We carried out an announced comprehensive inspection on 9 October 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 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 not providing well-led care in accordance with the relevant regulations. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

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.

Victoria - Vauxhall Bridge Road is a slimming clinic located in Victoria, London. The clinic consists of a reception area, a ground floor consulting room and a basement level consulting room. It is close to Victoria rail and tube station, and local bus stops. Parking in the local area is very limited. The clinic is wheelchair accessible.

The clinic is staffed by a receptionist, a patient care manager and a doctor. There are staff based at other locations that cover shifts at this clinic. If for any reason, a shift is not filled by one of the regular doctors, there are locum doctors who are familiar with the clinic that can be contacted. In addition, staff work closely with other staff based at the head office in Richmond. This clinic is one of five clinics that are run by the same provider organisation.

The patient care manager was the acting 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 provided slimming advice and prescribed medicines to support weight reduction. It was a private service. It was open for walk ins or booked appointments every day except Sundays for a minimum of four hours.

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 Victoria - Vauxhall bridge Road, the cosmetic procedure that was also provided is exempt by law from CQC regulation. Therefore we were only able to inspect the treatment for weight reduction but not the cosmetic service.

Patients completed CQC comment cards to tell us what they thought about the service. We received 13 completed cards and all were positive. We were told that the service was excellent, and that staff always made time to listen to people, were helpful and flexible.

Our key findings were:

• All patients received appropriate treatment breaks that were built in to their treatment regimens from the beginning.
• The clinic appropriately refused treatment to people with low weight, co-existing medical conditions or drug interactions.
• The clinic actively sought feedback from users of the service. Any negative feedback was discussed at team meetings where staff came up with ideas for improvement.

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

• Review the need for all doctors and senior staff to have safeguarding training (for both adults and children).
• Review the need to keep records to confirm that the blood pressure machine was regularly cleaned and calibrated.
• Review the current system of who can access medicines supplies in the clinic.
• Review the system of sharing medicines between all the doctors working in the clinic.
• Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.

Victoria- Vauxhall Bridge Road supported adults with a Body Mass Index (BMI) of over 27 to lose weight through a combination of healthy eating, exercise and medication. Before being assessed by a doctor, people met with a Patient Care Manager to discuss their options and current lifestyle patterns. People were given information on the service and menu plans, which had been developed by a nutritionist. People we spoke with told us that the information had been helpful and that they understood what they should be eating.

Everyone was seen by the doctor and their blood pressure taken to determine if medication was appropriate. People were encouraged to attend the service at least once every two weeks. The person was weighed and the doctor reviewed their medication. One person described using the service as a "life changing experience," while another person said "coming here has been the best thing I've ever done for myself".

Medication was stored and prescribed appropriately. Doctors were responsible for ordering and prescribing medication. People who use the service were given information on any possible side effects. We saw evidence that weekly medication audits were undertaken.

The appropriate checks on staff had been carried out before they could start working at the service. The records of people who use the service were kept in locked cabinets that were only accessible to staff. We looked at two people's records and saw that they were fit for purpose.

We did not have the opportunity to speak to people who use services on this occasion. During the review, there was only one service user at the location and this was their first consultation. We did not think it was appropriate to talk to them, but we have considered patient feedback on the website and through the annual patient survey. Patients were overwhelmingly positive about the care, treatment programmes and their individual outcomes. The majority of patients come to the clinic as recommendations through previous patients.