We carried out an announced comprehensive inspection on 14 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 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 requirements and regulations associated with the Health and Social Care Act 2008. CQC previously inspected this service on 2 July 2018 where breaches of legal requirements were found. After this inspection, the service wrote to us to say what they would do to meet legal requirements in relation to a breach of regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC carried out a comprehensive inspection on 12 September 2018 to check that they had followed their plan and to confirm that they now met legal requirements. Further breaches of legal requirements were found and we took further enforcement action to protect the safety and welfare of people using this service. We undertook this inspection on 14 January 2019 to determine whether the provider was now meeting their legal requirements. You can read the report from our previous inspections by selecting the 'all reports' link for Skinny Revolution Ltd on our website at www.cqc.org.uk.

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 Skinny Revolution 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.

On the day of our inspection there was no registered manager in post. This is a requirement of their registration with the Care Quality Commission. 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.

Our key findings were:

• The service now had clear systems to keep people safe and safeguarded from abuse.
• There was a prescribing policy in place which was being adhered to.
• Since our last inspection the provider had put a process in place to ensure electrical equipment and fire fighting equipment was tested for safety. Medical equipment was renewed to ensure it remained fit for use.
• There was an audit process in place to monitor the quality of the medical records and ensure prescribing was in line with the providers policy.
• Staff displayed understanding and a non-judgemental attitude when talking to patients who had concerns about their weight.
• Where video consultations were taking place there was an effective process to verify the identity of the patient.

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

• Review the need to routinely share prescribing information with the patient’s registered GP in line with GMC guidance

• Review future training and development needs for clinical staff and identify appropriate opportunities
• Review how they will provide access for patients whose first language is not English or who may need support for visual or hearing difficulties.
• Review the arrangements for monitoring the service to ensure all staff are involved in quality improvement processes
• Review the process for obtaining feedback on the service from patients and using this to adapt the service offered

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 12 September 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. There were no formal arrangements in place to receive and act upon patient safety alerts. There was no process in place to ensure electrical equipment was checked for safety. Medical equipment had not been calibrated and firefighting equipment had not been serviced in accordance with manufacturer recommendations. There was no prescribing policy in place and medicines were prescribed against manufacturer’s recommendations

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. There was no system in place to monitor the safety or effectiveness of the treatments provided. There was no record of mandatory training and no training records at all for the doctor. Written consent was obtained from each patient before treatment was commenced. The provider did not encourage patients to consent to sharing information about their treatment with their registered GP.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations. Staff displayed understanding and a non-judgemental attitude when talking about patients who had a diagnosis of obesity. The provider had ensured that consultations were conducted in private rooms and could not be overheard.

Are services responsive?

We found that this service was not providing responsive care in accordance with the relevant regulations. The provider had not carried out an analysis of patient needs when planning and delivering services. There was no information displayed on the premises or on the provider’s website about the steps people could take if they were not satisfied. Staff had not followed the complaints policy and procedure.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations. Staff were not always given the opportunity to contribute when changes were made to the service. There was no system in place to ensure staff had read and understood operational policies and staff were not always sure of their roles and responsibilities. There was no programme or system of clinical or internal audit to monitor the quality and safety of the service provided.

Background

We carried out an unannounced focused inspection of this service on 2 July 2018 where breaches of legal requirements were found. After the focused inspection, the service wrote to us to say what they would do to meet legal requirements in relation to a breach of regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this announced comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Skinny Revolution Ltd on our website at www.cqc.org.uk.

Following this inspection, we found further significant failings in patient care and treatment that will or may expose any person to the risk of harm, and further enforcement action was taken to protect the safety and welfare of people using this service.

Skinny Revolution Ltd is a private clinic which provides medical treatment for weight loss, and has been registered with CQC since May 2018. The clinic is open from 10:00am until 6:00pm Monday to Friday, and Saturdays from 10:00am until 4:00pm. The premises comprise of a reception and waiting area, a consulting room and an office area upstairs. There is a doctor and two nurses who carry out patient consultations. On the day of our inspection there was no registered manager in post. The provider told us they were in the process of applying to change 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.

In addition to the main clinic, the provider also delivered their services from a number of satellite locations where they rented a clinic room on an occasional basis. Where a medical professional carries on a regulated activity and travels to a variety of places to provide the care or treatment to people, the service provider can select the address from where they manage their service as the registered location. For this inspection, we visited the main clinic where the provider managed the service from.

Our key findings were:

• The premises were clean and tidy, and facilities were appropriate for the service being provided
• Staff displayed understanding and a non-judgemental attitude when talking about patients who had a diagnosis of obesity
• Employment records were not complete for all staff working at the clinic
• There was no prescribing policy in place and medicines were prescribed against manufacturer’s recommendations
• There was no process in place to ensure electrical equipment was checked for safety, medical equipment had not been calibrated and firefighting equipment had not been serviced in accordance with manufacturer recommendations
• There was no system in place to monitor the safety or effectiveness of the treatments provided
• The provider had not carried out an analysis of patient needs when planning and delivering services

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

• Ensure care and treatment is provided in a safe way for service users
• Ensure systems and processes are established to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users

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

Review the measures in place to support patients with hearing or visual impairment, or those who do not speak English, to understand their diagnosis and treatment.

We carried out an unannounced focused inspection of Skinny Revolution Ltd on 2 July 2018 because of concerning information we had received about the safe management of medicines at the service. Therefore, this report only covers our findings in relation to those concerns.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Background

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.

Skinny Revolution Ltd offer medical treatment for weight loss. Patients are seen by a doctor who carries out an initial consultation to determine if medical treatment is suitable. This includes the patient’s medical history, details of any medicines they are taking, dietary and exercise information, and a basic examination.

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 Skinny Revolution Ltd, 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:

• The practices for managing medicines were unsafe and staff did not follow national guidance and best practice recommendations when handling medicines
• There were a lack of policies and procedures available on-site to guide staff on the safe management of medicines
• Staff recruitment records were unavailable or incomplete
• Patient medical records were not available on-site for clinicians to access

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

• Ensure that care and treatment is provided in a safe way for service users
• Ensure that fit and proper persons are employed

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