In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. This will be updated.

We spoke with two people who used the service and looked at 29 feedback questionnaires that had been completed in June 2013. People were given sufficient information and knew what to expect. One person had stated "it was all explained during the consultation and anything I'd forgotten was explained again" and another had said "I felt very cared for". Most people were satisfied with the care they had received. The people we spoke with told us that they felt comfortable raising a concern. We saw that the provider acknowledged, investigated and responded to complaints.

Care and treatment was planned and delivered in a way to ensure a person's safety and welfare. Equipment was appropriately maintained and single-use items were used where possible. There were arrangements in place for reusable instruments to be sterilised off site. Before any treatment was undertaken people were assessed by a consultant to ensure the procedure would be safe. Pre and post-operative checks were carried out and there were arrangements in place to deal with emergencies. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with people who use the service and looked at the clinic’s feedback questionnaires that had been completed between January and August 2012. Overall, people were pleased with the care and treatment received. One person told us that they were satisfied and that their expectations had been met. Another person described their experience as "excellent". We saw that people were asked to sign a consent form before their procedure. People who use the service felt that the consultant had explained the procedure very well. Medical histories were taken for each person and there were procedures in place to deal with emergencies.

People were cared for in a clean environment by staff that had received the necessary training and appraisal. Staff we spoke with confirmed that they were appraised annually by their manager. They told us that they felt well supported and confirmed that they had regular training. The clinic had systems in place to ensure that people were protected from the risk of infection. We saw cleaning schedules, looked at infection control audits that had been carried out and spoke to the Infection Control Lead. People who use the service described the cleanliness of the clinic as "excellent".

There were systems in place to monitor the quality of the service being provided. We saw that audits had been undertaken and action plans put in place. There was evidence that learning from incidents took place and that these were discussed at staff meetings.

People who use the service understood the care and treatment options open to them. People we spoke with said that their choice of clinic had been based on the treatment they were considering and the individual consultant who provided the treatment. The internet and The Cadogan Clinic website had been used as a research tool for some people. People spoken with said their consultant had given them sufficient information and discussed various options with them. One person said that the information on fee’s had not been clear on a previous visit and there had been an unexpected cost.

People we spoke with said they were happy with the treatment and procedures they had received at The Cadogan Clinic. One person said that they were prepared adequately for discharge and had an after care pack and the mobile telephone number of their consultant should they have any concerns. Out of the three people spoken with one person said that they received ‘paperwork’ on their treatment plan and another did not recall a treatment plan.

Some of the comments made about the clinic were “very good practice” and “experienced consultant, with good information given”.

People we spoke with commented that they were satisfied with the care given by staff.

The Cadogan Clinic is operated by Personal Health Service Ltd. The service provides medical outpatient appointments and day surgery, predominantly for cosmetic procedures. It also provides mole and skin cancer treatments. Facilities include four operating theatres, outpatient and diagnostic facilities.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 1 December 2016, along with an unannounced visit to the hospital on 8 December 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

The clinics main services are cosmetic surgery. We regulate cosmetic surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• The number of theatre and post-recovery care staff was lower than national recommendations although the risk register stated that these were being followed.
• Compliance with the World Health Organisation (WHO) safety checklist and the ‘5 steps to safer surgery’ was low, and although improvement in compliance with the WHO checklist was being made, main elements, such as the face to face briefing of all staff and a debriefing, were still not occurring.

• There were unclear processes for responding to the ‘crash bell’ which could mean that no one would be available to respond.
• A number of policies, although updated in the last year, did not reflect up to date national guidance. This included consent guidance for under 16s which was not correct.
• There were very limited competency records held for staff members.
• Safeguarding training had not been completed for some staff as is a requirement in healthcare settings.
• There were inconsistencies between what the MAC chair and senior managers told us and what we observed staff doing.

However, we found the following areas of good practice:

• All clinic staff we observed treated patients with respect and dignity throughout all interactions at the clinic. Feedback from patients was overwhelmingly positive about the caring nature of the staff looking after them.

• The clinic was responsive to feedback and complaints raised by patients and had made improvements to their services as a result.
• The clinic followed best practice guidelines and was determined to set realistic expectations for patient’s outcomes after surgery. This resulted in a low number of complaints about the procedure.
• Clear information was provided to patients about the cost of their treatment or procedure.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals