We carried out an announced comprehensive inspection on 21 March 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 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.

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 clinic was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of laser treatments for hair removal, thread veins and pigmented lesions. Laser treatment is also used for the removal of warts, verruca and tattoo removal (which is out of scope for registration with CQC). Aesthetic cosmetic treatments are also provided at Outline Skincare Limited which are exempt by law from CQC regulation. We were only able to inspect services provided in relation to laser treatments and not the aesthetic cosmetic services.

One of the directors of Outline Skincare 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.

The registered manager is a registered Nurse Prescriber and underwent revalidation in September 2017 by the Nursing and Midwifery Council, following an appraisal by the British Association of Cosmetic Nurses.

Care Quality Commission (CQC) comment cards were completed by 15 patients. All patients commented that they felt welcomed, respected and that staff were friendly and caring. This feedback was provided by all patients attending the clinic, not only those attending for laser treatment. Three patients commented they had been attending the clinic for over three years and were happy with the outcome of their treatment.

Our key findings were:

• There were systems and processes to minimise risks to patient safety. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with the team and outcomes had been actioned.
• There was a system for recording, actioning and tracking patient safety alerts. Alerts had been reviewed and action taken where appropriate. All alerts were reviewed by clinical staff.
• All appropriate recruitment checks had been carried out on staff prior to being employed by the clinic.
• The clinic was well equipped to treat patients and meet their needs. This included appropriate arrangements for equipment and medicines that may be required to respond to a medical emergency.
• Staff had received appropriate training and told us what they would do in the event of an emergency.
• There was appropriate management of medicines.
• Infection prevention and control was effectively managed.
• Patient records were stored securely. Patients received appropriate pre-treatment and aftercare advice.
• Information about services and how to complain was available to patients. The clinic made improvements to the quality of care as a result of learning from complaints and concerns.
• Policies and procedures were available and these had been kept under review and updated regularly. For example, risk management, safeguarding adults and children and checking patient identification.
• There was a clinic development plan that documented both long and short-term priorities for the service. There was visible clinical and managerial leadership with audit arrangements in place to monitor quality.
• Staff told us they felt well supported and positive about working at the clinic. They enjoyed their jobs and were proud to work in the clinic.
• Feedback from patients about their care was consistently positive.

This service is rated as Good overall.

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 Outline Skincare Ltd on 16 April 2019 as part of our current inspection programme. The clinic had been inspected on 21 March 2018 under our previous methodology and no rating had been applied.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of laser treatments for hair removal, thread veins and pigmented lesions. Laser treatment is also used for the removal of warts, verruca and tattoo removal but these are out of scope for registration with CQC. Aesthetic cosmetic treatments are also provided at Outline Skincare Limited which are exempt by law from CQC regulation. We were only able to inspect services provided in relation to laser treatments and not the aesthetic cosmetic services.

One of the directors of Outline Skincare 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.

The registered manager is a registered Nurse Prescriber and underwent revalidation in September 2017 by the Nursing and Midwifery Council, following an appraisal by the British Association of Cosmetic Nurses.

Our key findings were:

We found that:

• The clinic provided care in a way that kept patients safe and protected them from avoidable harm.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks of health and safety.
• The clinic reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and best practice.
• Patients’ needs were assessed and care delivered in line with current guidelines. Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Staff treated patients with kindness and respect and involved them in decisions about their care.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. The clinic had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the clinic learned from them and improved their processes.
• There were clear responsibilities, roles and systems of accountability to support effective governance.
• Policies and procedures had been kept under regular review and updated in most instances. Establishing a review timeframe that was consistent for all policies would be beneficial. This would ensure that review periods did not expire or that they were missed.
• The way the clinic was led and managed promoted the delivery of high-quality, person-centred care.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There was a clinic development plan that documented both long and short-term priorities for the service. There was visible clinical and managerial leadership with audit arrangements in place to monitor quality.
• Staff told us they felt well supported and positive about working at the clinic. They enjoyed their jobs and were proud to work in the clinic.
• Feedback from patients about their care was consistently positive.

The area where the provider should make improvements is:

• Establish a review timeframe that is consistent for all policies to ensure that review periods do not expire or are not missed.

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