We carried out an announced inspection at B Matti Company Limited on 20 February 2018. We found that this service should make improvements in providing safe care in accordance with the regulations. The full report on the February 2018 inspection can be found by selecting the ‘all reports’ link for B Matti Company Limited on our website at www.cqc.org.uk.

The provider was asked to make improvements regarding recruitment processes including references and DBS checks. In addition, review policies and procedures to ensure they meet with the Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance. We also asked the provider to eview the legionella risk assessment to ensure they are appropriate for the service premises and ensure meet the service premises meet the requirements of the Electrical at Work Regulations 1989.

This inspection was an announced focused inspection carried out on 10 January 2019 to confirm that the service had carried out their plan to meet the legal requirements in relation to the issues that we identified in our previous inspection on 20 February 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We carried out an announced focused follow-up inspection on 6 December 2018 to ask the service the following key question; Are services safe?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

CQC inspected the service on 20 February 2018 and asked the provider to make improvements regarding infection prevention procedures, recruitment, legionella and to ensure that all policies were in line with current legislation. We checked these areas as part of this focused desktop inspection and found this had been resolved.

The provider was an aesthetic (plastic) surgeon who offered consultations pre and post-operatively to aesthetic surgery at private clinic rooms. The provider performed the surgery within a designated hospital.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At B Matti Company Limited services, the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation unless they are used to treat a medical condition. Therefore, we were only able to inspect the treatments covered by the CQC registration. At this service these included:-

• Pre and post-operative care for aesthetic surgery.
• Minor surgery carried out on the premises.
• Botulinum toxin, when used for increased sweating or acne.

Mr Basim Matti is 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.

Our key findings were:

• Systems and processes were in place to keep people safe. The service lead was the lead member of staff for safeguarding and had undertaken adult and child safeguarding training.

• The provider was aware of current evidence based guidance and they had the skills, knowledge and experience to carry out his role.

• There were clear policies governing infection control and the decontamination of reusable instruments.

• The provider had a recruitment policy which included obtaining references and a DBS check prior to a candidate starting employment. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.

• The service had a number of policies to govern activity and these had been reviewed since the last inspection to ensure they were in line with current legislation.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 February 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 providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations .

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service B Matti Company Limited was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The provider was an aesthetic (plastic) surgeon who offered consultations pre and post-operatively to aesthetic surgery at private clinic rooms. The provider performed the surgery within a designated hospital.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At B Matti Company Limited services, the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation unless they are used to treat a medical condition. Therefore, we were only able to inspect the treatments covered by the CQC registration. At this service these included:-

• Pre and post-operative care for aesthetic surgery.

• Minor surgery carried out on the premises.

• Botulinum toxin, when used for increased sweating or acne.

As part of our inspection, we reviewed three CQC comment cards completed by patients. All made positive comments, stating the service was excellent and that they would recommend it.

Our key findings were:

• Staff wrote and managed individual care records in a way that kept patients safe.

• The practice had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.

• The provider and the nurse understood their responsibility to raise concerns, to record safety incidents, concerns and near misses, and report them internally and externally where appropriate.

• The provider had arrangements in place to receive and comply with patient safety alerts, recalls, and rapid response reports issued by the Medicines & Healthcare products Regulatory Agency (MHRA).

• The provider assessed needs and delivered care in line with relevant and current evidence based guidance and standards such as the National Institute for Health and Care Excellence (NICE) best practice guidelines.

• The provider assessed patients' needs, prior to the operation and following the operation.

• The provider offered the patient’s time to consider their decision to agree to surgery.

• The practice manager informed patients about the cost of the procedures.

• Written information was available to inform patients about the surgical procedures and post-operative care.

• When the service was closed, patients were advised to contact the hospital that had carried out their operation, who would contact the provider if necessary.

• The practice obtained consent to care and treatment in line with legislation and guidance.

There were areas where the provider could make improvements and should:

• Continue to review policies and procedures to ensure they meet with the Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance.
• Review the recruitment procedure to ensure that the provider keeps a written record of all staff references prior to commencing work and staff have the correct level of DBS in place. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Review the legionella risk assessment to ensure they are appropriate for the service premises and ensure meet the service premises meet the requirements of the Electrical at Work Regulations 1989.
• Review all procedures and policies to ensure they reflect the services practices and are in line with current legislation.