We carried out an announced comprehensive inspection on 23 November 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 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.

The Hospital Group Exeter Clinic is based on the outskirts of Exeter City Centre. There are good public transport links within the area and two railway stations located within short walking distance of the clinic. Car parking is available nearby.

The Hospital Group operates from 16 different clinics across England which are used for initial consultations between patients and surgeons as well as post-operative care. The location at Exeter provides consultation for cosmetic and weight loss surgical procedures, pre-operative assessment and post-operative care. The clinic is open and responsive to patient demand between the hours of Monday to Friday 8am to 8pm and Saturday and Sunday 10am to 5pm.

Consultation for cosmetic and weight loss surgical procedures are carried out at the Exeter clinic. Therefore we were only able to inspect the consultation service and not the Surgical procedure services.

This service is registered with Care Quality Commission (CQC) under the Health and Social Care Act 2008 to provide diagnostic and screening procedures, surgical procedures and for the treatment of disease, disorder or injury.

CQC inspected the Hospital Group, Exeter Clinic in 2013 and asked the provider to make improvements regarding assessing and monitoring the quality of the service. The provider sent us an action plan, which we monitored and followed up. The reports for this period are archived on our website. We re-checked these areas as part of this comprehensive inspection and found governance and risk management systems were in place, with clear lines of accountability from clinic manager to governance and risk committee.

The patient co-ordinator is the registered manager for Exeter Clinic. A registered manager is a person who is registered with the CQC 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.

During the inspection we received written and verbal feedback from 20 patients about the Hospital Group Exeter Clinic. Patients described staff as being accommodating, kind, reassuring and informative.

Our key findings were:

• Staff had the information they needed to deliver safe care and treatment to patients.
• Exeter Clinic had a good safety record.
• There was a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of surgical procedures, post-operative care and support and the outcomes for patients.

• Patient consent to care and treatment was obtained and in line with legislation and guidance.
• Staff treated patients with kindness, respect and compassion.
• Patients were respected and their privacy and dignity was maintained.
• The provider took complaints, concerns and comments seriously and responded to them appropriately to improve the quality of care.
• Structures, processes and systems to support good governance and management were clearly set out, understood and effective. Directors of the company all had specific accountable lead roles as well as the overarching management of the business and service.

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

• Review the patient assessment process to include carrying out identification checks of every patient.

• Review the company complaints procedure to clarify CQC’s role in reviewing information received.

• Review guidance about prescribing antibiotics to include a risk assessment tool so that staff are provided with guidance about red flag symptoms and actions to take if a patient has suspected early sepsis.

• Review communication needs of the population using the service and consider how information in the waiting room, website and booklets could be made more accessible in different formats and languages.