We undertook comprehensive inspections of The Hospital Group - Liverpool Clinic

on 22 November 2017 and 2 February 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At this time, we found that effective, caring, responsive and well led services were provided however, safe care was not being delivered in accordance with relevant regulations.

The full comprehensive report following the inspection on 22 November 2017 and 2 February 2018 can be found by selecting the ‘all reports’ link for The Hospital Group - Liverpool Clinic on our website at www.cqc.org.uk.

We carried out an announced focused inspection of The Hospital Group - Liverpool Clinic on 14 February 2019 to confirm that the clinic had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection. Our key findings were as follows:

• Action had been taken from the previous inspection with some improvements shown on the follow up for this inspection.

• Safeguarding policies and procedures were up to date to ensure patients were protected from abuse and improper treatment. Since the last inspection staff had completed updated adult and children’s safeguarding training. However, we were unable to verify the level of children’s safeguarding and if this was appropriate for the clinicians working at the clinic.

We also looked at action taken in response to the recommendations we had made to the provider following the last inspection visit. We found:

• Patient information about how to make a complaint had been reviewed. This information was now added to the clinic website. We were assured that if a patient asked to make a formal complaint they would be directed to the clinic website or to the terms and conditions in their initial health assessment contract.

• Plans were in place to implement clinical supervision for clinic nurses. Information was provided following the inspection to show that systems were being developed.

• The systems and processes in place to ensure good governance required further improvements. Monitoring arrangements had been reviewed and we saw evidence that the provider Medical Advisory Committee had oversight of all quality improvement activities. However, there was no evidence of clinical audit activity and further work was required to demonstrate a robust quality assurance process was in place.

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

• Ensure patients are protected from abuse and improper treatment.

In addition, the provider should:

• Review the service quality improvement activities to ensure care and services are measured against evidence base standards. Ideally, a clinical audit is a continuous cycle should be put into place that is continuously measured with improvements made after each cycle.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 22 November 2017. At this time there was insufficient evidence to show that all key lines of enquiries had been met and were unable to gather all of the evidence we needed without the support of a CQC Specialist Advisor. A second CQC inspection was carried out on the 2 February 2018 with a Specialist Advisor 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 the 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

We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service.

The Hospital Group - Liverpool Clinic is part of a corporate organisation named Combine OpCo Limited trading as The Hospital Group. The service provides a number of treatments including cosmetic surgery, pre and post-operative consultations, wound care management and gastric band adjustment. Adults aged 18 years and over only are treated here. The service is open Monday to Friday 9am to 8pm and on Saturday and Sunday they are open from 10am to 6pm. Patients have access to an on call nurse for emergencies at all times.

The clinic is registered with CQC to provide the following regulated activities:

• Treatment of disease, disorder or injury

The provider 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 46 comment cards which were all positive about the standard of care received. Patients said the clinic was always clean, they found it easy to get an appointment and they felt staff were respectful and treated them with dignity.

The clinic 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.

We made patient comment cards available at the clinic prior to our inspection visit. All of the 46 comment cards we received were positive and complimentary about the caring nature of the service provided by the clinic. We spoke with one patient during the inspection and there feedback aligned with the patient views expressed in the comments cards.

Our key findings were:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The clinic had some systems to minimise risks to patient safety.

• There were policies and procedures in place for safeguarding patients from the risk of abuse. Staff demonstrated they understood their responsibilities however, the provider did not ensure that all staff had the minimum safeguarding training requirements for children and adults.

• Staff were aware of current evidence based guidance. Staff were trained to provide them with the skills and knowledge to deliver effective care and treatment. However, clinical supervision for nurses was not taking place.

• The service took part in quality improvement activity such as monitoring infection rates however, clinical audits activities were not completed.

• Patients reported they were treated with care, compassion, dignity and respect and were involved in their care and decisions about their treatment.

• The provider offered consultations to anyone who requested this and did not discriminate against any client group. During our inspection we observed that members of staff were courteous and very helpful to patients and treated them with dignity and respect.

• Systems were in place to monitor complaints however, patient information required improving.

• There was a leadership structure and staff felt supported by management.

• The service proactively sought feedback via patient surveys from patients, which it acted on. However, communications with staff required improvements.

• Staff worked well together as a team.

• The provider was aware of the requirements of the duty of candour.

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

• Ensure persons employed in the provision of the regulated activity receive the appropriate, training and supervision necessary to enable them to carry out the duties.

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 the information available to support patients to raise concerns or complaints.
• Review the arrangements for clinical supervision for nurses.
• Review the monitoring activities undertaken at the clinic to ensure up to date information about clinical audits is used and understood by staff. This information should be monitored and checked under the organisational governance framework at such meetings as the Medical Advisory Committee.