Wimpole Aesthetic Centre (WAC) is operated by Wimpole Aesthetic (Medical) limited. The hospital has no inpatient beds. Facilities include an operating theatre, treatment rooms (one of which was used for laser treatments) and a reception area.

The hospital provided cosmetic surgery and non–regulated cosmetic treatments to adult patients.

We inspected this service using our comprehensive inspection methodology on 28 March 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We regulate cosmetic surgery services, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

During our inspection we found significant concerns, and the provider needed to improve in a number of areas. This included staff recruitment and training, governance arrangements relating to other medical professionals working at the service, infection prevention and control, and adherence to surgical safety protocols, including the World Health Organisation surgical safety checklist. They also needed to make improvements with regard to the management of medicines.

Following this inspection, we told the provider that it must take some urgent actions to comply with the regulations. They were asked to make other improvements to the service, even though a regulation had not been breached. Details are at the end of the report. Following our inspection we took the unusual step to suspend the regulated activity of surgery until further notice because of our concerns about patient safety.

On 28 June 2017, the Head of Inspection (London South Acute Hospitals), a CQC inspector and a specialist advisor returned to the hospital to conduct an announced focused inspection. We are able to report the hospital had made significant improvements in all areas previously of concern.

However, we found the process for the decontamination of surgical instruments was contrary to best practice, government issued guidelines and the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance. As a result we issued a warning notice requiring the provider become compliant by 4 August 2017. Full details can be found at the end of this report.

Taking the areas of improvement into account we were sufficiently assured regarding patient safety to lift the suspension of the regulated activity of surgery. We will return to conduct a further focussed inspection in the near future to ensure the provider continues to meet the requirements of the HSCA and associated regulations.

Professor Edward Baker

Chief Inspector of Hospitals

We spent time talking to people that use the service during our visit. They were mainly positive about the service and made comments which included "staff are very welcoming and I am very happy with the treatment I have had at the clinic" and "I could go anywhere for my treatments but I choose here and have been coming for over five years". We also saw a recent patient feedback audit from November 2011 to November 2012 which documented positive patient views of the service. People were also positive about the amount of information they received and the respect they were shown by staff.

There were processes to assess each person's suitability for treatment prior to it taking place. Information was available about each procedure the service provided.

People who had used the service were encouraged to give feedback. Policies and procedures were available to staff. The provider had systems to review and monitor the quality and safety of the service provided.

On this occasion we did not speak to people about this service as there were no patients available to talk to on the day of the inspection.

Wimpole Aesthetics Centre Ltd is operated by Wimpole Aesthetics (Medical) Ltd . The service did not provide in-patient facilities and patients did not stay overnight at the location. Facilities include two theatres with one being used as a recovery room, clinic rooms, treatment rooms and waiting area.

The centre provides elective non-major cosmetic surgery for adults. The centre did not treat any patient under 18 years old. We inspected the service under our cosmetic surgery core service framework.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 25 September 2018, followed by an announced visit to the centre on 4 October 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Summary

We rated Wimpole Aesthetic Centre Ltd as Inadequate overall. We inspected the service in March 2017 and did not have the power to rate the service at that time. We found areas of regulatory breaches and had concerns including; lack of screening new admissions, lack of governance structures, lack of employment checks and more which can be found in the previous inspection report. Although the service had improved in a limited way since our last inspection, we found some new areas of concern and there were still areas where the service still did not meet legal requirements.

We found the following:

• The centre had started providing mandatory training to all staff as it did not previously, however it was not ensuring staff were completing their training.
• The centre did not manage infection risk well. They did not screen patients for micro-organisms before procedures and did not monitor surgical site infection rates.
• The centre did not have a detailed policy regarding a deteriorated patient and did not have access to evacuation equipment.
• Staff did not complete VTE risk assessments for patients recommended by NICE guidance.
• Staff kept records of patients’ care and treatment, however they were of variable quality and not all aspects of the pathway were recorded.
• Staff recognised incidents and reported them appropriately, however there was no formalised system of reviewing incidents or sharing the learnings.
• The centre did not collect safety information and use this to improve the service.
• The centre did not fully provide care and treatment based on national guidance and evidence of its effectiveness.
• Staff did not record any assessments or observations for patients regarding pain.
• The centre did not monitor the effectiveness of care and treatment.
• The provider did not appraise staff’s work performance or hold supervision meetings with them to provide support and monitor the effectiveness of the service.
• The centre was unable to evidence that it took account of people's individual needs.
• Managers did not always have the right skills and abilities to run a service providing high-quality sustainable care.
• The centre did not have a vision for what it wanted to achieve.
• The centre still lacked a robust governance system and risk management system.
• The centre had limited engagement with patients regarding improving the service.

However;

• Staff had training on how to recognise and report abuse.
• Staff kept themselves, equipment and the premises clean.
• The centre had suitable premises and equipment and looked after them well.
• Patients received the right medication at the right dose at the right time.
• Staff of different kinds worked together as a team to benefit patients.
• Staff always had access to up-to-date and accurate information on patients’ care and treatment.
• The centre planned and provided services in a way that met the general needs of its patients.
• People could access the service when they needed it
• The centre treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• The centre promoted a positive culture that supported and valued staff.

Following this inspection, I am placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration

We told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Edward Baker  

Chief Inspector of Hospitals