We carried out an announced comprehensive inspection of The Mole Clinic on 14 June 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 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.

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.

The Mole Clinic, established in 2016, is a clinical location of the provider The Mole Clinic Limited and operates from 7 Moorgate, London EC2R 6AF. The service also operates from its head office, which is a separately registered location based at 9 Argyll Street, London W1F 7TG. We inspected both locations on the same day with two separate inspection teams. Operational systems and processes were generic to both locations and employed staff worked across both sites.

The service specialises in skin cancer screening, diagnosis and skin lesion removal.

The day-to-day running of the service at both Moorgate and Argyll Street is provided by the clinic manager supported by a clinic coordinator at both locations. The service also employs seven nurses, two healthcare assistants, a systems and data manager and a receptionist. Skin lesion diagnosis using digital images (tele-dermatology) is provided remotely by three sessional dermatology-specialist general practitioners. Mole removal surgery is provided on-site by five surgical consultants in the specialities of dermatology, plastic surgery and general surgery, all of whom worked under practising privileges (the granting of practising privileges is a well-established process within independent healthcare whereby a medical practitioner is granted permission to work in an independent hospital or clinic, in independent private practice, or within the provision of community services).

The service offers pre-bookable face-to-face appointments for adults aged 18 and over. Patients can access appointments at this location on Monday, Wednesday and Friday from 8am to 5pm and Tuesday, Thursday 8am to 7pm. For the period 1 June 2017 to 31 May 2018 the service has seen approximately 4,300 patients at this location.

The provider is registered with the Care Quality Commission (CQC) for the regulated activities of Diagnostic & Screening Procedures and Surgical Procedures. After the inspection the service submitted an application to add the regulated activity Treatment of Disease, Disorder or Injury to reflect its current service provision.

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.

As part of our inspection, we asked for CQC comments cards to be completed by patients prior to our inspection. Five comments cards were completed, all of which were positive about the service experienced. Patients commented that the service offered an excellent, professional, caring and thorough service. Patients said staff were friendly, helpful and informative.

Our key findings were:

• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns. All staff had been trained to a level appropriate to their role.
• The service had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The practice carried out staff checks on recruitment, including checks of professional registration where relevant.
• Clinical staff we spoke with were aware of current evidence-based guidance and they had the skills, knowledge and experience to carry out their roles.
• There was evidence of quality improvement, including clinical audit.
• Consent procedures were in place and these were in line with legal requirements.
• Staff we spoke with were aware of their responsibility to respect people’s diversity and human rights. The service was caring, person-centred and compassionate.
• Systems were in place to protect personal information about patients. The service was registered with the Information Commissioner’s Office (ICO).
• Patients were able to access care and treatment from the clinic within an appropriate timescale for their needs.
• Information about services and how to complain was available.
• The service had proactively gathered feedback from patients.
• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.

There were areas where the provider could make improvements and should

• Consider the infection prevention and control lead undertaking enhanced training to support them in this extended role.
• Review practice policies and procedures so they are consistently service-specific.