We carried out a focused inspection on the 1 May 2018 to ask the following key questions; Are services safe, effective, and well-led?

Our findings were:

Is the service 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 well-led?

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

Background

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.

At the last inspection on 1 August 2017, we found a breach of Regulation 17 of the HSCA (RA) Regulations 2014 (Good Governance) because there were limited or no systems or processes in place that enabled the registered person to assess, monitor and improve the quality and safety of the service being provided. In particular:

• There were outdated policies and procedures and staff who were unsure of the content.
• There was no quality improvement programme that included clinical audit.
• There was a lack of documentation to show the calibration of medical equipment had been carried out.
• There was a lack of systems to assess and monitor risks to staff and service users which may arise from the carrying on of the regulated activity.
• There was no system or process to ensure that staff who had been employed by the service for some time had appropriate identity checks.
• There were no risk assessments in place to mitigate against these risks.

We checked this as part of this focussed inspection and found that these issues had been resolved.

Kings Private Clinic is one of four locations owned by the same provider. This clinic is located in the London Bridge area. The clinic consists of a reception room and a consulting room on the second floor of 56 Borough High street. It is very close to London Bridge rail and tube station, and local bus stops. Parking in the local area is very limited and the clinic is not wheelchair accessible.

The clinic provided slimming advice and prescribed medicines to support weight reduction. It was a private service. It was open for walk ins or booked appointments on Tuesdays, and Saturday mornings.

The clinic is staffed by a receptionist and a doctor. There is also a receptionist who only works on Saturdays. If for any reason, a shift is not filled by the doctor, a locum doctor is brought in. In addition, staff work closely with other staff based at the head office in Ilford.

The receptionist 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 Regulations about how the clinic is run.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of weight reduction.

Patients completed CQC comment cards to tell us what they thought about the service. We received three completed cards and all were positive. We were told that the staff were friendly and helpful, and that visits to the clinic were always pleasant.

Our key findings were:

• Provisions had been made for people with sight and hearing impairments.
• The provider had taken steps to update the policies and procedures and ensured that staff had received training.
• The provider had made information available to patients with regards to translation services.

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

• Review how staff assure themselves that patients meet the providers requirements of being between 18 and 65 years old to receive appetite suppressants.
• Review how staff explain to clients that the medicines prescribed at the clinic are unlicensed.
• Review the prescribing policy with regards to the use of waist circumference as a way of assessing suitability for treatment with appetite suppressants.
• Review how clinical information from other health care professionals is recorded and acted upon.
• Review how audits could be used to identify areas for improvement.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

We carried out an announced comprehensive inspection on 1 August 2017 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 not providing effective care in accordance with the relevant regulations. The impact of our concerns, in terms of the effectiveness of clinical care, is minor for patients using the service.

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 not 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.

Background

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.

Kings Private Clinic is a slimming clinic located near London Bridge. The clinic consists of a reception room and a consulting room on the second floor of 56 Borough High street. It is very close to London Bridge rail and tube station, and local bus stops. Parking in the local area is very limited and the clinic is not wheelchair accessible.

The clinic is staffed by a receptionist and a doctor. There is also a receptionist who only works on Saturdays. If for any reason, a shift is not filled by the doctor, a locum doctor is brought in. In addition, staff work closely with other staff based at the head office in Ilford. This clinic is one of four clinics that is run by the same provider organisation.

The receptionist 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 Regulations about how the clinic is run.

The clinic provides slimming advice and prescribes medicines to support weight reduction. It is a private service. It is open for walk ins or booked appointments on Tuesdays, and Saturday mornings.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of weight reduction.

Patients completed CQC comment cards to tell us what they thought about the service. We received 13 completed cards and all were positive. We were told that the service was excellent, and that staff were caring and compassionate, friendly, understanding and professional.

Our key findings were:

• The clinic appropriately refused to provide medicines to people who had high blood pressure (BP) readings.
• The feedback from patients was always positive about the care they received, the helpfulness of staff and the cleanliness of the premises.

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

• Ensure that medicines are prescribed safely to patients who fit the treatment criteria as defined in the clinic guidelines.
• Ensure that all staff are trained in the safeguarding of children and that there is an adequate safeguarding policy.Ensure there are systems and processes in place to monitor and improve the quality of services being provided. (To include quality improvement programmes including clinical audit, medical emergency risk assessments, communication with patients’ own GPs, the documentation of the maintenance and calibration of equipment and supporting policies and procedures that are appropriate to the service provided and that are up to date and understood by all staff.)
• Ensure staff receive appropriate support, training, professional development, supervison and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

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 methods to ascertain the age and identity of patients accessing the clinic services.
• Review facilities to maintain the dignity and privacy of service users.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
• Review the appropriateness of using friends and family for translation.
• Review fire safety procedures to provide assurance that people would be kept safe in an emergency.

We spoke with two members of staff which included the clinic manager and the doctor and six patients. All people we spoke with told us they were informed about the risks/side effects of their prescribed medication before treatment started and we saw consent was gained in all cases.

People we spoke with told us they were happy with the advice and treatment they received from the doctor. One person told us, 'the doctor answered all my questions.' Another told us, 'they are very thorough here, very friendly and did not make me feel at all awkward.'

The clinic appeared clean, tidy, well maintained, organised and fit for purpose on the day of our inspection. There were systems in place for keeping the clinic clean and free from possible infection.

There were two members of staff on duty who competently and respectfully dealt with all people's needs in a timely manner.

People told us they knew how to make a complaint if necessary and we found the complaints form was easily accessible and displayed on the reception desk in the clinic for patients to read and complete. A person new to the clinic told us, 'I have been told how to make a complaint.'

The clinic was situated on the second floor of an office building. This service was accessed by steep set of stairs, meaning that those with restricted mobility had difficulty in accessing the consulting area.

The consultation areas were private and appeared clean and in good repair.

We saw a range of information displayed in the waiting area that people could take away with them. We also saw displayed information on pricing and clinic opening times, further contact information for other health professionals; staff confirmed that this information was current.

We looked at the company's complaints procedure and noted that all complaints received had been handled in a timely manner and resolved satisfactorily. We also looked at the incident reporting and noted that no incidents had been reported to date.

There was enough staff on hand to respond to peoples needs and people were treated with respect.

Peoples medical notes and information was stored securely and kept current.

Medication was stored securely and dispensed by the doctor at the point of consultation.

We reviewed the patient satisfaction survey and all completed questionairres demonstrated a high level of satisfaction with the service.