The Care Quality Commission (CQC) has completed a focused inspection of The Belvedere Private Hospital in Knee Hill, south east London.
The hospital, which is operated by Pemberdeen Laser Cosmetic Surgery Limited, provides cosmetic and plastic surgery.
CQC inspected The Belvedere Private Hospital in July to check whether improvements had been made after an earlier inspection in March. At that time, CQC imposed a temporary suspension on the regulated activity of surgery, to ensure that the service was providing safe and effective care for all its patients. The suspension was later lifted and replaced with conditions.
Following this inspection, CQC took further action to limit surgical activity in the hospital. This has now been lifted, after the provider gave CQC assurance that it was safe to recommence the regulated activity.
At this was a focused inspection, the service was not re-rated and the overall rating of inadequate remains in place.
CQC’s deputy chief inspector of hospitals, Nigel Acheson, said:
“We found some improvement at The Belvedere Private Hospital during this latest inspection. The leadership team was working to improve the governance of the service, although this was not fully in force when we inspected in July.
“Due to the current enforcement action in place, surgery could not take place until we were completely satisfied that the hospital was providing consistent safe, effective care for all of its patients.
“We will continue to monitor the hospital closely and if we do not see evidence of improvement, we will not hesitate to take to take further action on behalf of the people who use the services.”
Inspectors found:
- Although medical staff did not receive mandatory training with the provider and did not always provide evidence of training received elsewhere, the provider was able to show how this was being addressed
- The training contract arranged between The Belvedere Private Hospital and an external company did not accurately reflect the legal entities registered with the Care Quality Commission. This was rectified after the inspection.
- The provider was not able to demonstrate how it would be assured that staff arranged through the external agency would have been subject to checks on their suitability and trained in the required safety related subjects. Information was later provided to confirm that such checks would be made available in advance of agency staff commencing work
- Despite its efforts to obtain the necessary information, the provider was not in a position to approve practising privileges to all the surgeons and anaesthetists they wished to work with. However, the provider was in the process of obtaining the necessary documents, assurances and checks from surgeons and anaesthetists they wished to grant practising privileges to and assured inspectors that such documents would be available for inspection before any surgery commenced on site.
However, inspectors found areas of improvement:
- A strategy to look at the governance of the service had been developed and the provider had made suitable arrangements to improve the day to day running of the service through formal meetings.
Full details of the inspection are given in the report published on our website.
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