Archived: Jacqui Mac Medispa

Updated 6 April 2023

Jacqui Mac Aesthetics operates from a small building located at the rear of 41 Kirkgate in the village of Silsden, Keighley, West Yorkshire. The service website can be found at www.jacquimac.com. We visited this location as part of our inspection.

On road parking is available to the side of the clinic or on a short drive in front of the clinic.

Services are delivered by the provider who is a registered nurse prescriber, and two further part time registered nursing staff. The service specialises in a combination of medical aesthetic treatments, treatment for obesity and other health conditions and cosmetic procedures, some of which do not fall under the scope of the CQC.

Services are available to adults aged over 18.

The clinic opening times are:

Monday: 9am to 3pm

Alternate Wednesdays: 2pm to 7pm

Thursday: 9am to 7pm

Friday: 9am to 3pm

Alternate Saturdays: 10am to 2pm

Opening times may vary slightly to accommodate patient needs.

The service is registered with the CQC under the Health and Social Care Act 2008 to provide the following regulated activities:

• Treatment of disease, disorder or injury

• Surgical procedures

How we inspected this service:

Before we visited the service, we reviewed the information available to us on the service website and our own internal systems. We also reviewed online feedback from patients and the information provided to us by the service as part of our pre-inspection information return.

We spoke with the two members of nursing staff prior to the inspection.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 6 April 2023

This service is rated as Good overall. (Previous inspection 27 July 2022 – Inadequate)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Jacqui Mac Aesthetics on 22 March 2023. 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 carried out to review the quality of care provided at the location and the breach of regulations identified at the inspection on 27 July 2022.

At the previous inspection in July 2022, we rated the provider as inadequate overall and inadequate for providing safe and well-led services. We rated the provider as requires improvement for providing effective services and good for providing caring and responsive services.

Following the inspection in July 2022, we told the provider to make improvements with regard to Regulation 12, Health and Social Care Act (HSCA) (Regulated Activities) (RA) Regulations 2014 Safe care and treatment and Regulation 17, HSCA (RA) Regulations 2014 Good governance. At this inspection we found the provider had responded to our concerns and made significant improvements following our last inspection.

The provider offers services to manage weight loss, the treatment of hyperhidrosis (excessive sweating) and Polydioxanone (PDO) thread lifts (non-surgical face lift). At the time of our first inspection the service was offering treatment for the management of hay fever; this has now ceased.

This service is registered with CQC under the HSCA 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services, and these are set out in Schedule 1 and Schedule 2 of The HSCA 2008 (Regulated Activities) Regulations 2014.

Jacqui Mac Aesthetics also provides a range of non-surgical cosmetic interventions, for example, Botox, dermal fillers, vitamin injections and cheek contouring which are not within the CQC scope of registration. Therefore, we did not inspect or report on these services. Jacqui Mac Aesthetics is also registered with a national organisation of registered practitioners which review standards for non-surgical cosmetic treatments.

Feedback from patients on the provider’s website was positive and mirrored feedback from online reviews. Approximately 30 online patient reviews had been left within the last four months. The reviews were all exceptionally positive and described the provider and staff as informative, friendly, knowledgeable, and good at listening. All the reviews rated the service as five stars.

We saw that the provider responded kindly to all comments.

Our key findings were:

• The provider had significantly improved record keeping at the clinic. We found that patient records were accurate, complete, and contemporaneous.
• The provider ensured the proper and safe management of medicines at the clinic. We saw that medicines were stored correctly, and environmental and refrigerator temperatures were monitored in line with best practice.
• The provider had established policies, systems and processes which operated effectively to assess, monitor and improve the quality and safety of care.
• We found the consent policy which was in place at the clinic was up to date and followed by the staff team. Consent to treatment and the sharing of information with the patient’s GP was evidenced in the patient records. When appropriate, consultations were shared with the patient’s usual GP to support safe prescribing.
• The processes which were in place for the management of infection, prevention and control kept people safe.
• The provider had significantly improved the management of staff recruitment. A comprehensive overview of skills and mandatory training requirements was maintained.

The areas where the provider should make improvements are:

• Continue with quality audits and the ongoing review of appropriate care and treatment to ensure that standards are maintained in line with best practice.
• Record the discussion and decision to prescribe an ‘off label’ medicine when a licensed alternative medicine is available.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services