We spoke with four people who used the service. The people we spoke with were positive about the treatment they had received from the clinic. One person told us, “Staff are always helpful, supportive and reassuring. The doctor was realistic in their expectations of what I could expect.” Another told us, “I was informed of the risks and the side effects to treatments.”

We observed two consultations and looked at three people’s medical records. Patient records we viewed showed that patients gave written consent to treatment before commencement. We also saw that consent was reviewed when patients returned for treatment after an extended period of time. Consultation forms showed us that people were informed of any risks associated with their treatments and these were signed by patients.

We saw records of monthly clinical audits and records of clinical staff meetings. This showed us that the service was monitoring their clinical practice.

There was evidence that the quality of the services provided for patients at the clinic were being continuously monitored. People were encouraged to give feedback and their views were captured in a variety of ways including verbally during consultations, internet surveys and post treatment feedback forms.

Zenith Cosmetic Clinics Limited operates Zenith Cosmetic Clinic and a satellite clinic in London. The clinic provides cosmetic surgery and other cosmetic treatments to people over the age of 18 years.

The clinic does not have in-patient beds, patients are treated on a day surgery basis. Facilities include one operating theatre, a two bedded recovery room for the recovery of patients who undergo general anaesthesia and one treatment room for minor surgical procedures such as mole removal. There are several other treatment rooms within the clinic where a variety of cosmetic treatments are performed.

We inspected the clinic using our comprehensive inspection methodology. We carried out an announced inspection on 10 and 11 October 2016.

Zenith Cosmetic Clinics Limited is registered to provide services in slimming clinics but we did not inspect this regulated activity during this inspection.

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 service 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

We do not currently have a legal duty to rate cosmetic surgery services or the regulated activities they provide but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• The provider had a system in place for the identification and management of incidents.

• The clinic was visibly clean and had processes in place to reduce the risk of infection.

• Staff and patient records were accurate, complete, legible, up to date and stored securely.

• Staff had attended statutory and mandatory training.

• Patients had a full assessment prior to surgery.

• There were adequate numbers of nursing and medical staff to care for patients.

• Policies, procedures and practice incorporated evidenced based care and treatment.

• Pain management was effective.

• Patients had access to food and drinks.

• Staff displayed competencies to carry out their duties, worked well together as a team and had access to the information they needed.

• Consent processes were effective and patients received enough information to make an informed decision about their procedures.

• Staff treated patients with care and respect and maintained their dignity at all times.

• The clinic carried out an annual patient survey and patients surveyed reported high levels of satisfaction.

• Patients received adequate information throughout their care.

• Chaperones were available.

• The date of surgery was planned to suit the patient

• Admission and discharge procedures were clear and patients were contacted following surgery, seen one week post-surgery and were given emergency phone numbers.

• The clinic catered for individual patient needs.

• The provider managed complaints effectively.

• The clinic had a clear vision and strategy.

• There was a governance structure and meetings took place.

• The provider identified risks and documented mitigating actions.

• The clinic kept a local register of cosmetic implants.

• There was an effective system in place to ensure that an annual review took place of consultant practicing privileges.

• Leaders were visible and staff told us they had supportive managers.

However, we also found the following issues that the service provider needs to improve:

• The World Health Organisation Safer Surgery checklist was not consistently completed by the appropriate person.

• Systems to monitor deteriorating patients were not used throughout the patient journey.

• Medicines management procedures were not fully implemented including the lack of an antibiotic formulary for antibiotic prescribing. We found some medicines not stored securely

• The provider did not have a Home Office licence for the storage of controlled drugs.

• The theatre doors and the exit door adjacent to the theatre were not secure.

• Clinical governance meetings were not robust.

• Governance processes around policies and procedures were not effective.

• There was no documented evidence of legionella flushing procedures.

• The provider did not audit staff hand hygiene.

• The provider had insufficient hand cleansing gel in the theatre and recovery areas.

• We found open sterile equipment on the resuscitation trolley.

• The scrubbing sink in theatre did not follow Department of Health best practice guidance HBN26.

• Pre-operative assessment did not include a psychological risk assessment.

• The safeguarding policy and staff safeguarding training did not cover female genital mutilation.

• Pre-operative assessments did not include the Association of Anaesthetists of Great Britain and Ireland’s risk assessment.

• The provider had not implemented the Royal College of Surgeons quality patient reported outcome measures.

• The provider did not submit data to the private health information network and national breast and cosmetic implant register.

• Patient documentation did not include a record of a two-week ‘cooling off’ period post consultation.

• Capacity to consent was not documented in the pre-operative assessment documentation.

• Cosmetic surgical procedures were not being coded in line with the systemized nomenclature of medicine clinical term.

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

Ellen Armistead

Deputy Chief Inspector of Hospitals (North of England)