The Care Quality Commission (CQC), has taken action to protect people using services provided by the Signature Clinic – Central London, after their first inspection, in August sees them rated as inadequate.
The clinic provides cosmetic surgery services, and 100% of people using the service were self-paying.
As well as being rated as inadequate overall, the clinic which is run by Signature Medical Limited, was rated as being inadequate for how safe, effective, responsive and well-led it is. Caring was rated as good.
Following this inspection, CQC served the provider with two warning notices to focus their attention on making improvements around safe care and treatment and good governance. CQC will continue to monitor the clinic and return to carry out another inspection to ensure people are receiving safe care.
Antoinette Smith, CQC deputy director of operations in London, said:
“Despite finding caring staff at the Signature Clinic – Central London, we also found a service that was providing inadequate care to people that had chosen to have cosmetic procedures there.
“When we spoke to people who used the service we heard mixed reviews. Some people were extremely happy, whereas others were extremely unhappy and felt their expectations weren’t managed well. Some people told us they’d been sold the idea of perfection in one surgery, when in actual fact revision surgery was necessary to achieve the look they wanted.
“Some people also told us their surgeries were much more painful than they felt had been communicated to them, and we saw evidence that medications weren’t managed in line with their own policies. People weren’t always given enough pain relief to last them during their recovery, and medications weren’t given to them by qualified staff.
“We saw dusty theatres, and beds where the linens in the recovery area hadn’t been changed between different people using them. The clinic also didn’t have the right equipment to check that surgical instruments had been decontaminated properly in between surgeries, both of these issues posed a real infection risk to people.
“The medical’s team’s handwritten notes were mostly illegible, and the manager struggled to read the information recorded to us. As these notes contained important, personalised post-operative advice for each person, it was concerning that staff couldn’t pass this advice on to people after their surgery.
“We weren’t always assured of people’s safety and dignity, anyone accessing the bathroom could just walk into one of the theatres. We also saw the camera used to take photos before and after people’s procedures was always left out overnight and not locked away, meaning anyone could look at these very private photos, although the provider addressed this immediately when we raised it.
“However, staff took time to interact with people using the service, and those close to them in a respectful and considerate way when they were in the clinic. It was also positive that surgeons refused to perform surgery on people when they thought they wouldn’t benefit.
“We’ve told the clinic where we expect to see rapid improvements, and will monitor the service closely to keep people safe during this time.
“I would encourage anyone considering having a surgical cosmetic procedure in England to look at the CQC website to help them choose a service that are registered with us and meeting the necessary standards by using our ratings and reports. People can also visit our website for more advice on how to choose a cosmetic surgeon.”
Inspectors found:
- The service provided care and treatment which wasn’t always based on national guidance or evidence-based
- The service’s policies stated that non-clinical staff weren’t allowed to handle medicines, but people told us their medications had been issued to them by a healthcare assistant (HCA). CQC didn’t see any evidence that HCA’s had completed any appropriate training to do this. There was also no clear oversight or management of medications more generally and saw evidence they failed to follow not just their own policies but national medication guidelines
- Medical documentation audit forms were just a tick box exercise. There was no space for notes or actions, which didn’t support the service to continuously improve or share learning
- Internal communications need improved to enable changes in guidance and best practice to be shared more easily. There was only one computer on site, which was also used to check people in, so the clinical manager had limited access to their work emails to share information. There was also no reliable alternative method to share information if the clinical manager wasn’t at work. One computer also meant that not all staff could access the information they needed in a timely manner
- Staff did not monitor the effectiveness of care and treatment, and due to the number of concerns that were raised to CQC, inspectors weren’t assured the service was managing expectations as best they could. Inspectors also weren’t assured that surgeons were being made accountable for people’s outcomes
- Employed staff weren’t always qualified or had the right skills and knowledge to meet people’s needs, although mandatory training rates on the service’s own policies were high. The clinical manager was not medically trained and had limited clinical based knowledge and skills, and therefore did not have the correct qualifications or skills to assess these competencies or train HCA staff in key skills
- The service didn’t always follow national guidance around consent. People should give consent in a two-stage process with a cooling off period of at least 14 days between stages but inspectors saw that treatment plans could be adapted on the day of the procedure including removing parts of the surgery already consented to and adding on parts to the surgery with ill formed consent.
However:
- Staff knew to call 999 in case of an emergency. The service had also developed a deterioration and transfer policy in response to the CQC inspection carried out in their Manchester branch. This policy had been implemented in August 2023
- HCA staff were fully vetted before employment, and employment checks were thorough
- Doctors, nurses and other healthcare professionals worked together as a team to benefit people using the service.