People who had used the service told us that they were given information about their treatment before they underwent procedures. They said that staff were "very professional", "welcoming" and "very attentive". One person told us that they were always treated with dignity and respect by staff.

People who had used the service described it as "very good" and "reassuring". Appropriate medical checks were undertaken before people received treatment and they received appropriate support and after-care. Staff had been trained in what to do in a medical emergency including calling 999.

Staff were trained in safeguarding vulnerable adults and child protection on an annual basis. There was a policy and procedure in place for how to report any concerns, including to the local authority.

When staff started at the service they received an induction. Staff undertook mandatory training on an annual basis, including in safeguarding and what to do in a medical emergency. All staff received annual appraisals where their performance would be discussed and targets set for the coming year. All staff received one to one meetings with their line managers, the staff we spoke with told us they were supported at the service.

The service conducted audits to monitor the quality of the service it was providing. Regular patient feedback questionnaires were completed. Accidents and incidents were logged, reviewed and changes made accordingly.

We were unable to speak to people who use services on this occasion however information leaflets and the patient guide was available and being giving to people to enable them make an informed decision about their care and treatment.

The clinic has systems in place to seek feedback from people who use the service. Recent client satisfaction survey was available, which showed that people rated the clinic and its services positively.

We found the following areas of good practice:

• The provider had a separate continuity fund in place to support patients in exceptional circumstances who were unable to pay for further treatment.
• Patients were extremely positive about their experience at the service and felt that staff were professional.
• The service employed a skilled group of specialist clinicians who were able to meet the needs of patients.
• Staff comprehensively assessed patients’ needs and ensured that the most appropriate treatment was recommended.
• There was an appointed safeguarding lead for staff to contact if they had concerns.
• The service held regular continuing professional development (CPD) events for all staff to attend. Clinicians and external speakers discussed a relevant subject or a case study.
• The service was flexible in its approach to appointments. Staff ensured that they were able to offer patients an initial appointment within 48 hours and on a Saturday.
• Staff enjoyed working at the service and the morale was good. The practice manager had worked at the service for over 30 years.
• Patients who used a wheelchair were able to easily access the building and consultation rooms on the ground floor.
• A member of staff was appointed as the safeguarding lead. Staff understood how to report concerns.

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

• Staff did not always complete comprehensive risk assessments, risk management plans and crisis plans for those patients who were deemed to be at risk.
• The service did not have systems in place to safely manage controlled drug prescriptions. The service had not identified a safe place to store controlled drug prescription pads and had not recorded prescription numbers that had been given to patients.
• Staff did not take the appropriate steps to follow up on patients who were at risk and did not attend an appointment or disengaged from the service.
• The service did not have an effective incident reporting system in place. Incidents were not formally recorded and there was no incident reporting protocol in place.
• The service did not have an effective recording system in place to demonstrate that doctors received an appraisal from another place of work in the past 12 months. The service did not have a system in place to record staff training.
• The provider had carried out a health and safety assessment in May 2017. The assessment identified areas of the environment that needed to be addressed without delay such as fire exit signage.

• Clinical equipment such as the weighing scales had not been regularly serviced to ensure they were working correctly.