Re-Enhance Limited

Re-Enhance is operated by Re-Enhance Limited. The service offer cosmetic day case services for surgery (liposuction procedures), dental treatments and medicine services (bio-identical hormone therapies) for adults. Facilities include four treatment rooms and diagnostic facilities. The service provides surgery, medicine and dental services.

Following our inspection on 1 and 14 March 2017 we issued warning notices against the registered manager and nominated individual. The warning notices were issued as a result of regulatory breaches relating to safe care and treatment, good governance, fit and proper persons employed and staffing.

We carried out this unannounced focussed inspection to see if the clinic had met the concerns we raised in the warning notice following our inspection in March 2017.

At the previous inspection on 1 and 14 March 2017 we found the following issues that the service provider needed to improve:

• Staff did not have current statutory training in key areas such as health and safety, manual handling, fire safety and infection control. Staff also did not have current safeguarding training.
• The system to learn from and make improvements following any accidents, incidents or significant events required improvement.
• The clinic did not have any standard operating procedures for bio-identical hormones and did not reference applicable guidance.
• Whilst patients’ needs were assessed and their care was planned and delivered in line with the clinical lead’s range of course guidance materials, patients’ records did not demonstrate how the clinic complied with these standards and how decisions were made.
• At the time of our inspection, audits were not undertaken to monitor compliance with guidance and standards.
• At the time of our inspection, outcomes of people’s care and treatment were not routinely collected and monitored.
• Patient records were not completed in line with the GMC guidance on good record keeping. They lacked evidence of comprehensive pre-assessment and clinical reasoning for decision-making was not contained within patients’ medical records.
• There was no documented process for referring patients on to services such as counselling, if needed.
• The provider did not have a clear governance framework and management could not evidence that they regularly reviewed the systems that were in place.
• There was not a comprehensive assurance system and service performance measures in place at the time of our inspection.
• The provider did not have arrangements in place to collate information to monitor and manage quality and performance.
• Not all staff that were registered with the General Dental Council (GDC) could provide evidence that met the requirements of their professional registration by carrying out regular training and continuing professional development (CPD).

We inspected this service on 30 May 2017 to check whether improvements had been made. At this inspection we found that the clinic had met the requirements of the warning notice because:

• Managers had a clear oversight of the issues we had previously identified and had put in place systems and processes to address them.
• Immediate patient safety issues had been addressed. Medicines and other consumable items were stored and handled appropriately. There were systems in to monitor and audit infection prevention and control processes.
• Patient records had been revised and included relevant information such as risk assessments, medical histories and details of prescribed medication.
• Equipment used for patient treatment, including emergency equipment, was available and checked on a routine basis.
• Recruitment processes were clearly defined. Staff had completed their mandatory training and annual appraisals. Staff competencies were assessed and reviewed.
• Senior staff had developed an evidence-based governance structure. Risk assessments for staff had been developed. A risk register was in place to enable leaders within the clinic to have an oversight of key risks to the service.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Re-Enhance is operated by Re-Enhance Limited. The service offer cosmetic day case services for surgery, dental treatments and medicine services. Facilities include four treatment rooms and diagnostic facilities.

The service provides surgery, medicine and dental services. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 1 March 2017, along with an unannounced visit to the service on 14 March 2017. We also visited the service’s satellite location on 8 March 2017.

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 clinic was medicine. Where our findings on medicine – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the medicine core service.

We regulate cosmetic surgery services, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• Staff did not have current statutory training in key areas such as health and safety, manual handling, fire safety and infection control. Staff also did not have current safeguarding training.

• The system to learn from and make improvements following any accidents, incidents or significant events required improvement.

• The clinic did not have any standard operating procedures for bio-identical hormones and did not reference applicable guidance.

• Whilst patients’ needs were assessed and their care was planned and delivered in line with the clinical lead’s range of course guidance materials, patients’ records did not demonstrate how the clinic complied with these standards and how decisions were made.

• At the time of our inspection, audits were not undertaken to monitor compliance with guidance and standards.

• At the time of our inspection, outcomes of people’s care and treatment were not routinely collected and monitored.

• Patient records were not completed in line with the GMC guidance on good record keeping. They lacked evidence of comprehensive pre-assessment and clinical reasoning for decision-making was not contained within patients’ medical records.

• There was no documented process for referring patients on to services such as counselling, if needed.

• The clinics complaints policy referenced the Local Government Ombudsman rather than the Independent Sector Complaints Adjudication Service (ISCAS). This showed that the service provided incorrect information as to who patients should raise concerns with.

• The provider did not have effective systems and processes in place to ensure there was appropriate governance and managerial oversight of the clinic.

• The provider did not have a clear governance framework and management could not evidence that they regularly reviewed the systems that were in place.

• There was not a comprehensive assurance system and service performance measures in place at the time of our inspection.

• The provider did not have arrangements in place to collate information to monitor and manage quality and performance.

• Not all staff that were registered with the General Dental Council (GDC) could provide evidence that met the requirements of their professional registration by carrying out regular training and continuing professional development (CPD).

However, we also found:

• Infection prevention and control procedures broadly followed nationally recognised guidance from the Department of Health. We saw instruments were placed in pouches after sterilisation but these were not dated to indicate when they should be reprocessed if left unused.

• Equipment for decontamination procedures, radiography and general dental procedures were tested and checked according to manufacturer’s instructions.

• Emergency medicines were stored appropriately but some adjustments were necessary to comply with Resuscitation Council UK guidelines.

• Staff were aware of their responsibilities under the Duty of Candour.

• The premises and clinical areas were visibly clean at the time of our inspection.

• Equipment was appropriately tested and calibrated.

• In terms of dentistry, we found that this practice was providing effective care in accordance with the relevant regulations.

• Dental professionals referred to resources such as the National Institute for Health and Care Excellence (NICE) guidelines and the Delivering Better Oral Health toolkit (DBOH) to ensure their treatment followed current recommendations.

• Dental care records were kept securely on computer systems, which were password protected and backed up at regular intervals.

• Patients were treated with dignity, compassion and empathy.

Following this inspection, we issued a warning notice for the breach of four regulations under the Health and Social Care Act. We also told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though other regulations had not been breached, to help the service improve. We also issued the provider with requirement notices that affected medicine and surgery. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals