We spoke with the registered manager and infection control lead during our inspection, and reviewed twenty patient records. We also looked at the cleanliness of the building.

Patient records included details of the batch number and expiry date for any local anaesthetic that was administered. Pre and post-operative observations that were carried out ensured patients were safe to be discharged. Consent to treatment forms were completed and demonstrated that the benefits and risks of the surgery had been explained to patients.

A member of staff had been appointed as the inspection control lead. Cleaning schedules were in place and the building was noticeably cleaner than during our previous inspection.

Systems were in place for the safe ordering and disposal of medication. Medicine keys were stored securely in a key safe, and only clinical staff had access to the code.

Accurate and appropriate records were maintained, and all records were stored securely. Improvements had been made to the standard of record keeping. The policies had been reviewed and updated as required.

We spoke with the registered manager, reviewed documents and looked at the storage of medicines in the clinic.

We found that the arrangements for the handling of medicines were not effective to maintain the health and welfare of the people who used the clinic.

During our visit we spoke with two staff who work at the clinic; the registered manager; a consultant who provided services to patients; and with two patients who used the clinic. We also spoke with an executive director who was visiting on the day of our inspection.

Both of the patients we spoke with told us they were happy with the treatment they received. One patient told us, “The treatment I have received here has made a significant difference and has had a really positive effect on my life.” Another patient told us, “The consultant I have been seeing has been great. They go out of their way to make you feel relaxed and comfortable.”

The staff we spoke with said the clinic was good in terms of ensuring that staff training was up-to-date and that they really enjoyed working at the clinic, some of which had worked there for a number of years.

We spoke with one consultant who was available on the day of our visit who told us that before being accepted by the clinic to provide services they had to meet set criteria which included having their own liability insurance, up-to-date General Medical Council registration and an up-to-date annual professional appraisal undertaken by an independent senior doctor in line with The Royal College of General Practitioners guidance.

The executive director we spoke with told us they meet regularly with clinic directors to oversee the operational management of the clinic.

The Nottingham Road Clinic is operated by Aligie Ltd. It is located in the town of Mansfield in Nottinghamshire. The premises consist of a large Victorian building which has been converted to provide waiting areas, consultation rooms, treatment rooms and a minor operating theatre. The clinic does not have inpatient beds. The clinic provides a range of services including minor surgical procedures, cosmetic surgery, ultrasound scanning, psychological services and some holistic therapies. We inspected surgery and diagnostic imaging including non invasive pre natal blood testing.

We inspected these services using our comprehensive inspection methodology. We carried out the announced inspection on 28 and 29 August 2018.

To get to the heart of patients' experience of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to peoples 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.

The main service provided by this clinic was surgery. Where our findings on surgery - for example, management arrangements - also apply to other services, we do not repeat information but cross-refer to the surgery service level.

Services we rate

We rated  surgery and diagnostic imaging services as good overall.

We found the following areas of good practice:

• Robust systems and processes were in place to keep people safe.

• Compliance with mandatory training was 100% for all staff.

• Staff were aware of their responsibilities around safeguarding children and adults. Chaperones were readily available.

• Procedures were in place to ensure the environment was clean and hygienic and infection prevention and control measures were adhered to in line with recommended guidance.

• There was sufficient and appropriate equipment to carry out safe care and treatment. Equipment was serviced regularly.

• There was robust management of Control of Substances Hazardous to health products and thorough accompanying risk assessments.

• Robust procedures were in place for assessing and responding to patient risk .

• There was close support and supervision of patients who were consciously sedated. 

• Staffing levels were more than adequate with the right number of staff, with the right skills to deliver safe care and treatment.

• Records were managed in accordance with the Data Protection Act 1998 and comprehensive pre and post operative notes were documented in the patients records.

• Medicines were managed in line with the clinics policy and in line with best practice guidance.

• Staff knew how to recognise and report incidents. There had been no serious incidents in the reporting period.

• Quality measures were in place to ensure patients received effective care delivered by competent staff.

• Policy and procedures reflected national best practice guidance and a programme of local audit was in place.

• During surgical procedures pain and comfort levels were checked and pain relief given if necessary.

• Thorough consent processes were in place including explanation of risks and benefits and a two week cooling off period for cosmetic surgery patients.

• Staff treated patients with care and compassion, privacy and dignity were respected, patients and those close to them felt involved in their care.

• We observed delightful interactions between staff and patients and feedback from patients was overwhelmingly positive.

• Services were responsive and flexible to meet the needs of patients and service users.
• Appointment systems were efficient with minimal waiting times for appointments or treatments.
• There were low numbers of complaints. Complaints management was thorough and learning was shared with staff and contributed to service developments.
• There was strong leadership in place, an open and honest culture and effective governance processes.
• Leaders were visible and approachable with a good understanding of the challenges to the service.
• There was a clear vision with patients, staff and quality at the heart of it.
• There was a culture of openness and honesty which we experienced during the inspection.
• Regular patient engagement took place by patient surveys and questionnaires which were analysed and used to improve services.

However we found the following areas for improvement:

• Staff had not attended specific detailed training in the Mental Health Act, dementia, learning disability or child exploitation.
• The safeguarding children policy did not include reference to child exploitation.
• Some clinic areas were carpeted which meant they could not be cleaned effectively and was not in line with HBN 00-09.
• Hand hygiene audits were not carried out on consultants with practising privileges.
• We found two pieces of electrical equipment that did not display a service date.
• Referral criteria were understood by staff but not formally documented.
• The clinic did not operate a 24 hour helpline.
• There was no evidence of a psychological assessment for cosmetic surgery patients.
• Antibiotic protocols were not in place for prophylactic antibiotics used for cosmetic surgery procedures (liposuction)
• There was a lack of patient outcome data.
• There was no formal interpreting service for private patients.
• Staff had not received training in counselling skills or delivering bad news particularly in relation to the ultrasound service and non invasive pre natal testing for Downs Syndrome.

Following this inspection, we told the provider that it should make some improvements even though a regulation had not been breached to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)