Dr Alexandra Chambers Medical and Aesthetic Practice NewApproachComprehensive Report

19 Pages·2017·0.27 MB·English

DDrr AAlleexxaannddrraa CChhaammbbeerrss
MMeeddiiccaall aanndd AAeesstthheettiicc
PPrraaccttiiccee
Quality Report
62WimpoleStreet
London,W1G8AJ
Tel:[phone] Dateofinspectionvisit:6October2016
Website:www.dralexchambers.co.uk Dateofpublication:09/05/2017
Thisreportdescribesourjudgementofthequalityofcareatthislocation.Itisbasedonacombinationofwhatwe
foundwhenweinspectedandareviewofallinformationavailabletoCQCincludinginformationgiventousfrom
patients,thepublicandotherorganisations
1 Dr Alexandra Chambers Medical and Aesthetic Practice Quality Report 09/05/2017
Summary of findings
LetterfromtheChiefInspectorofHospitals
DrAlexandraChambersMedicalandAestheticsPracticeisasmallindependenthospitalofferingcosmeticsurgery
servicestoprivatelyfundedadultpatients.Theservicehasbeenregisteredwiththecommissionsince2011.
ThehospitalwaspreviouslyinspectedbytheCareQualityCommission(CQC)inApril2013.Whenthereportwas
publishedinMay2013wehadconcludedthelocationhadmetallofthestandardsinspected.Onthisoccasionwe
inspectedthehospitalon6October2016aspartofourindependenthospitalinspectionprogramme.Theinspection
wasconductedusingCQC’scomprehensiveinspectionmethodologyandwasaroutineplannedinspection.The
inspectionfocussedontheregulatedactivitiesofsurgicalproceduresanddiagnosticandscreening.Proceduresnot
currentlysubjecttoregulationwerenotpartoftheinspection.
Togettotheheartofpatients’experiencesofcareandtreatment,weaskthesamefivequestionsofallservices:arethey
safe,effective,caring,responsivetopeople'sneeds,andwell-led?Wherewehavealegaldutytodosowerateservices’
performanceagainsteachkeyquestionasoutstanding,good,requiresimprovementorinadequate.
Throughouttheinspection,wetookaccountofwhatpeopletoldusandhowtheproviderunderstoodandcomplied
withtheMentalCapacityAct2005.
Theservicesprovidedbythishospitalwerecosmeticsurgeryandtreatments.
Wehavenotpublishedaratingforthisservice.CQCdoesnotcurrentlyhavealegaldutytoawardratingsforthose
hospitalsthatprovidesolelyormainlycosmeticsurgeryservices.
Ourkeyfindingswereasfollows:
•Therewereadequatesystemstokeeppeoplesafeandtolearnfromadverseeventsorincidents.
•Theenvironmentwasvisiblycleanandwellmaintainedandthereweremeasurestopreventandcontrolthespreadof
infection.
•Therewereadequatenumbersofsuitablyqualified,skilledandexperiencedstafftomeetpatients’needs,andstaff
hadaccesstotraininganddevelopment,whichensuredtheywerecompetenttodotheirjobs.
•Therewerearrangementstoensurepatientshadaccesstosuitablerefreshments,includingdrinks.
•Treatmentandcarewasdeliveredinlinewithnationalguidanceandtheoutcomesforpatientsweregood.
•Patientconsentfortreatmentandcaremetlegalrequirementsandnationalguidance.
•Patientscouldaccesscareinatimelyway,andhadchoicesregardingtheirtreatmentday.
•Staffensuredpatientsprivacyandthedignityofpatientswasupheld.
•Theleadershipteamwerevisibleandappropriategovernancearrangementsmeanttheservicecontinuallyreviewed
thequalityofservicesprovided.
However,therewerealsoareasofwheretheproviderneedstomakeimprovements.Theprovidershould:
• Makearrangementstostoreclinicalequipmentmoreappropriately.
• Checkstaffcomplywiththehospitalpolicyandtheinfectionpreventionandcontrol(IPC)requirementregardingthe
wearingofjewelleryandnailpolish.
• Considerattachingsecuretagstocheckedresuscitationtrolleys
• Considerfurthertrainingforstaffarounddrugcabinetsecurityandcheckingforoutofdatemedication.
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Summary of findings
• Considerhowtoimprovestaffknowledgeofmentalcapacity,dementiaawarenessanddeprivationofliberty
safeguards.
• Considerintroducingaformalhospitalriskregister.
ProfessorSirMikeRichards
ChiefInspectorofHospitals
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Summary of findings
Contents
Summary of this inspection Page
BackgroundtoDrAlexandraChambersMedicalandAestheticPractice 6
Ourinspectionteam 6
Whywecarriedoutthisinspection 6
Howwecarriedoutthisinspection 6
InformationaboutDrAlexandraChambersMedicalandAestheticPractice 6
Thefivequestionsweaskaboutservicesandwhatwefound 8
Detailed findings from this inspection
Outstandingpractice 19
Areasforimprovement 19
4 Dr Alexandra Chambers Medical and Aesthetic Practice Quality Report 09/05/2017
Dr Alexandra Chambers
Medical and Aesthetic
Practice
Serviceswelookedat
Surgery
DrAlexandraChambersMedicalandAestheticPractice
5 Dr Alexandra Chambers Medical and Aesthetic Practice Quality Report 09/05/2017
Summaryofthisinspection
Summary of this inspection
BackgroundtoDrAlexandraChambersMedicalandAestheticPractice
DrAlexandraChambersMedicalandAestheticsPractice • Familyplanning(18May2011)
openedin2010andwasregisteredbyCQCin2011.The • Surgicalprocedures(15April2011)
hospitaloccupiedtwofloorsofaVictorianfivestorey • Treatmentofdisease,disorder,orinjury(18May2011).
buildinginWimpoleStreet,London,anareaknownfor
Thehospitalprovidedelectivecosmeticsurgical
thenumberofprivateindependenthospitalsandclinics.
procedureswhichweinspected.Othercosmetic
DrChambersisthemedicaldirectorandhasalsobeen treatments,whicharenotsubjecttoregulationandthe
theregisteredmanagersince2011. associatedconsultations,werenotinspected.
Thehospitalhasonewardandisregisteredtoprovide CQChaveinspectedthehospitalonthreeprevious
thefollowingregulatedactivities: occasionsin2012and2013.
• Diagnosticandscreeningprocedures(15April2011)
Ourinspectionteam
TheteamthatinspectedtheservicecomprisedaCQC
leadinspector,oneotherCQCinspectorandaspecialist
advisorwithexpertiseinsurgicaltheatrenursing.The
inspectionteamwasoverseenbyNickMulholland,Head
ofHospitalInspection.
Whywecarriedoutthisinspection
Weinspectedthehospitalaspartofourindependent
hospitalinspectionprogramme.
Howwecarriedoutthisinspection
Tounderstandthepatients’experiencesofcare,we nurses,healthcareassistants,receptionstaff,medical
alwaysaskthefollowingfivequestionsofeveryservice staffandseniormanagers.Wespokewithtwopatients.
andprovider:•Isitsafe?•Isiteffective?•Isitcaring?•Isit Wealsoreceived21‘tellusaboutyourcare’comment
responsivetopeople’sneeds?•Isitwell-led? cards,whichpatientshadcompletedpriortoour
inspection.Duringourinspection,wereviewedsixsetsof
Weanalysedinformationthatweholdontheservice
patientrecords.
priortoourinspection.Duringtheinspection,wevisited
oneward.Wespokewithsixstaffincluding;registered
InformationaboutDrAlexandraChambersMedicalandAestheticPractice
DrAlexandraChambersMedicalandAestheticPractice bothmaleandfemalepatientsovertheageof18and
openedin2010.Sincethenthelocationhasprovided under75years.ThehospitalopenedMondaytoFriday
electivecosmeticsurgicalandaestheticproceduresto
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Summaryofthisinspection
Summary of this inspection
andoneSaturdaypermonth.Thefacilitiesincludedtwo Wedonotcurrentlyhavealegaldutytoratethisservice
consultationrooms,anoperatingtheatreusedfor ortheregulatedactivitiesitprovidesbutwehighlight
surgicalprocedures,asinglebedward,onetreatment goodpracticeandissuestheserviceprovidersshould
roomandvariousothernon-clinicalareas. improve.
Therewere1,496patientappointmentsintheperiodJuly
2015toJune2016.Theseappointmentswerefor
aesthetictreatmentsaswellascosmeticsurgical
procedures.Inthesameperiodtherewere105visitsto
theatre.
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Summaryofthisinspection
Summary of this inspection
Thefivequestionsweaskaboutservicesandwhatwefound
Wealwaysaskthefollowingfivequestionsofservices.
Are services safe?
Wefoundthereweresystemstoreportandinvestigatesafety
incidentsandtolearnfromthese.Patientrecordswereproperly
completedandpatientriskmitigatedbypre-admissiontestingand
arobustassessmentprocess.TheatrestaffcompletedtheWorld
HealthOrganisation(WHO)surgicalchecklistduringproceduresand
theyhadenoughproperlymaintainedequipment.However,the
serviceneededtoimprovestaffcompliancewithinfection
preventionandcontrol(IPC)standardsanddrugcabinetsecurity.
Are services effective?
Carewasplannedanddeliveredinaccordancewithcurrent
guidance,bestpracticeandlegislationbysuitablyskilledand
competentstaff.Therewasaprogrammeofaudit,whichwasused
toassesstheeffectivenessofservicesandtomaintainstandards.
Patients’painwaswellcontrolled,andtheirnutritionalneedswere
met.However,theserviceshouldconsiderimprovingstaff
knowledgeofmentalcapacity,dementiaawarenessanddeprivation
oflibertysafeguards.
Are services caring?
Patientsweretreatedwithkindnessandrespect.Patientsgave
positivefeedbackandsaidtheyweretreatedwellbystaff,andwith
compassionanddignity.
Are services responsive?
Serviceswereplannedtomeettheneedsandchoicesofpatients,
andthearrangementsfortreatmentwereprompt.Therewere
arrangementstoensuretheindividualneedsofpatientswerefully
considered,assessedandmet.Complaintswereappropriately
acknowledged,investigatedandrespondedtoinatimelyway.
Are services well-led?
Theservicehadawell-establishedleader,whohadanexcellent
workingrelationshipwiththeirstaff.
Staffunderstoodwhatthevaluesandpurposeoftheservicewere,
andwhatwasexpectedofthem.Theywerecommittedtomeetthe
requirementsoftheirpatients.
Patentsandstaffwereencouragedtofeedbackonthequalityof
services.
Thegovernancearrangementsprovidedassuranceofsystematic
monitoringofthequalityofservices.
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Summaryofthisinspection
Summary of this inspection
However,althoughrisksweremanaged,aformalriskregisterwas
notinusetocapturesuchinformation.
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Surgery
Surgery
Safe
Effective
Caring
Responsive
Well-led
notifypatients(orotherrelevantpersons)ofcertain
Aresurgeryservicessafe?
‘notifiablesafetyincidents’andprovidereasonable
supporttothatperson.Thismeansprovidersmustbe
Safemeanstheservicesprotectyoufromabuseand openandhonestwithserviceusersandother‘relevant
avoidableharm. persons’(peopleactinglawfullyonbehalfofservice
users)whenthingsgowrongwithcareand
Incidents
treatment,givingthemreasonablesupport,truthful
• Thehospitalhadnotreportedany‘neverevents’ informationandawrittenapology.Thestaffwespoke
betweenJuly2015andJune2016.Nevereventsare withhadagoodunderstandingof‘dutyofcandour’.The
seriouspatientsafetyincidentsthatarewholly hospitalstaffactedaccordingtothedutyofcandour
preventableandshouldnothappenifhealthcare policyintheclinicalincidentmentionedabove.The
providersfollownationalguidanceonhowtoprevent patientandherpartnerwerekeptinformedthroughout,
them.Eachnevereventincidenttypehasthepotential theyreceivedanapology.Inadditiontheirpaymentwas
tocauseseriouspatientharmordeathandmustbe refunded.
reportedtoCQCasaseriousincidentevenifitdidnot
ClinicalQualityDashboardorequivalent(howdoes
resultinharmtothepatient.Anynevereventindicatesa
theservicemonitorsafetyanduseresults)
failureinmeasurestokeeppeoplesafefromharm.
• Thestaffwespokewithwerefullyawareofhowto • Thehospital,unlikeNHStrusts,wasnotrequiredtouse
reportincidents.Theincidentwastheninvestigatedby thenationalsafetythermometertomonitorareassuch
themedicalandmanagingdirectors.Informationonthe asvenousthromboembolism(VTE).However,wesaw
stepstakentorectifymatters,andthefinaloutcomes evidenceinpatient’srecordswereviewed,which
werefedbackatregularbi-monthlymeetingsattended demonstrated100%compliancewithmonitoringand
byallstaffandthemedicaldirector. reportingofVTEassessmentsduringtheperiodJuly
• In2015afemalepatient,whohadpreviouslyundergone 2015andJune2016.Theassessmentofpatientsforthe
cosmeticsurgerywithoutincident,hadan riskofVTEwasinlinewithvenousthromboembolism:
unanticipatedandrarereactiontoadrugusedduringa reducingtheriskforpatientsincentreNICEguidelines
minifaceliftprocedure.Thepatientwasstabilisedand CG92.
transferredtoanotherprivatehospitalwhereshe
Cleanliness,infectioncontrolandhygiene
remainedovernightasaprecautionarymeasure.Aroot
causeanalysiswasundertakenintotheincidentand • ThehospitalhadasuitableInfectionPreventionand
properlydocumented.Learningfromtheincidentwas Control(IPC)policy,andstaffwespokewithwereaware
communicatedtoallclinicalstaff. oftheIPClead.WesawevidenceofyearlyIPCreportsby
• FromNovember2014,registeredpersonswererequired anindependentexternalcontractorandregularinternal
tocomplywiththedutyofcandour,Regulation20ofthe auditswereconductedbytheIPClead.Thestaffhad
HealthandSocialCareAct2008(RegulatedActivities) signedtoconfirmtheyhadreadthetheatreIPCpolicy.
Regulations2014.Thedutyofcandourisaregulatory StaffwereupdatedonIPCmattersattheregular
duty,thatrelatestoopennessandtransparency,and bi-monthlystaffmeetings.
requiresprovidersofhealthandsocialcareservicesto
10 Dr Alexandra Chambers Medical and Aesthetic Practice Quality Report 09/05/2017