We carried out an announced comprehensive inspection on 12 September 2018 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?
Our findings were:
Are services safe?
We found that this service was not providing safe care in accordance with the relevant regulations. There were no formal arrangements in place to receive and act upon patient safety alerts. There was no process in place to ensure electrical equipment was checked for safety. Medical equipment had not been calibrated and firefighting equipment had not been serviced in accordance with manufacturer recommendations. There was no prescribing policy in place and medicines were prescribed against manufacturer’s recommendations
Are services effective?
We found that this service was not providing effective care in accordance with the relevant regulations. There was no system in place to monitor the safety or effectiveness of the treatments provided. There was no record of mandatory training and no training records at all for the doctor. Written consent was obtained from each patient before treatment was commenced. The provider did not encourage patients to consent to sharing information about their treatment with their registered GP.
Are services caring?
We found that this service was providing caring services in accordance with the relevant regulations. Staff displayed understanding and a non-judgemental attitude when talking about patients who had a diagnosis of obesity. The provider had ensured that consultations were conducted in private rooms and could not be overheard.
Are services responsive?
We found that this service was not providing responsive care in accordance with the relevant regulations. The provider had not carried out an analysis of patient needs when planning and delivering services. There was no information displayed on the premises or on the provider’s website about the steps people could take if they were not satisfied. Staff had not followed the complaints policy and procedure.
Are services well-led?
We found that this service was not providing well-led care in accordance with the relevant regulations. Staff were not always given the opportunity to contribute when changes were made to the service. There was no system in place to ensure staff had read and understood operational policies and staff were not always sure of their roles and responsibilities. There was no programme or system of clinical or internal audit to monitor the quality and safety of the service provided.
Background
We carried out an unannounced focused inspection of this service on 2 July 2018 where breaches of legal requirements were found. After the focused inspection, the service wrote to us to say what they would do to meet legal requirements in relation to a breach of regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We undertook this announced comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Skinny Revolution Ltd on our website at www.cqc.org.uk.
Following this inspection, we found further significant failings in patient care and treatment that will or may expose any person to the risk of harm, and further enforcement action was taken to protect the safety and welfare of people using this service.
Skinny Revolution Ltd is a private clinic which provides medical treatment for weight loss, and has been registered with CQC since May 2018. The clinic is open from 10:00am until 6:00pm Monday to Friday, and Saturdays from 10:00am until 4:00pm. The premises comprise of a reception and waiting area, a consulting room and an office area upstairs. There is a doctor and two nurses who carry out patient consultations. On the day of our inspection there was no registered manager in post. The provider told us they were in the process of applying to change the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
In addition to the main clinic, the provider also delivered their services from a number of satellite locations where they rented a clinic room on an occasional basis. Where a medical professional carries on a regulated activity and travels to a variety of places to provide the care or treatment to people, the service provider can select the address from where they manage their service as the registered location. For this inspection, we visited the main clinic where the provider managed the service from.
Our key findings were:
- The premises were clean and tidy, and facilities were appropriate for the service being provided
- Staff displayed understanding and a non-judgemental attitude when talking about patients who had a diagnosis of obesity
- Employment records were not complete for all staff working at the clinic
- There was no prescribing policy in place and medicines were prescribed against manufacturer’s recommendations
- There was no process in place to ensure electrical equipment was checked for safety, medical equipment had not been calibrated and firefighting equipment had not been serviced in accordance with manufacturer recommendations
- There was no system in place to monitor the safety or effectiveness of the treatments provided
- The provider had not carried out an analysis of patient needs when planning and delivering services
We identified regulations that were not being met, and the provider MUST:
- Ensure care and treatment is provided in a safe way for service users
- Ensure systems and processes are established to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users
There were areas where the provider could make improvements, and should:
Review the measures in place to support patients with hearing or visual impairment, or those who do not speak English, to understand their diagnosis and treatment.