We carried out a focussed inspection of Prime Health & Beauty Clinic – Nottingham on 20 April 2017. This was to check that improvements had been made following the breach of legal requirements we identified from our comprehensive inspection carried out on 24 February 2016. During our inspection in February 2016 we identified regulatory breaches in relation to regulations 13 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

This report only covers our findings in relation to the areas identified as requiring improvement following our inspection in February 2016. You can read the report from this comprehensive inspection by selecting the 'all reports' link for SDC (UK)1 Limited Prime Health & Beauty Clinic - Nottingham on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in February 2016 were as follows:

• Ensure that the doctor undertakes training on safeguarding vulnerable adults
• Ensure that recruitment procedures are followed and that the relevant checks are made on clinical staff in line with Schedule 3 of the Health and Social Care Act (Regulated Activities) Regulations 2014

Our focused review on 20 April 2017 showed that improvements had been made

We carried out an announced comprehensive inspection on 9 February 2016 to ask the service the following questions; are the 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 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 providing responsive 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 (Regulated Activities) Regulations 2015, and to look at the overall quality of the service, under the Care Act 2014.

Prime Health and Beauty Clinic provides a private weight reduction service for adults and supplies medicines and dietary advice to the patients accessing the service. The clinic operates from a first floor consulting room in the centre of Nottingham. It is open from 10.30am to 6.00pm on Tuesdays and Saturdays.

The clinic is run by one doctor who 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There is another clinic in Derby run by the same provider.

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. At Prime Health & Beauty - Nottingham, the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for weight reduction and not the aesthetic cosmetic services.

At our last inspection on 19 November 2013 we asked the provider to make improvements regarding sharing information with other health professionals, prescribing medicines outside national guidance and the complaints procedure.   We checked these areas as part of this comprehensive inspection and found that they had been resolved.

We spoke with three people on the day of the inspection and received feedback from 52 people who completed comment cards before our visit.   People said they found staff at the clinic friendly, helpful and supportive.  They said the doctor made time for them and felt she was thorough in her approach.   

Our key findings were:

• Overall the clinic provided an effective service
• Arrangements were in place to manage medicines in a way that kept people safe
• There was a treatment protocol in place which was followed
• Feedback from patients was positive.   People told us that staff were helpful, and that additional time was allowed for the first appointment
• There were a number of policies and procedures in place to govern activity

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

• Ensure that staff undertake training on safeguarding vulnerable adults appropriate to their role
• Ensure that recruitment procedures are followed and that the relevant checks are made on clinical staff in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

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:

• .Ensure a system is in place for regular and appropriate cleaning, inspection, calibration, maintenance and replacement of equipment
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available
• Review their arrangements for dealing with medical emergencies
• Consider how to make the service accessible to patients who don't speak English

The inspection date on the front page of this report is incorrect and should read 19 November 2013.

One patient told us and a survey conducted about the manager showed that most patients thought that respect was shown to them. Records showed that patients were involved in decisions about treatment initially, but that there was not enough information to show patients were involved on a continuous basis.

Treatment records were written in enough detail to show the treatment that had been prescribed and to provide an on-going record of progress.

Medicines were stored appropriately and records were maintained to provide a clear audit trail for controlled drugs. However, the manager prescribed medicines for the treatment of obesity against national guidance and there were inadequate systems to ensure patients’ GPs were advised when this occurred.

The manager completed enough training each year to maintain their registration and licence to practice with the General Medical Council.

The service had a policy and procedure to guide patients in how to make a complaint but there was inadequate information about taking complaints further. Patients said they were not aware of the complaints procedure.

People who use services did not want to speak with us during our inspection so we inspected care plans, documentation and talked with staff to evaluate the quality of care provided to people using the service at SDC UK Limited t/a Prime Health & Beauty Clinic – Nottingham.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found that people experienced care, treatment and support that met their needs. We also found that the provider took steps to assess the quality of the service being provided and people’s personal records including medical records were accurate and fit for purpose. However, we found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.