During our visit we spoke with the registered manager, four members of staff and one of the ophthalmic consultants. We spoke with three people using the clinic and also spoke with five people on the telephone after our visit.

People told us they were satisfied with their care and treatment. People told us that they were given sufficient information to enable them to make informed choices about their treatment before giving consent to it. They also told us that the staff were attentive and that they had been kept comfortable following surgery.

Appropriate checks were undertaken before staff commenced work at the clinic. This ensured people were cared for by suitably qualified and experienced staff.

We found there were good arrangements for infection control at the practice. These included the use of protective equipment and procedures for keeping the premises and the instruments clean.

There were systems in place for recording and responding to complaints. Patients were provided with information so that they could feed back their views and opinions.

During our visit we spoke with the acting manager, two dental nurses, a theatre nurse and a dental consultant. We spoke with three people using the clinic and also spoke with three people on the telephone after our visit to the clinic. People told us they were satisfied with their care and treatment. One person told us, ‘'I have confidence in them and they came up to my expectations.’’

People told us they were given information about the treatments they were considering including the benefits and any associated risk. Information was given verbally and in writing so that they could make an informed decision about whether to have the treatment or not. Once people had made the decision to go ahead with their treatment written consent was obtained to ensure people understood the information given to them. Treatment plans were comprehensive and showed the treatments given.

The service was unable to evidence that they had followed robust recruitment procedures before staff started working with people.

There were systems in place to monitor the quality of the service. Complaints and comments from people were used to assess if they were happy with the service.

The Westbourne Centre (the Centre) is operated by The Westbourne Centre, Birmingham Limited. It is a joint venture between Ramsay Healthcare UK (40%) and the Cosmetic Surgery Partnership (CSP- 60%). CSP consists of four consultants who also operate at the Centre.  The service provides day case surgery, outpatients and dental diagnostic imaging, which we inspected.We inspected this service using our comprehensive inspection methodology.

We carried out the announced part of the inspection on 18th November 2016 along with an unannounced visit to the Centre on 24 November 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.

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

We rated this service as good overall because:

• There were systems and processes in place to promote practices that protected patients from the risk of harm. Openness and transparency about safety was encouraged and staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• There was an open culture where staff felt encouraged to report incidents and lessons learned shared across the Centre.
• The service had a consistent track record for safety.
• There were policies and procedures in place to assess and respond to patient risk and staff understood their responsibilities to do so.
• The environment was visibly clean and well maintained and there were measures to prevent the spread of infection. We observed all staff adhering to hand hygiene practices.
• There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patient’s needs. There were arrangements to ensure staff had and maintained the skills required to do their jobs.
• Staff were proud of the service they provided including day-surgery care provision under local anaesthetic meaning patients did not stay overnight.
• There were arrangements to ensure people received adequate food and drink that met their needs and preferences.
• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.
• Patients could access care when they needed it. Waiting times, delays and cancellations were minimal and appropriately managed.
• Staff treated patients with compassion and their privacy and dignity was maintained.Feedback from patients was consistently positive with few complaints made to the service.
• Improvements were made to the quality of the service as a result of complaints or concerns. Consent was gained and recorded in line with relevant national guidance.
• There was a stable leadership team who were highly regarded by staff. Staff felt supported, valued and proud to work at the Centre.
• The senior leadership were responsive to issues identified at the time of the inspection and took immediate remedial action where possible.

We found areas of practice that require improvement in both surgery and in outpatients and dental diagnostic imaging services.

In surgery:

• Staff did not adhere to the safe storage and administration of medicines policies and the processes failed to store medications safely.
• Staff did not consistently check resuscitation equipment in line with local policies and procedures.
• Psychological and mental wellbeing was not consistently recorded in cosmetic patient care pathways as recommended by national guidance.
• Some mandatory training modules fell below the target including mental capacity training for all clinical staff.
• Completion of documentation including vital observations on the National Early Warning Score was inconsistent.
• The Centre-wide risk register did not identify all clinical risks. Some governance processes required strengthening such as serious incident investigation documentation and meeting records.

In outpatients and dental diagnostic imaging:

• There was no clear strategy for the outpatient department despite the high-level of activity within this department.
• There were no specific policies written for dentistry, although this represented 52% of the centre’s service at the time.
• Adults safeguarding level 2 training for outpatients staff was low at 50%.
• Five mandatory training modules for dental staff were below the Centre’s target of 85%.
• Management of medical emergencies was not robust for dental staff including some standard items of medication missing from the medical emergency kit in dentistry.
• There was no Radiographic Protection Folder, received from the Radiographic Protection Authority in place, with proper local rules clearly outlining dosages and identifying the clinicians operating them.
• Audit data was lacking within outpatients and dentistry.
• There was no information available in dentistry or outpatient’s signposting patients to additional emotional support services if they needed them.

We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

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 two requirement notices that affected surgery and outpatients and dental diagnostics. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals