We carried out an announced comprehensive inspection on 16 January 2019 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.

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 provides a specialist dermatology service to fee-paying patients.

As part of our inspection, we asked for Care Quality Commission comment cards to be completed by patients prior to our inspection. We received 13 CQC comment cards that were mostly positive about the service. The cards told us that patients found the service friendly and welcoming and the clinicians knowledgeable and caring. The negative comments were regarding communication about appointment bookings.

Our key findings were:

• There was no oversight of the risks associated with the service. For example, there had been no risk assessment completed for the premises, health and safety, fire, security, legionella or emergency medicines.
• All staff had been recently employed and had completed a full induction. However, non-clinical staff had not received safeguarding or basic life support training at the time of inspection.
• A record of staff immunisations was not held.
• The system to manage safety alerts was ineffective and the service could not assure us that all staff received relevant safety alerts.

• An infection control audit had not been completed to identify or address concerns, however the service was less than a year old and was visibly clean and tidy.
• Clinical records were detailed and held securely. The service did not keep paper records on site.
• Staff members were knowledgeable and had the experience and skills required to carry out their roles.
• There was evidence of meetings with all staff from the building, including other providers, and effective communication with staff.
• Staff told us they enjoyed working at the service.
• The provider had systems to record and learn from complaints and significant events however, none had occurred at the time of inspection.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Commence and maintain a programme of clinical and infection control audit.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice