Archived: Acuitus Medical Ltd

Updated 20 August 2019

Acuitus Medical Ltd is operated by Acuitus Medical Ltd. The service opened in 2015. It is a private cosmetic service in Watford, Hertfordshire. The service primarily serves the communities of London and the Home Counties. It also accepts patient referrals from outside this area. Services are provided for patients aged over 18 years. It provides a range of cosmetic procedures including rhinoplasty (nose reconstruction), rhytidectomy (facelift), breast augmentation (implants), liposuction (fat removal) and abdominoplasty (tummy tuck). All patients are seen on a day case basis.

The service has had a registered manager in post since 11 June 2015. The short announced comprehensive inspection took place on 11 June 2019.

We regulate cosmetic surgery services and we now 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.

The service provides day case cosmetic surgery for adults only. No persons under the age of 18 are seen and/or treated at the service. The service is operational Monday to Friday 9.00am to 8.00pm and Saturdays from 9.00am to 5.30pm.

The service offers services for self-paying clients only.

Updated 20 August 2019

Acuitus Medical Ltd is operated by Acuitus Medical Ltd. The service provides day case cosmetic surgery. Facilities include one operating theatre, an admissions room, a recovery room and one consultation room. There is also a waiting room, toilet and shower.

The service provides cosmetic day surgery. We inspected cosmetic day surgery.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 11 June 2019 (we gave staff 48 hours notice that we were coming to inspect). We last inspected this service in June 2018 when we issued a requirement notice for breach of regulation 12 (safe care and treatment) and regulation 17 (good governance).

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 cosmetic 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 service report.

See surgery section for main findings.

Services we rate

The service was previously inspected but not rated.

We found safe was inadequate, effective was required improvement, caring and responsive were good and well led was inadequate. We rated it as Inadequate overall.

We found areas of practice that require improvement in services:

• Staff did not always complete and update risk assessments for each patient and remove or minimise risks.

• Patients completed on line pre-operative assessments, but we could not see that staff checked these and acted on any concerns

• The service had enough staff, but they did not all have the right skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• Records were not always clear and there were omissions to some records.

• Managers did not always check to make sure staff followed guidance.

• The service did not use clear systems and processes to safely prescribe, administer or record medicines. Medicines were not prescribed or administered in accordance with national guidance.

• The provider did not have robust processes in place to monitor and assess patient outcomes and the quality of the service.

• The service did not always provide care and treatment based on national guidance and evidence-based practice, polices were not consistent and did not contain relevant up to date information.

• Staff did not monitor the effectiveness of care and treatment. They did not use the findings to make improvements to achieve good outcomes for patients.

• Leaders did not all have the skills and abilities to run the service. They did not always understand and manage the priorities and issues the service faced.

• Although the service had a vision for what it wanted to achieve there was not a clear strategy or plans to turn it into action. Leaders and staff did not always understand and apply them to monitor progress.

• The provider did not have effective systems and processes in place to develop and review policies. Not all policies were reflective of the service and not all policies were adhered to.

• Leaders did not operate effective governance processes, throughout the service and with partner organisations.

• Leaders did not use effective systems to manage performance effectively. They did not identify and escalate relevant risks and issues or identify actions to reduce their impact. They had some plans to cope with unexpected events. It was not clear how often risks were reviewed and completed audits lacked detail.

• Although staff were committed to continually learning and improving services, they did not have a good understanding of quality improvement methods or the skills to use them.

However, we found the following areas of good practice:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff kept records of patients’ care and treatment. Records were stored securely and easily available to all staff providing care.

• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• Patients were supported to make informed decisions about their chosen procedures and treatments and were given sensible expectations.

• The service controlled infection risk well. The service used systems to identify and prevent surgical site infections.

• Managers were visible and approachable in the service for patients and staff.

• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

Following our inspection we took urgent enforcement action.

I am placing this service into special measures. Following this inspection, we sent a letter raising our concerns. In response to our letter, the provider took some immediate actions to address the concerns we raised. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

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 procedures and treatment of disease, disorder or injury. Details are at the end of the report.

Nigel Acheson

Deputy Inspector of Hospitals

Updated 20 August 2019

We rated this service as inadequate overall because it did not manage medicines safely and in line with national guidance, staff did not review all risk assessments and act upon them, records were not well maintained, leaders did not have the skills and ability to run the service and governance processes were not effective.

However, feedback from patients was positive. Appointments were scheduled to meet the needs and demands of the patients who required their services.