• Hospital
  • Independent hospital

Archived: Leenside Surgical

Overall: Inadequate read more about inspection ratings

367 Derby Road, Nottingham, NG7 2EB 07791 039239

Provided and run by:
The Hair Loss Clinic (NW) Limited

Latest inspection summary

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Background to this inspection

Updated 13 June 2024

Leenside Surgical is operated by The Hair Loss Clinic (NW) Limited. The service provides private hair transplant surgery for aesthetic, non-medical purposes to self-paying adult patients. Staff deliver follicular unit transplantation (FUT) and follicular unit extraction (FUE), which relate to specific types of hair transplantation.

The service is provided from rented space in a clinic that is owned, operated, and maintained by another CQC-registered provider. The service employs or contracts its own staff and is responsible for patient care and outcomes but uses equipment, medicines, and medical consumables provided by the building operator. While the building operator does not form part of our judgement, the areas of responsibility of staff working for or providing care under the registration of The Hair Loss Clinic (NW) Limited are included.

The provider did not deliver any care under its CQC registration between December 2022 and June 2023. Between July and December 2023, the service provided treatment to an average of 2 patients per week. Data and evidence in our report relate to this 6-month period.

The service registered with CQC in March 2018 to provide the following regulated activities:

  • Surgical procedures

We have not previously inspected the service.

After our inspection the provider told us they had submitted an application to deregister this location.

Overall inspection

Inadequate

Updated 13 June 2024

We have not previously inspected this location. We rated it as inadequate because:

  • The service did not control infection risk well. There were gaps in monitoring and assurance of safety standards, practices, and the environment. The service was not compliant with multiple national standards.
  • Staff training was inconsistent, and records did not provide assurance of good standards.
  • Staff lacked oversight of key clinical safety measures and processes, including for emergency medical equipment and health and safety equipment.
  • There was limited monitoring of the effectiveness of care and the service did not have a patient outcome audit programme.
  • Leaders did not operate the service with reliable information systems that provided assurance of quality, safety, and performance. Outsourcing of some key processes and policies to another organisation had resulted in risks to patients and staff that the provider had not identified.
  • Staff did not understand all their roles and accountabilities and had not identified or acted on clear, demonstrable risks. The provider had no oversight of these gaps.
  • The provider did not effectively manage policies and procedures, some of which were significantly overdue for review or undated.

However:

  • Staff had training in safeguarding and understood how to protect patients from abuse.
  • The service had enough staff to care for patients. Staff assessed clinical risks to patients, acted on them, and kept good care records.
  • Staff provided good standards of surgical care and managed pain well.
  • Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good clinical information.
  • The service planned care to meet the individual needs of people.
  • Staff worked within high standards of medical ethics. They felt respected, supported and valued and were focused on the needs of patients.
  • Staff treated patients with compassion and kindness and helped them understand treatment options.

As we found the provider breached the regulations, we took action to ensure they improve. Following our inspection, we have served 2 Warning Notices under Section 29 of the Health and Social Care Act 2008. We notified the provider that they failed to comply with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; the provider failed to comply with Regulation 12 (1)(2)(a)(b)(d)(e)(f)(g)(h)(i), Safe care and treatment, and Regulation 17(1)(2)(a)(b), Good governance. The provider is required to achieve compliance with the relevant requirement within the timescale set in the Warning Notices.