Liverpool Skin Clinic

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all 8 quality statements from this key question for the service. Our rating for this key question has improved to requires improvement. We did not see evidence of learning or actions taken from external safety events. Risks were not always managed and reviewed to keep people safe. We found concerns with some infection control practices of the service. We also found an instance of staff performing duties they were not qualified to undertake. There were gaps in processes to monitor the prescribing and disposal of medicines. Risks were understood and care and treatment were mostly delivered in safe environments. The service mostly provided qualified, skilled and experienced staff, who worked together effectively to provide safe care that met patient's individual needs. The service planned care and treatment with people in way that ensured and maintained their safety across their care journey .

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. They felt the service took concerns seriously and used them to make improvements to their care.

Staff told us the service had a process of reporting incidents and felt confident in reporting incidents. They were able to describe types of clinical and non-clinical incidents they would report. They told us that the service had not had any incidents since our last report. Leaders were working to embed a culture of openness and collaboration, but it was not consistent, and learning was not always shared with staff. Staff understood their responsibility to be open and honest with patients and their relatives when something had gone wrong.

The service was registered to receive external alerts however, there was no process in place to support continuous learning from these alerts. The service had a policy and procedure in place for acting on complaints received. However, they were past their review date at the time of our inspection.

People told us the service managed their care well from pre-procedure to post-procedure and were told what to expect in terms of their recovery. People were clear about their next steps, including their medication and how to contact the service if they had any issues.

Staff followed policies and procedures and worked together to provide safe and effective care throughout the patient’s journey. Care and support were planned and organised to ensure continuity of care for the patient. There was staff awareness of the risks to people across their care journey and the service had processes in place to keep patients safe.

We contacted partners that worked with the service and no concerns were raised.

Policies and processes about safety were aligned to include other key partners such as primary care, who were involved in people’s care journey to enable shared learning. Pre-treatment disclaimer forms included gaining consent from patients to contact their primary care provider if there was clarification needed about a patient’s health history before their procedure.

People who provided feedback did not have any concerns regarding safeguarding at the service.

Staff understood their responsibilities for safeguarding of patients. Leaders confirmed that they did not treat patients under the age of 18.

The service had an adult and children safeguarding policy including relevant legislation however, this was past the review date. Adult safeguarding policy included guidance for staff to report any concerns of female genital mutilation (FGM). Although we received verbal confirmation from clinical leader while we were on site, the children’s safeguarding policy did not make it explicit that the service would only treat people over the age of 18.

Patients told us they were well informed about potential risks and benefits to the procedure they were having. They had been given details about the surgical procedure and the post-treatment recovery period. Information had been given to them both verbally and in paper format. They had been given time to ask questions about their care and treatment.

Staff explained the hair transplant surgical pathway to us and how risk was assessed and reviewed regularly throughout the patient’s care journey. Staff completed risk assessments for patients undergoing procedures and used nationally recognised tools such as observation charts and pre-surgical checklists. Care plans were developed using this information to provide care and treatment and minimise risks as identified.

The service had resuscitation equipment and medication on site however, there was no clinician trained in Advance Life Support (ALS) as recommended in surgical settings by the Resuscitation Council UK. Following our inspection, we were informed the hair surgeon was preparing to complete their ALS training.

We saw evidence of risk assessments being completed and acted upon in patient records. The service only admitted patients after assessing whether the service had the facilities and expertise to care for. Acceptance for hair transplant surgery was only considered on the presentation of all relevant clinical evidence, a risk assessment and the formulation of a plan to mitigate risk. All staff had training in immediate life support including the surgeon.

Feedback from patients was positive regarding the environment and they did not raise any concerns regarding the clinic’s facilities.

Staff told us they had enough suitable equipment to support them to safely care for patients. They scheduled procedures so that there was only one patient at a time undergoing treatment at the service.

During our inspection, we observed that some electrical plugs were overloaded. Some equipment was not routinely calibrated to ensure that there were suitable for intended use. The service had easy to clean floors. There was a steel trolley and an emergency trolley containing in date supplies in line with Cosmetic Practice Standards Authority (CPSA) guidelines. The service had a process of monitoring electrical testing of equipment.

The service did not always follow policies and procedures to ensure facilities, equipment and technology were well-maintained and ready for use which meant staff were not supported to deliver safe and effective care. Environmental risk assessments were not always carried when due and recommended actions were not implemented. The service informed us this was an ongoing issue with their landlord.

Patients told us they felt safe and knew how to contact staff if needed. They told us staff were always around.

Staff told us they received ongoing training appropriate and relevant to their role. Staff appraisals did not routinely happen. However, because it was a small service, development needs were flagged and acted upon in the absence of a formal appraisal. Staff worked closely with the hair surgeon and were supervised during procedures. The hair surgeon had an active GMC registration and recently completed her professional revalidation.

On the day of inspection, there were no patients undergoing clinical procedures on site so observations could not be completed.

The service could not evidence that they had a robust process for monitoring mandatory training compliance among staff. The service did not always follow policies and procedures to ensure staff were competent for their roles, received regular development meetings and annual constructive appraisals of their work to identify training needs, good and poor performance . The clinic manager was 64% compliant with mandatory training. The hair transplant technician was 70% compliant with mandatory training. And the hair transplant surgeon was 80% compliant with mandatory training.

Feedback from patients was positive regarding the environment with patients saying rooms were clean and comfortable.

Not all staff had received appropriate training and fully understood their roles and responsibilities in relation to infection prevention and control. Clinical manager could not evidence vaccination records for hepatitis B for all clinical staff as required by NHS guidelines for health care workers.

We observed the presence of appropriate PPE with posters with information on donning and doffing. We observed washing facilities and the availability of single use equipment. The blood spinner, which was used for platelet rich-plasma injections, was clean without spills of biohazardous materials. The service had a desktop autoclave which was used for surgical bowls and tracked to each patient use. However, cycle audits were not completed to ensure the proper sterilisation of equipment. We received correspondence from the provider after our inspection that the service had discarded the autoclave and strictly used single use equipment. We observed a sharp bin which was not assembled correctly thus not fully compliant relevant IPC requirements.

The service did not meet current national guidance and standards in relation to infection control. Policies, procedures and practices on infection control were up to date however, they were not applied consistently by relevant staff. We were told that daily cleaning audits were carried out, but we could not be provided with evidence of this while on site. The service provided us with a cleaning log 3 weeks post inspection. Monthly hand washing audits were not always completed.

Service had no reported post procedure infection since the last inspection.

People did not raise concerns with us regarding medicines and pain management.

Patients were prescribed local anaesthetic, pain control and antibiotics in a timely manner. The clinical lead told us this was based on best practice in the field and knowledge. However, they could not provide evidence of which guidelines which they were based on.

We observed an an instance of staff, without evidence of medicines training, co-signing for medication administration. The service did not keep a stock of controlled drugs. However, the controlled drugs book was used to record and track medicines stocked. There was no name and signature log in the controlled drugs book to properly account for who was responsible for administering medicines . Prescription stationery was not numbered or logged. Therefore, we could not be assured that prescription stationery could be accounted for. However, we observed that medicines were stored safely and securely.

The service had a process of prescribing medicines. Allergies were noted on patient medicine records. The service had a medicine management policy which was passed its review date at the time of inspection. The service did not always keep records of proper disposal of medicines.