We carried out an announced focused inspection on 28 January 2019 to ask the service the following key questions; Are services safe, effective 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 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

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.

CQC previously inspected the service in November 2017 and in September 2018 when breaches of legal requirements were found regarding safeguarding, governance and staffing. We took enforcement action to protect the safety and welfare of people using the service and at this inspection on 28 January 2019 we found that the provider had made improvements in these areas. You can read the reports from our previous inspections by selecting the 'all reports' link for North London Slimming Clinic on our website at www.cqc.org.uk.

North London Slimming Clinic is located in Enfield, London. The clinic is run from a residential property. There is a ground floor reception, waiting room and consulting room. It is accessible by public transport, and there is parking available on the street close to the clinic. 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.

The clinic manager 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 and associated Regulations about how the service is run.

Our key findings were:

• Safety policies were in place and staff had received training on safeguarding.
• Patient records were stored appropriately.
• There were systems to manage patient safety alerts and to record and investigate incidents.
• Staff records were completed to show that employment checks had been carried out.
• There was a process to ensure medicines were only prescribed to patients aged 18 or over
• Policies and procedures were in place to support the day to day running of the clinic and provide assurance to service leaders that the service was operating as intended.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced focused inspection on 10 September 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 not providing effective care 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.

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.

CQC inspected the service on 13 November 2017 and asked the provider to make improvements regarding safeguarding, governance and staffing. We checked these areas as part of this focused inspection.

North London Slimming Clinic is located in Enfield, London. The clinic is sited in a residential property. There is a ground floor reception, waiting room and consulting room. It is accessible by public transport, and there is parking available on the street close to the clinic.

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.

When we last inspected, the clinic was open on Mondays (6pm – 8pm) and Saturdays (9am-11am). At the time of this inspection the clinic was not providing prescribed medicines as there was no doctor working at the service. However, some patients had accessed advice and weight measurement free of charge.

The clinic manager 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 and associated Regulations about how the service is run.

We did not receive any feedback from comment cards. This was because the service is not currently running clinics in which they prescribe medicines for weight loss.

Our key findings were:

• Customer satisfaction surveys and a framework for clinical audit had been developed but not used in practice
• Staff at the clinic, including the safeguarding lead, had not undertaken safeguarding training
• Access to controlled drugs was not appropriately restricted
• Some policies lacked relevant details to adequately support the day to day running of the service
• Some employment records for staff working at the clinic were incomplete
• The clinic was clean and tidy and a legionella risk assessment had been undertaken
• Staff had signed confidentiality clauses

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

• Establish effective systems and processes to ensure service users are protected from abuse and improper treatment in accordance with the fundamental standards of care.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and that persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

We are now taking further action against the provider in line with our enforcement policy and we will report further on this when it is completed.

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

• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 13 November 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.

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.

North London slimming clinic is located in Enfield, London. The clinic is in a residential property with the reception, waiting room and consulting room on the ground floor and staff office on the first floor. It is accessible by public transport, and there is limited parking on the street. The clinic also operates from another premises located at Broxbourne Borough Buildings, Cheshunt EN8 9XQ on Thursday evenings.

The clinic is open on Mondays (6pm – 8pm) and Saturdays (9am-11am) at the Enfield location and Thursdays (6pm – 9pm) at the Cheshunt address. Patients are able to attend without appointments. They are provided with slimming advice and prescribed medicines to support weight reduction.

The clinic manager 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 and associated Regulations about how the service is run.

The clinic is staffed by a registered manager, a nominated individual and a doctor. There were also two administrative staff members employed on an adhoc basis. The registered manager told us they were not permanent staff but work as and when required by the clinic. If for any reason, the doctor is unable to cover a shift, staff told us that the clinic would be closed.

Patients completed CQC comment cards to tell us what they thought about the service. We received twenty one completed cards and all were positive. We were told that the service was excellent, and that staff was always helpful and made people to feel comfortable.

Our key findings were:

• People using the service told us that staff were always available to them including out of hours.
• Medicines were not prescribed safely to patients who fit the treatment criteria as defined in clinical guidelines.
• There were no effective systems and processes in place to prevent abuse of service users.
• The provider did not have systems and processes in place to monitor and improve the quality of services being provided. This included incident reporting, emergency medicine risk assessments, patient safety alerts, communication with the patient’s own GP, procedures that were appropriate to the service provided, up to date and understood by all staff.
• Staff did not have appropriate recruitment checks or given suitable support, training, professional development and supervision as is necessary to enable them to carry out the duties they are employed to perform.
• Patients’ records were not stored securely.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

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 establish methods to ascertain the age and identity of patients accessing the clinic services.
• Review and action the necessity for chaperoning at the service and staff training requirements.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

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

Patients we spoke with confirmed they were treated with consideration by staff and their privacy and dignity were respected. One patient told us, “the staff are so lovely.” Patients were given appropriate information about the care and treatment provided. A patient told us, “the doctor tells you what you need to know”. Another said they had been provided with “leaflets about everything.” We saw a range of leaflets provided to patients on different topics related to weight loss and management.

Patients were positive about the quality of care and treatment they received. Patients told us that the doctor reviewed whether there had been any changes to their health at each appointment and checked their blood pressure. They said they had recommended the service to others.

Medicines were stored securely and records of medicines dispensed to patients were kept. Patients said the possible side-effects had been explained to them. Staff received appropriate training to enable them to provide the care and treatment that patients needed. The provider monitored the service to make sure that risks to people were minimised and an appropriate standard of care and treatment provided.