111 Harley St.

Updated 23 March 2023

American Cosmetic Surgery Ltd trading as 111 Harley St. is a small independent clinic offering elective cosmetic surgical and aesthetic procedures to both male and female patients over the age of 18 years. The clinic offered services to privately funded adults only and include cosmetic and reconstructive surgery.

The clinic is registered to provide the following regulated activities:

• Surgical procedures

• Treatment of disease, disorder or injury

The on-site surgical procedures are carried out under local anaesthetic. The consultants performed surgical operations requiring conscious sedation or general anaesthetic at other local private hospitals under their practising privileges.

The medical director is the nominated individual and the practising consultant at the location. There has been a registered manager in the post since the clinic registered with the commission in 2019.

At the time of the inspection, the clinic employed a managing director (the registered manager), two surgical nurses, a healthcare assistant and two patient co-ordinators.

The location was rated requires improvement following a comprehensive inspection of the service in August 2022. Following the August 2022 inspection, we used our enforcement powers to serve a Warning Notice to the provider for breaches under section 29 of the Health and Social Care Act 2008. The warning notice was served for failing to comply with Regulations 12: Safe Care and Treatment. We carried out a focussed follow up inspection on 24 January 2023 to check compliance with concerns identified in the Warning Notice issued in October 2022. Following this inspection, we used our enforcement powers to serve a Warning Notice to the provider for outstanding breaches under section 29 of the Health and Social Care Act 2008. The warning notice was served for failing to comply with Regulations 12: Safe Care and Treatment.

We previously inspected this service in August 2022 and rated it as overall requires improvement, with safe as inadequate, effective, caring and responsive as good and well led as requires improvement. We did not re-rate the service at this inspection as we only inspected and reported on specific key lines of enquires and previous rating remains unchanged.

Updated 23 March 2023

We carried out an inspection of 111 Harley St. using our comprehensive methodology on 3 and 9 August 2022. This was the first time we rated this service. We rated it as requires improvement because:

• The provider did not have control measures to protect patients, themselves and others from infection. The provider did not ensure equipment and the premises were clean. Staff did not manage clinical waste well and systems were non-compliant with the safe management of disposal of healthcare waste HTM 07-01.
• The design, maintenance and use of facilities and premises did not keep people safe. The design and layout of the basement where the theatre was located did not provide effective identification of clean and dirty areas.
• The service did not have effective systems to store and check emergency medicines.
• The service did not manage patient safety incidents well.
• The service did not audit pain.
• The complaint policy did not state the process for referring unresolved complaints for independent review.
• Leaders did not manage risks well. Not all staff were aware of the vision of the service. Equality and diversity training was not offered to all staff. The service did not carry out any staff survey.

However,

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. The registered manager made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders were visible and approachable in the service for patients and staff and supported staff to develop their skills. Staff felt respected, supported and valued. Staff were clear about their roles and accountabilities. The service engaged well with patients.

Following this inspection, we have taken regulatory action and served a warning notice under Section 29 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as we believe the quality of health care at the service required significant improvement. We may take further action if the registered person does not comply with the notice within the stated timescale and the breach continues. For information about what the service needs to do to improve, see the Areas for improvement section.

Updated 11 November 2022

We rated this service for the first time. We rated it as requires improvement because:

• The provider did not have control measures to protect patients, themselves and others from infection. The provider did not ensure equipment and the premises were clean. Staff did not manage clinical waste well and systems were non-compliant with the safe management of disposal of healthcare waste HTM 07-01.
• The design, maintenance and use of facilities and premises did not keep people safe. The design and layout of the basement where the theatre was located did not provide effective identification of clean and dirty areas.
• The service did not have effective systems to store and check emergency medicines.
• The service did not manage patient safety incidents well.
• The service did not audit pain.
• The complaint policy did not state the process for referring unresolved complaints for independent review.
• Leaders did not manage risks well. Not all staff were aware of the vision of the service. Equality and diversity training was not offered to all staff. The service did not carry out any staff survey.

However,

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. The registered manager made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders were visible and approachable in the service for patients and staff and supported staff to develop their skills. Staff felt respected, supported and valued. Staff were clear about their roles and accountabilities. The service engaged well with patients.