When we carried out an announced comprehensive inspection of Snowberry Lane Clinic on 5 December 2017 we identified one area where the provider was not providing safe care in accordance with the relevant regulations.

We said they must:

• Ensure care and treatment is provided in a safe way to patients. For example, with regard to appropriate equipment and medicines for use in an emergency.

We also advised the service they should:

• Put guidance in place to help staff decide which phone calls to their out-of-hours phone number should be escalated to medical staff.

• Revise their complaints policy to ensure patients are given information on how to escalate a complaint if they are not satisfied with the service response.

Following our inspection the provider sent us an action plan setting out the action they would take to meet the relevant regulation.

This inspection was an announced focused inspection carried out on 21 March 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 December 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found that the service was meeting the regulation they had previously breached and was providing safe care in accordance with the relevant regulations.

Our key findings were as follows:

• The practice now had oxygen available for use in emergency and had developed protocols and systems to ensure it was kept safe and fit for use

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• The service had developed a protocol giving guidance to staff who answered the out-of-hours phone on when a doctor should be contacted.

• The practice had revised their complaints policy to include information on how to escalate a complaint.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 5 December 2017 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

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.

Snowberry Lane Clinic is a private clinic offering medical and cosmetic procedures and weight loss programmes to adults and children over 12 years of age. Not all procedures are available to patients between the ages of 12 and 18. The service is based in Melksham in Wiltshire. The clinic’s facilities include five treatment rooms, a minor operations room and a range of specialist equipment used in the delivery of their services, such as lasers. There was a waiting area, patient toilets and an automatic front door that facilitated easy access. The clinic is open six days a week. Opening times are: 9am to 7.30pm, Monday to Thursday; 9am to 4pm on Friday; and 8.30am to 1.30pm on Saturday. There are three part-time GPs, a part-time ophthalmologist, three nurses, two health care assistants, four therapists, a practice manager and deputy practice manager, four receptionist administrators and a domestic assistant.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service, such as botox treatments,and these are set out in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice manager 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received 30 comment cards which were all highly positive about the service overall and about the standard of care received from GPs and Nurses.

Our key findings were:

• The clinic had checked that the GPs and nurses working at the clinic were appropriately registered and revalidated in line with their professional requirements.
• The clinic had a range of systems, processes and practices in place to minimise risks to patient safety.
• We saw evidence the clinic was following NICE guidelines where appropriate, such as their guidelines for treating skin lesions.
• The consultation and treatment rooms were well equipped, clean and comfortable.
• We saw evidence that the clinic had a consistent focus on service improvements.

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

• Ensure care and treatment is provided in a safe way to patients. For example, with regard to appropriate equipment and medicines for use in an emergency.

The areas where the provider should make improvements are:

• Put guidance in place to help staff decide what which phone calls to their out-of-hours phone number should be escalated to medical staff.
• Revise their complaints policy to ensure patients are given information on how to escalate a complaint if they are not satisfied with the practice response.