We carried out an announced focussed inspection on 21 November 2018 to ask the service the following key questions; Are services safe 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 well-led?

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

CQC inspected the service on 27 June 2018 and as a result asked the provider to make improvements regarding: staff training, regularly reviewing emergency use equipment and medicines, its definition of significant events and to record minutes of meetings. We issued requirement notices for breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked these areas as part of this focussed inspection and found all issues had been resolved.

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 as a focussed follow up inspection to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, in respect of issues we found at the previous inspection.

The report for our previous inspection in June 2018 can be found on the CQC website by selecting the Reports tab from: https://www.cqc.org.uk/location/1-4487596434.

Enterprise Health Care (also known as London Dermatology Clinic) is a private service providing general dermatology consultations and treatments. it also conducts minor cosmetic treatments to day-clients using a range of non-invasive or minimally invasive procedures. It is located in Eastcheap, London. It provides services to adults and children between the ages of four to 18.

The registered manager is a qualified GP with a special interest in dermatology, who shares the day-to-day management of the service with a director of the service who is a qualified pharmacist. 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:

• The service had changed its definition of significant events to include acts or omissions in clinical, organisational and communication areas that provided an opportunity to identify an area of learning, improvement or the dissemination of good practice.

• Staff personnel files contained evidence staff had received training to an appropriate level in safeguarding training for vulnerable adults and children.
• The service had implemented an appropriate system for checking equipment for use in a medical emergency, and was regularly reviewing its stocks of emergency medicines. It had an appropriate re-ordering system to replace any used or soon to expire stock.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 27 June 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.

Enterprise Health Care (also known as London Dermatology Clinic) is a private service providing general dermatology consultations and treatments. it also conducts minor cosmetic treatments to day-clients using a range of non-invasive or minimally invasive procedures. It is located in Eastcheap, London. It provides services to adults and children between the ages of four to 18.

The registered manager is a qualified GP with a special interest in dermatology, who shares the day-to-day management of the service with a director of the service who is a qualified pharmacist. 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.

As part of this inspection we asked for CQC comment cards to be completed. We received 11 completed CQC comment cards. All the completed cards indicated that patients were treated with kindness and respect. Staff were described as friendly, caring and professional. Some patients commented on how using the service had helped them with their individual care needs and to resolve their concerns.

Our key findings were:

• Not all the information we would expect to find on staff personnel records was stored on the records that we reviewed, including, interview summaries and evidence of training in the Mental Capacity Act and information governance.
• Systems were in place to deal with medical emergencies and staff were trained in basic life support. However, there was no record that all medicines and equipment for use in an emergency were being regularly checked.
• Screens provided in consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments were not made of a suitable material that could be kept clean within a clinical environment.
• The service did not have a suitable system in place for reporting, recording and analysing significant events.
• The service was offered on a private, fee paying basis.
• There was a clear procedure for handling alerts from organisations such as MHRA (Medicines and Healthcare products Regulatory Agency).
• Information about services and how to complain was available and easy to understand.
• All health assessment rooms were well organised and equipped, with good light and ventilation.
• Clinicians regularly assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence.
• Staff were kind, caring, competent and put patients at their ease.
• Patients were provided with information about their health and with advice and guidance to support them to live healthier lives.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.
• Systems were in place to ensure that all patient information was securely stored and kept confidential.

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

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

• Review and consider replacing the screens in consultation and treatment rooms with screens that can be kept clean in a clinical environment.
• Review and consider putting warning signs outside all treatment room doors to prevent staff entering during a patient consultation.
• Continue to review and monitor that care and treatment is provided in a safe way to patients.