We carried out an unannounced follow up inspection at JHA Medical Services PVT LTD t/a Renewal Skin and Health on 25 September 2014 to review four areas of non-compliance from our previous inspection on 15 May 2013.

We found that the provider had introduced systems to protect people from abuse and to protected people from unsafe or unsuitable equipment.

Appropriate checks were undertaken before staff began work. We found that improvements had been made to the recruitment process and its recording.

Systems were in place to identify, assess and manage risks to the health, safety and welfare of people using the service or others.

The evidence we found assured us that the provider had taken the necessary action required to be complaint in respect of the outcomes looked at.

We spoke with the manager and deputy manager. Following the inspection we tried to contact some patients to get their opinion on the service but were unsuccessful.

Recruitment records of a new member of staff confirmed that the company recruitment processes had not been followed as identified within their human resource policy. We found that some pre-employment checks had not been completed prior to the person starting work at the clinic.

Patient’s needs had been assessed, risks identified and personalised plans of care developed. We saw evidence of patient involvement in consent processes.

We found that adequate systems had not been put in place in relation to the maintenance of equipment. We asked that some items be removed as they were out of date. We found that checks had not been carried out for some equipment, including fire equipment at the clinic which could put people at risk.

We identified at the providers previous inspection in October 2012 that staff were not aware of the arrangements in place at the clinic to ensure that people were protected from abuse. These arrangements related to a lack of staff training in the safeguarding of vulnerable adults and a lack of staff awareness about the clinic's vulnerable and disadvantaged adult protection policy. Staff confirmed that they had not received training in adult protection or been made aware of the local authorities ‘Safeguarding of Vulnerable Adults Policy.’

We spoke with one person using the service about their care and treatment. We asked whether they had been involved in making decisions about their care and had been kept informed. They said they had been involved in the decision making process and had been happy with the care and support they had received. We also looked at some previously completed patient questionnaires and testimonials. Findings identified that people had been happy with the treatment, care and support they had received from the staff and medical practitioner at the clinic.

We found that the home was compliant against four of the outcomes we inspected and have asked the provider to take note of some findings:

One person’s treatment consent form had not been signed or dated by the medical practitioner.

The clinic did not have written arrangements in place to deal with foreseeable emergencies.

A risk assessment, local rules and medical guidance were not in place for the radio surgery machine which we were told had been used to remove superficial skin lesions.

We have identified a minor concern against outcome seven which is 'Safeguarding people who use services from abuse'. We found staff were not aware of the arrangements at the clinic to ensure that people were protected from abuse. We found a lack of staff training in the safeguarding of vulnerable adults and a lack of staff awareness about the clinic's vulnerable and disadvantaged adult protection policy.