Ziering London Clinic (One Health) is operated by Curis Healthcare Limited. Facilities include one main theatre, two clinic rooms used for hair transplant operations, consulting rooms, a two-bedded recovery area and a three-bedded ward with overnight stay facilities.
The service provides cosmetic surgery such as breast enlargement and hair transplants, as well as non-surgical interventions.
The service was inspected three times before, in February and March 2018 and on 12 June 2019. During the June 2019 inspection, we served a warning notice and identified breaches in Regulation 12(Safe Care and Treatment)and Regulation 17(good governance)of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We inspected this service using our focused inspection methodology to re-inspect the safe and well-led domains only to determine if improvements had been made. We looked at processes around mandatory training, infection control, environment, culture and leadership. We carried out the unannounced focused inspection on 30 October 2019.
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 rate
Our rating of this hospital stayed the same. We rated it as Requires Improvement overall. Our rating for safe and well led stayed the same as requires improvement. Our rating for effective, caring and responsive remain unchanged as these domains were not inspected this time.
At the last inspection in June 2019 we identified following actions the provider must take to meet the regulations:
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The provider must have systems to monitor staff compliance with mandatory training.
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The provider must ensure there are effective systems to control infection risk well.
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The provider must ensure there are effective systems to safely record and store medicines, including controlled drugs and emergency medicines on resuscitation trolleys.
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The provider must have effective systems for the maintenance of facilities, premises and equipment to keep people safe.
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The provider must ensure they are auditing their compliance with Association of Anaesthetics of Great Britain and Ireland (AAGBI) and Association for Perioperative Practice (AfPP) guidance for nursing and theatre staffing.
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The provider must ensure leaders have effective governance systems in place.
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The provider must ensure practising privileges are reviewed according to their policy.
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The provider must review the safeguarding policy to reflect the requirements of the Care Act 2014 (Chapter 14) statutory guidance.
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The provider must ensure there are regular and effective staff meetings or forums to support staff.
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The provider must ensure there is an open reporting culture in relation to incidents and shared learning from complaints and incidents.
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The provider must ensure it is meeting requirements under Regulation 20 (Duty of Candour) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At the last inspection in June 2019 we identified following actions the provider should take to make improvements in relation to safe and well-led:
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The provider should embed a culture of using the World Health Organisation (WHO) Surgical Safety Checklist in a meaningful way for all surgical procedures, including hair transplant procedures.
The provider should have effective systems for disposal of medicines.
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The provider should amend the admission policy to reflect what senior staff reported on the day of inspection regarding body mass index (BMI) limits for patients treated at the clinic.
At this inspection, we found following areas the provider still needs to improve:
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Not all premises were visibly clean, and we found dust on high surfaces. The provider did not monitor the standards of cleaning carried out by the external company. However, the service had made improvements to control infection risk since our last inspection and had strengthened their own systems for the maintenance of facilities, premises and equipment within the theatre.
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Although there was now a functioning medical advisory committee (MAC) and the provider had reviewed the practising privileges of all doctors, they still did not follow their own policy and reviewed these outside of the MAC.
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Leaders had re-established governance processes which operated throughout the service. However, we were unable to comment on the effectiveness of this system as it was at an early stage of implementation. We were also concerned the registered manager may not have sufficient allocated time to focus on governance and operational duties.
However, we found provider had made improvements in the following areas:
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Managers regularly reviewed staffing levels and skill mix, and gave bank and agency staff a full induction. The provider had assessed compliance with Association for Perioperative Practice (AfPP) and Association of Anaesthetics of Great Britain and Ireland (AAGBI) guidance. All staff had in-date basic life support training (level two) and five staff had immediate life support training.
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The service managed patient safety incidents well. Staff recognised incidents and near misses but did not always report them or grade them appropriately. Managers investigated incidents and there was now a system to share learning from incidents with staff. The service used monitoring results to improve safety. Staff collected safety information.
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At the time of the last inspection, a safer surgical checklist based on the World Health Organisation (WHO) guidance was used for cosmetic procedures only and the service did not use the WHO checklist for hair transplant procedures. Since the last inspection, this had now been implemented for hair transplant procedures too.
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The provider had amended the admission policy to reflect body mass index (BMI) limits for patients treated at the clinic.
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Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. The centre had made improvements to the risk management system and engaged with staff regarding improving the service.
Following this inspection, we told the provider it must take action to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with two requirement notices which affecting the Ziering London Clinic. Details are at the end of the report.
Nigel Acheson
Deputy Chief Inspector of Hospitals (London and South)