information being shared with their GP.

Records about people’s treatment were clear, accurate and securely stored. They showed that people were being treated appropriately in line with up to date medical guidance. However, there was no clear documented delegation of responsibility within the clinic’s procedures for the safe management of controlled drugs. The medicines were also not being disposed of in a safe way, as detailed within current guidance.