We carried out an announced comprehensive follow up inspection at Staianoplasticsurgery on 15 October 2018. This was to follow up on progress made by the practice since our previous inspection on 15 February 2018. We also asked 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.

The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right.

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 not providing well-led care in accordance with the relevant regulations. The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right.

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.

CQC inspected the service on 15 February 2018 and identified the following regulatory breaches in relation to the Health and Social Care Act (Regulated Activities) regulation 2014: Regulation 17 good governance; Regulation 19 persons employed for the purposes of carrying on a regulated activity must be fit and proper persons; Regulation 18 staffing and Regulation 12 safe care and treatment. We asked the provider to make improvements. We checked these areas as part of this comprehensive follow up inspection and found the provider had made improvements but identified some areas where further improvements were still needed.

The service provided at the clinic were pre-surgery and post-operative consultations for patients considering and undergoing plastic surgery. The principal consultant specialised in breast and body contouring procedures. Post operative dressings and some minor procedures (under a local anaesthetic) were also carried out on site. Procedures requiring a general anaesthetic were carried out at various local private hospitals.

The principal consultant 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.

We received feedback from 26 patients, 10 through CQC comment cards and 16 via the CQC website. Of the responses 23 were very positive about the care and treatment received and one was mixed in their views.

Our key findings were:

• The provider had made progress to address the concerns identified during our previous inspection however, we identified areas where these still needed to be strengthened.
• We found safeguarding arrangements had been improved to fully incorporate child safeguarding.
• Recruitment checks were comprehensive for most staff but this was not consistently the case.
• The practice had taken action to improve systems and processes for the management of the premises and equipment. The premises appeared clean and well-maintained however, infection control audits introduced were not comprehensive.
• Patient information was well documented, routinely audited and supported the delivery of safe care and treatment.
• Incidents, complaints and safety alerts were used to support improvement and the safety of the service.
• The provider had identified core training requirements and appraisals for all staff were now in place. However, those with lead or key roles were not always up to date with their training.
• The provider actively sought patient feedback and used this to deliver improvements. Feedback was very positive.
• Risks were mostly being managed but action taken to mitigate risks in some areas was not always implemented effectively.

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

• Ensure effective systems and processes are established to ensure good governance in accordance with the fundamental standards of care.
• Ensure appropriate recruitment checks are in place for all staff employed.

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:

• Review systems for checking age and identity to ensure the information is accurately recorded.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 15 February 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.

The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right.

Are services effective?

We found areas where the service was not providing effective care in accordance with the relevant regulations.

The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right

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 not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report).

The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right.

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.

Our key findings were:

• The systems to keep patients safe and safeguarded from abuse needed improving. We identified several areas including arrangements for child safeguarding, recruitment and ongoing staff checks, legionella, equipment, unforeseen medical emergencies and management of safety alerts that were not sufficiently well established.
• We found the premises appeared well maintained and visibly clean and tidy however, audits undertaken in relation to infection control were not sufficiently detailed to fully identify potential risks.
• Patient information was well documented and routinely audited to support the delivery of safe care and treatment.
• The provider had arrangements for the safe management of medicines.
• Incidents were used to support learning.
• The provider had established a good network within the private healthcare sector for advice and support if needed. We saw that the principal Consultant had undertaken training to update knowledge and also carried out training for others. However, the provider had not clearly identified core training needs of clinic staff and evidence of regular staff appraisals for all staff were limited.
• We found the provider had not adequately assessed the risks for the removal of lesions in the absence of routinely sending samples for histology.
• The provider monitored outcomes for patients in terms of satisfaction with the outcome of their surgery. Feedback was positive. Patient feedback through CQC comment cards and the provider’s own surveys also showed patients were happy with the service received and that they felt involved in decisions about their care.
• There was limited evidence of clinical improvement activity such as clinical audit undertaken.
• The provider had effective systems for obtaining consent and patient information was well documented.
• Services were provided that were responsive to the needs of the population served. This included timely and flexible services.
• There was a complaints process in place and complaints seen were appropriately managed, although information about how to complain was not clearly displayed to patients.
• There was clear leadership to support the running of the service. Staff felt supported and worked well as a team. However, governance arrangements did not adequately identify and address all areas of risk.
• Following our inspection the provider sent an update of actions they were taking to address the issues identified during the inspection.

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

• Ensure effective systems and processes are established to ensure good governance in accordance with the fundamental standards of care.
• Ensure appropriate recruitment checks are in place for all staff employed and where relevant registration with professional bodies are routinely monitored.
• Ensure appropriate provision to ensure staff receive appropriate support, training, supervision and appraisals for the duties they are employed to perform.
• Ensure care and treatment is provided in a safe way to patients.

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:

• Review safeguarding arrangements to ensure these are adequate to safeguard children who may come into contact with the service.