The London Centre for Aesthetic Surgery is operated by 'London Centre for Aesthetic Surgery’

and is a small independent clinic, which has been registered since April 2002. The clinic provides

cosmetic surgery services for private adult patients over the age of 18 years. Patients

are admitted for planned day case surgery procedures. The service does not provide overnight

accommodation for patients. Facilities include one treatment room, two recovery rooms and two

consultation rooms.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 21 March 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

The clinic’s main service is cosmetic surgery. We regulate cosmetic surgery service, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staffing levels and skills mix were sufficient to meet patient needs and staff assessed and responded to patient risks.
• Medicines were safely, administered, stored, and given to patients in a timely manner.
• Patient records were detailed with clear plans of the patient’s pathway of care.
• Patient consent was obtained prior to commencing treatment. Patients were provided with information to enable them to make an informed decision.
• A cooling off period was observed for patients undergoing cosmetic surgery procedures. This was in line with cosmetic surgery guidelines.
• We spoke to two patients. They were positive about the care and treatment they had received.
• Staff treated patients with dignity and respect and patients were kept involved in their care.
• Equipment we checked had been tested for electrical safety and serviced as required.
• There were arrangements to ensure patients received adequate food and drink that met their needs and preferences.
• There were processes to audit patient and clinical outcomes on a quarterly basis and these were discussed in the Medical Advisory Committee (MAC) meetings.
• There was appropriate management of quality and governance and mangers were aware of the risks and challenges they needed to address.
• There was clear visible leadership within the services. Staff were positive about the culture within the service and the level of support they received.

However, we also found the following issues that the service provider needs to improve:

• The treatment room was cluttered and disorganised. There were no clearly defined separate clean and dirty zones within the treatment room. The Department of Health Building Note (HBN) 00-09: Infection control in the built environment states that clean and dirty areas should be kept separate and the workflow patterns of each area should be clearly defined. Maintaining separate clean treatment and contaminated zones, helps reduce the risk of infection.
• The World Health Organisation (WHO) surgical safety checklist was not routinely used for all patients and there were no audit arrangements to test staff practice and adherence to the WHO checklist.
• The provider had no processes to collect performance measures and supply these to the Private Healthcare Information Network (PHIN). This is a requirement of the Private Healthcare Market Investigation Order (2014).
• The safeguarding policy did not reflect national guidelines, for example, there was no reference made to female genital mutilation (FGM), slavery, sexual exploitation and PREVENT.
• We were told there were routine checks to ensure anaesthetic equipment was working correctly, but these were not recorded.
• The practice manager had not received the appropriate training for their role as the accountable officer for controlled drugs.
• The controlled drugs register did not contain entries for supply, administered, and destroyed, which is recommended and regarded as good practice.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

There was no one available to talk to us during our inspection, but we looked at six feedback questionnaires that had been completed between October 2013 and December 2013. These indicated that people were satisfied with the care and treatment they had received, with the consent process and the level of aftercare provided. One person had stated, "it was a very positive experience, I felt well treated and looked after".

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Consent was obtained on the day of the procedure by the most appropriate person and the risks and limitations were clearly explained.

People received care that ensured their safety and welfare from staff that had been appropriately recruited. People were assessed and treated by a doctor who was responsible for ensuring they were fit for discharge and prescribing any medicines required. There was emergency equipment available and the provider used a surgical safety checklist for each person to minimise the risks associated with surgery.

Medicines were obtained, stored and dispensed safely. The arrangements for recording and storing controlled drugs were compliant with the relevant regulations. There were systems in place to obtain feedback from people and to respond to complaints appropriately. However, no audits (clinical or environmental) had been carried out recently.

We spoke with people who use the service and looked at recent feedback that people had sent to the provider. Overall, people were very satisfied with the care and treatment they had received. One person described their treatment as “fantastic”. Another commented on the level of individual care they received. People felt involved in making decisions about their treatment and fully informed about their options.

Care was delivered in a way to ensure a person's safety. Follow- up appointments and telephone calls were organised by the service to check on people after their procedures. Staff were trained to deal with emergencies and there was emergency equipment available. People were protected from the risks of infection and observed that the clinic was clean and hygienic.

Staff received ongoing professional development and support. People commented on their professionalism and expertise.

Complaints and comments were listened to, investigated and dealt with in line with a clear procedure. People said they felt happy to raise issues if they needed to.

It was not possible for us to speak to service users on this occasion as they were undergoing treatments and are unable to talk to us.