We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Sk:n - Brighton Jubillee Street 8-9 Jubilee Street, Brighton, BN1 1GE Tel: Date of Inspection: 14 November 2013 Date of Publication: December 2013 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Safety and suitability of premises Safety, availability and suitability of equipment Assessing and monitoring the quality of service provision Inspection Report Sk:n - Brighton Jubillee Street December

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Lasercare Clinics (Harrogate) Limited Miss Emily Lilian Rose McHenry Sk:n Brighton is a private clinic owned by Lasercare Clinics (Harrogate) Limited. The service provides non-invasive cosmetic skin treatments, including laser hair and tattoo removal. Acute services without overnight beds / listed acute services with or without overnight beds Diagnostic and screening procedures Surgical procedures Treatment of disease, disorder or injury Inspection Report Sk:n - Brighton Jubillee Street December

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Safety and suitability of premises 10 Safety, availability and suitability of equipment 12 Assessing and monitoring the quality of service provision 14 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Sk:n - Brighton Jubillee Street December

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 14 November 2013, observed how people were being cared for and talked with people who use the service. We talked with staff. What people told us and what we found We spoke with the registered manager, two beauty therapists and four people who used the service. We found people were involved in making decisions about their care and treatment and there was comprehensive information available to support them. One person said, "They definitely explained the process and answered any questions." There was a stringent system of checks to ensure that people received treatment that was safe and appropriate to their needs. We found the premises were well maintained. The environment was pleasant and suitable for the regulated activity being carried out. Government guidance that ensured the safe use of lasers was being followed. There was a system of receiving and following up feedback from people who used the service. There were arrangements to record, report and analyse critical incidents and complaints and to disseminate learning from these. There was a comprehensive audit programme that ensured the safety of staff and people who used the service. People were satisfied with the service provided. One person summed up their experience as, "Friendly, informative and excellent." You can see our judgements on the front page of this report. Inspection Report Sk:n - Brighton Jubillee Street December

5 More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Sk:n - Brighton Jubillee Street December

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement People who use the service understood the care and treatment choices available to them. All people had an initial consultation with an appropriately qualified person. A staff member told us, "I always tell them about the clinic, who works here, the treatment process, what to expect and what will happen and any adverse reactions." One person told us, "They definitely explained the process and answered any questions." Another person said, "The staff are lovely. They offered me treatment that would be better. They had the information to hand along with the prices. I didn't feel pressured." We accessed the provider's website and found this contained all relevant information on the provider's services. The range of treatments was fully described with frequently asked questions answered. These included when treatments would be appropriate, expected results, the treatment process and aftercare. There was also information on costs. We also saw there was wide range of literature displayed in the waiting room for people to take away. This meant that when people were considering treatment there was information to support them. However, we noted that literature was only available in English. Before commencing treatment people signed a consent form. When people were seriously considering treatment we saw that more detailed information on the risks were made explicit. We saw this was recorded on people's consent forms. This meant people were made aware of any risks their treatment presented and signed to indicate their agreement to treatment. We saw that the costs of people's treatment were recorded in people's records. People told us that they were made aware of the costs of their treatment before treatment. The clinic offered finance options to spread the cost of treatment. Someone told us, "The finance paperwork gets ed to me, which makes things easy." This showed that people were made aware of the cost of treatment so they use this information when making a decision to proceed. Inspection Report Sk:n - Brighton Jubillee Street December

7 The manager told us they treated a number of people for who English was not their first language. The clinic did not employ translation services. However, we were told that people were encouraged to bring in someone who could translate for them. We were told if there was any doubt regarding a person's understanding of the treatment and its risk, then it was not carried out. The manager gave us examples of this. This showed that consideration was given to the communication needs of people with limited English. The clinic opened seven days a week until 8pm. We observed staff gave people options on appointment times and showed considerable flexibility to meet people's commitments and the timescales necessary to optimise their treatment. One person told us, "They are good at giving appointments at the time I want." This meant that people could access treatment easily when convenient for them. We observed people were treated with respect. Staff appeared friendly, welcoming and did all they could to meet people's preferences. We saw that treatment was carried out in private. Photographs of intimate areas in people's records that were necessary for the recording and evaluating of treatment were appropriately censored. People's records were securely kept. This meant that the privacy and dignity of people who used the service was upheld. Inspection Report Sk:n - Brighton Jubillee Street December

8 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We found that people use used the service received an initial consultation with staff appropriately trained to meet their care needs. We saw that there were computer records which detailed which staff were able to carry out consultations for each treatment. These formed part of the booking system which meant that consultations could only be booked with the appropriate staff and in a room with suitable equipment. For example, the consultation for any treatment which included any injection had to be made with a doctor. We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at four sets of records. We noted people's records included their medical history, allergies, medications and any reasons why the requested treatment would not be safe or appropriate. A pre-treatment check list was completed and retained in the people's file. We saw that people who used the service completed a skin type questionnaire and their individual skin type would be confirmed by the nurse. A patch test was performed before commencement of treatment and was repeated if necessary, for example if the skin was tanned or the site of treatment changed. This was to ensure that the treatment offered was safe and appropriate for the person's skin type. A staff member told us, "We cannot treat people unless a skin patch test and pre-treatment checklist has been completed". At subsequent appointments, or if the treatment has changed, we found that staff reviewed people's files and the person's health history to ensure there had been no changes since the last treatment administered which would make their treatment inappropriate. There were detailed records of each treatment given, and progress notes recorded in people's files. This meant that there were systems to ensure that any treatment provided was appropriate and safe. We saw from the records we looked at that people were given information and advice about their treatments and aftercare. One person who used the service told us "Everyone Inspection Report Sk:n - Brighton Jubillee Street December

9 was really friendly; it could be daunting if they weren't, but they really look after you." Staff told us "We must be sure that people understand the treatment and side effects". One person who used the service told us "They were clear in explaining after care and what I shouldn't do in the next 72 hours". We found that some people had been declined treatment. The manager told us about a person who was declined treatment due to their mental wellbeing and we saw records that detailed how this decision was made. The manager and staff we spoke with told us that they did not offer treatments, such as Botox injections to people under 25 years of age unless there was a clear medical reason for the treatment. Staff we spoke with told us that if they are unsure of the safety or appropriateness of performing a treatment they would seek clarification from the nurse or doctor. This showed that the provider was aware when care and treatment is not in the best interest of the person and did not perform it. We found that the service had clear care treatment pathways for the treatment of acne and laser hair removal. These were clearly displayed to people who used the service and staff. The manager told us these were developed by the provider based on up to date research and guidance. This meant the provider was providing evidence based treatment. We found there were systems that ensured treatments given conformed to agreed protocols. Details of every day's treatment were sent electronically to the provider's head office where they were analysed. Any treatments that were given outside of the protocols were notified to the manager for further investigation. We saw the records of this system. Additionally, each therapist or health professional had a random sample of their treatment records audited each month and any issues were resolved on an individual basis. We saw records that confirmed this. This meant that there were systems to check that staff providing treatment were doing so safely. We saw there were robust arrangements for managing skin specimens sent for laboratory analysis. We saw there was a log which detailed when samples were sent, when results were received, when the doctor reviewed them and when the person was informed of the result. This ensured that people's results were reviewed by an appropriate person and they were made aware of the result. There were arrangements in place to deal with foreseeable emergencies. A disaster recovery plan was in place and a local business next to the service also held a copy of the disaster recovery plan. All staff were required to attend basic mandatory life support and first aid training. Staff told us they completed this training annually. We saw copies of the staff training matrix confirming all staff had completed first aid and basic life support. We saw the first aid kit in an easily accessible position. We saw that staff were welcoming, polite and respectful when speaking with people and that they took the time to understand the person's individual needs. People we spoke with were positive about the service they received. One person summed up their experience as "Friendly, informative and excellent." Inspection Report Sk:n - Brighton Jubillee Street December

10 Safety and suitability of premises People should be cared for in safe and accessible surroundings that support their health and welfare Our judgement The provider was meeting this standard. People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. Reasons for our judgement The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. We toured the building and noted it was clean and hygienic and was well maintained. The reception and waiting areas were light and pleasant spaces. There was adequate comfortable seating and there were facilities for people to access drinking water. The treatment rooms allowed for consultations and treatments to be carried out in private. We noted that treatment rooms had matt surface decoration, and cupboards and other fittings had non-reflective surfaces. This was essential in minimising the risk of laser induced eye injuries. This meant the premises were suitable for the registered regulated activities. The manager described the process for maintenance of and repairs to the premises. We saw the contact list numbers. The provider had a maintenance team, and the manager could access outside contractors if this would result in the problem being fixed more quickly. Some services such as the air conditioning were subject to national contracts. The manager told that they had not experienced any difficulties getting maintenance tasks and repairs completed in a timely way. This meant there were systems to ensure the premises were kept in a sound state of repair. The clinic had level access suitable for wheelchair use. Treatment rooms were also accessible for disabled people. We also noted there were disabled toilet facilities. This meant that the clinic was compliant with the access requirements of the Disability Discrimination Act. We saw that hazardous waste was segregated and stored securely while awaiting collection by an approved contractor. This showed there were appropriate facilities for storing hazardous waste. We saw that public areas were covered by closed circuit TV. The clinic is situated in a busy urban street. The manager told us they could lock the door and rely on buzzer access if they felt that street activity presented any kind of security risk. We saw this system in operation when the reception desk was unattended. We saw there was a system Inspection Report Sk:n - Brighton Jubillee Street December

11 for controlling access to keys for the building, and there was a suitable alarm system in operation when the clinic was closed. This meant there were adequate security arrangements. We were shown the clinics fire risk assessment. We checked a sample of fire control measures and found they were in place. For example, we saw there were no smoking signs, adequate fire extinguishers and fire escape routes were marked and clear. This showed that there were appropriate measures in place to manage the risks of fire. Inspection Report Sk:n - Brighton Jubillee Street December

12 Safety, availability and suitability of equipment People should be safe from harm from unsafe or unsuitable equipment Our judgement The provider was meeting this standard. People were protected from unsafe or unsuitable equipment. Reasons for our judgement In 2008 the Medicines and Healthcare Products Agency (MHRA) published 'Guidance on the safe use of lasers, intense light source systems and LEDs in medical, surgical, dental and aesthetic practices. DB20018(03).' We found people were protected from unsafe or unsuitable equipment because the provider had because followed this government guidance. We saw that the provider had a designated Laser Protection Advisor and staff we spoke with knew who they were and how to contact them. There was also a designated Laser Protection Supervisor for the premises and we were told the arrangements for cover when this person was absent. This meant that staff had access to specialist advice on the safe use and management of laser equipment. Safety information for people who use the service was displayed in treatment areas. We saw that treatment protocols for each laser machine were displayed close by and staff referred us to these. Local rules which described the safe operation of laser equipment were present in each treatment room. These contained all the information specified by the guidance. Staff had signed to indicate they had read and understood each set of local rules. Staff we spoke with knew where these documents could be found. This showed that there was readily available information to ensure the safe use of laser equipment. We were shown training records which indicated that staff operating lasers were appropriately trained and their competency assessed on an on-going basis. Staff we spoke with told us that they were qualified practitioners when appointed to their jobs and confirmed that had undergone further training by the provider. We saw s where the outcomes of supervision sessions by the providers training staff were discussed. This indicated that staff using laser machines to treat people were trained and competent to do so. Staff we spoke with described in detail the safety checks that were carried out each day to ensure the laser machines remained fit for use. We saw that there was a record of these safety checks. The provider employed a team of specialist engineers who carried out routine maintenance of the laser machines. When machines developed faults this team were called to repair the equipment. The staff we spoke with all knew the process for reporting a fault and informing the engineering team. We saw that a log of faults, and Inspection Report Sk:n - Brighton Jubillee Street December

13 corrective actions taken was maintained. This showed that laser machines were checked and maintained to ensure they were safe to use. Outside each treatment room there was a warning sign indicating laser equipment was in use. We observed a no-entry sign was automatically illuminated when a laser was in operation. This meant that the staff and others were aware that hazardous equipment was in use and risks of accidental exposure were minimised. The use of lasers presents a risk of eye injury and damage to sight. We were shown that each room had eye protection for staff and people undergoing treatment. We saw there was a system for ensuring that the eye protection was appropriate for the laser machine used and was checked to ensure it was fit for purpose. We saw records that showed that eye protection was checked daily. Staff were clear about the importance of always using eye protection. This showed there were measures in place to minimise the risk of laser induced eye injury. The use of lasers creates a vapour plume which can be hazardous to the operator's health if inhaled. The vapour plume is not considered a risk to people undergoing treatment. Staff told us that laser face masks were used and we saw that these were present in treatment rooms. This meant the risks of vapour inhalation were minimised. Inspection Report Sk:n - Brighton Jubillee Street December

14 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive and had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Reasons for our judgement People who use the service were asked for their views about their care and treatment and they were acted on. Every person who used the service was sent a customer satisfaction survey. If they indicated dissatisfaction with the service, they were contacted by the manager who would aim to resolve any issues. We saw computer records that logged the outcome of satisfaction surveys, and trains which showed that the manager had contacted the person and discussed how things could be improved. For example, we saw someone was dissatisfied with the progress of their tattoo removal. We saw that the equipment was checked to ensure it functioned correctly and that a free session had been offered. We found there was a robust complaints system. Any complaints were logged on a computer system and the results of investigation and any actions taken were logged. These records were also kept in hard copy. We saw that any complaints were thoroughly investigated and appropriate actions taken. We saw that a complaint about the use of promotional vouchers had resulted in the person being offered a complimentary treatment and that the terms and conditions of the voucher scheme had been made clear to staff and were displayed in the office. We saw there was an effective system for recording and reviewing incidents. Incident reports were signed off by a senior person within the team and sent to the provider's head office who checked the report and advised if further action was necessary. We saw an example where a person had moved during treatment and this had resulted in "scuffing", to delicate skin. We saw that the incident was recorded and investigated in detail. This meant the provider had a system that ensured decisions were made at an appropriate level. All critical incidents were reported by the manager to the provider's head office. The provider analysed the data from all its locations and identified themes, trends and areas for action. These were communicated to all locations via a weekly 'Ops announcements and updates' report. We saw evidence that this information was cascaded to staff working at Inspection Report Sk:n - Brighton Jubillee Street December

15 the clinic. A staff member said, "Any new updates we have to read and sign." This showed the provider was monitoring critical incidents and disseminating learning to front-line staff. We saw minutes of staff meetings. These showed that important safety information was disseminated to staff and discussed. It also gave staff the opportunity to raise any issues of concern. This meant that the staff were engaged in matters of quality and safety. We found there were comprehensive systems of checks and audits to ensure that risks were identified and managed. We saw results of all the audits and noted that no major issues were identified. There was an annual, unannounced audit by the provider which covered the full range of quality and safety standards. Every six months the location risk assessment was checked and updated. This included areas such as fire, security arrangements, personal protective equipment and control of substances hazardous to health (COSHH). We saw that a six monthly infection control audit was performed. There was a monthly check by the manager which reflected the CQC outcome areas. This included staff training, safety of equipment, and safety of premises. This meant that the provider and people who used the service were assured that it was safe. Inspection Report Sk:n - Brighton Jubillee Street December

16 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Sk:n - Brighton Jubillee Street December

17 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Sk:n - Brighton Jubillee Street December

18 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Sk:n - Brighton Jubillee Street December

19 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Sk:n - Brighton Jubillee Street December

20 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Sk:n - Brighton Jubillee Street December

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Sk:n - Brighton Jubillee Street December

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