Acuitus Medical Ltd is operated by Acuitus Medical Ltd. The service provides day case cosmetic surgery. Facilities include one operating theatre, an admissions room, a recovery room and one consultation room. There is also a waiting room and toilet and shower.

We inspected this service to follow up on a warning notice and a requirement notice issued following our follow up inspection in December 2017. The warning notice was issued for a breach of regulation 12 (safe care and treatment) and the requirement notice was issued for a breach of regulation 17 (good governance). We carried out an unannounced inspection on 05 June 2018.

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.

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

We found the following areas of good practice:

• Patients with a history of mental health concerns received a psychological assessment before proceeding with their surgery.
• Equipment, including emergency equipment stored on the resuscitation trolley were in date.
• Meetings took with place with the relevant staff members and minutes were circulated to staff who attended the meetings.
• An induction programme was in place for all staff as well as a location orientation to the building. Staff competencies were also monitored.
• Staff files had been updated and included references and evidence of completed mandatory training.
• Decontamination continued to be outsourced to another provider.
• Audits were undertaken of venous thromboemolism (VTE) assessments and World Health Organisation (WHO) surgical safety checklists.
• We saw improvements in patient records including completion of VTE assessments, WHO surgical safety checklists, psychological assessments and observations.

However, we also found the following issues that the service provider needs to improve:

• We noted that not all entries within patient records were dated and signed.

• All entries in relation to administration of drugs were not dated and timed.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a requirement notice. Details are at the end of the report.

Heidi Smouldt

Deputy Chief Inspector of Hospitals (Central)

Acuitus Medical Ltd is operated by Acuitus Medical Ltd. The service provides day case cosmetic surgery. Facilities include one operating theatre, an admissions room, a recovery room, one consultation room and a decontamination room. There is also a waiting room and toilet and shower.

We inspected this service to follow up on three requirement notices issued following our comprehensive inspection in May 2017. The requirement notices were issued for breaches of regulation 12 (safe care and treatment), regulation 17 (good governance) and regulation 19 (fit and proper persons employed). We carried out an unannounced inspection on 18 December 2017.

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

We found the following areas of good practice:

• All medicines and medicine keys were stored securely.
• The operating room was fully commissioned and compliant with HTM 03-01.
• Staffing levels and responsibilities were compliant with the Academy of Medical Royal Colleges Safe Sedation Practice for Healthcare Procedures 2013 when sedating patients.

However, we also found the following issues that the service provider needs to improve:

• The decontamination room had not been commissioned in line with Health Technical Memorandum (HTM) 01-01 Part A.
• Not all patients were risk assessed for venous thromboembolism (VTE) on admission. This was identified at the previous inspection and was still a concern.
• Not all patients had all the necessary observations completed before, during or after their surgery. This was identified at the previous inspection and was still a concern.
• Not all patients had the World Health Organisation’s (WHO) ‘Five Steps to Safer Surgery’ checklist completed. This was identified at the previous inspection and was still a concern.
• Not all staff had evidence of completing their mandatory training. This was identified at the previous inspection and was still a concern.
• Not all patients with a history of mental health concerns received a psychological assessment prior to proceeding with their cosmetic surgery. This was identified at the previous inspection and was still a concern.
• In the operating room, we found two endotracheal tubes on the resuscitation, which went out of date in June 2017. We found other pieces of equipment out of date at our previous inspection.
• Medications for patients to take home after surgery were not labelled in accordance with the Human Medicines Regulations Schedule 26.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two warning notices and one requirement notice. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)

Acuitus Medical Ltd is operated by Acuitus Medical Ltd. The service provides day case cosmetic surgery. Facilities include one operating theatre and one consultation room.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 May 2017, along with an unannounced visit to the hospital on 17 May 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.

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:

• Some medication and equipment were out of date.

• Some medications were not stored securely.

• Medication keys were not stored securely.

• There was no record of a second checker or signature during the administration of controlled drugs.

• Controlled drugs were only checked on a monthly basis.

• There was no major haemorrhage pack within the operating room.

• There was no evidence that the operating room’s ventilation was compliant with Department of Health Technical Memoranda (03-01) Specialised ventilation for healthcare premises.

• At the time of our inspection, the management team were unaware of their non-compliance with various national standards, including the ventilation system requirements, the checking of the resuscitation trolley and the storage of medications.

• There was no contents checklist for the resuscitation trolley.

• Not all World Health Organisation ‘Five Steps to Safer Surgery’ checklists were completed fully.

We saw one patient with a history of depression, who was taking antidepressant medication, had cosmetic surgery without evidence of a GP summary or psychiatric evaluation.

• There were no dates on the sharps bins.

• Four out of six staff members employed on practising privileges had no evidence of completing mandatory training.

• Only one of seven employment staff files reviewed had evidence of two written employment references.

• Not all patient safety audits were completed. The results from completed audits were not shared with staff. Not all audits, which identified areas for improvement, had action plans.

• Staff employed on practising privileges did not have documented mandatory training.

• Most policies reviewed had no date of issue.

• Staff told us they did not receive summaries or minutes from team meetings.

• Theatre uniforms were not cleaned in accordance with national guidelines.

• Not all patient observations were recorded in patient records.

• New staff did not have a documented induction.

• The observation charts used to identify and manage a deteriorating patient were not in line with national guidance.

However, we also found the following areas of good practice:

• Staff were aware of the duty of candour and could explain how and when this duty would be engaged.

• Records were stored securely.

• Staff were familiar with the process for safeguarding adults.

• A consultant surgeon was present during the entirety of the patient’s admission.

• Guidance was followed for recording medical implants.

• All staff had valid disclosure and barring service certificates.

• Staff provided compassionate care to patients.

Patients’ dignity and respect was upheld.

• Evening and weekend consultations were available for patients.

• Translation services were available.

• The registered manager was seen as an approachable and visible leader within the service.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)