8 February 2018 & 1 March 2018
During a routine inspection
Ziering London Clinic is operated by Edgbaston Medical Group Limited. The service has two overnight beds. Facilities include one main theatre, two clinic rooms used for hair transplant operations, consulting rooms, and a two-bedded recovery area and ward. The clinic offers cosmetic surgery such as breast enlargement and hair transplants, as well as non-surgical interventions.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 8 February 2018, along with an unannounced visit to the clinic on 1 March 2018.
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.
Services we do not rate
We regulate cosmetic surgery services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.
We found the following areas of good practice:
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The service managed patient safety incidents well.
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Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
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The service provided mandatory training in key skills to all staff and made sure everyone completed it.
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The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
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The service planned for emergencies and staff understood their roles if one should happen.
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Staff gave patients enough food and drink to meet their needs.
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The clinic was submitting national data to the Private Healthcare Information Network (PHIN).
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The service made sure staff were competent for their roles. Managers appraised staff’s work performance.
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Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
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Staff understood their roles and responsibilities regarding obtaining informed consent.
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Staff cared for patients with compassion.
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Staff involved patients and those close to them in decisions about their care and treatment.
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People could access the service when they needed it.
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The service took account of patients’ individual needs.
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The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
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The clinic had a vision for what it wanted to achieve and workable plans to turn it into action.
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Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
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The clinic had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, we did find that these needed to be updated more regularly.
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The clinic engaged well with patients and staff to plan and manage appropriate services, and collaborated with partner organisations effectively.
However, we also found the following issues that the service provider needs to improve:
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The service did not always take all necessary measures to control infection risk well. We noted some areas were not always fully clean and staff did not always take all appropriate measures to prevent the spread of infection. The sinks throughout the service did not meet current clinical requirements, although these were due to be replaced in the near future.
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There were no locked doors between the reception of the clinic and the operating theatre, which may present a security risk.
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We noted some issues with the storage and audit of medicines. The emergency resuscitation drugs were not organised in a way that allowed for audit, with minor issues found. We found some ambient medications were past their expiry date and some medication left in the unlocked theatre room. Ambient room temperatures where drugs were stored were not monitored. No actions were documented when drug fridge temperatures were out of range. The medication fridge was not locked.
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Patient records were not always fully complete, although these had shown recent improvement.
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We were not always assured that patients were always discharged with an escort in line with the clinic’s local policy.
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Not all policies referenced current clinical best practice guidance.
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The provider acknowledged that they needed to improve and widen existing audit activity in order monitor patient outcomes more effectively.The service was in the process of preparing to collect data in relation to Quality Patient Reported Outcome Measures (Q-PROMS), for example.
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No formal training was provided to staff on the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS).
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Feedback indicated that patients were not always fully satisfied that they could find someone to talk to about their worries or their fears.
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At the time of inspection, the clinic was not a subscriber to the Independent Healthcare Sector Complaints Adjudication Service (ISCAS), but told us that they had made inquiries regarding this.
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Although all practicing privileges documents were found in place, these were not organised in a structured manner, making them difficult to review and for the service to audit effectively.
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. Details can be found at the end of the report.