We carried out an announced comprehensive inspection on 1 October 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.

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 not 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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Bishop's Green Cottage operates three satellite clinics where it provides advice and treatment to assist people to manage and lose excess weight. Treatments include diet management and the use of appetite suppressants.

12 people completed CQC comment cards prior to our inspection to provide feedback about the service. Patients told us that they felt they always received good care and felt respected.

Our key findings were:

• The facilities were appropriate to meet people’s needs
• Staff were caring and supportive
• The provider was open about his vision for the service
• The provider did not have systems in place to record risk assessments carried out at clinic premises
• The provider did not have a system in place to monitor when training needed to be refreshed

We identified regulations that were not being met and the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Establish systems and processes to effectively ensure service users are protected from abuse and improper treatment in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

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

• Review and improve the way in which medicines are disposed of from the clinic

• Review the prescribing of medicines and only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available
• Review the way in which translation services are provided at the clinics
• Review they way in which they record assurance from landlords around the safety of premises used.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We looked at a sample of medical records and found they recorded details about people's care and treatment. We saw information about people’s general and mental health, weight loss, medicines prescribed and further treatment plans. We saw that Body Mass Index (BMI) and 'target weight' were always recorded on the initial consultation. At each visit a person’s blood pressure and weight was checked and recorded.

We completed an inspection visit of this service on 9 May 2012. We looked at three outcomes on that occasion. We needed to look at two further outcomes to complete our inspection of the service. We chose to do this by asking the provider to send us written information and did not visit the service or talk to anyone who used the service when inspecting these two outcomes.

We found that the provider had a comprehensive safeguarding policy and procedure in place and renewed his registration with the General Medical Council, as appropriate.

We were not able to speak to people who used the service during this inspection. This was because during the inspection, only one person attended the clinic and was unable to speak to us due to time constraints. The issues that we were following up could be assessed using documentary evidence and by speaking with staff.

We spoke to five people who had recently used the service. They told us that they were satisfied with the service provided. All the people said that they had discussed their medical history, diet and exercise with the doctor on their first appointment. They had also discussed the possible side effects and had been given written information about the medicines.