A west London cosmetic clinic has been given an inadequate rating by the Care Quality Commission (CQC) after inspectors busted unqualified staff handing out medicines to patients.
The medical watchdog said over the last 12 months Signature Clinic in Notting Hill did not have enough suitably qualified staff to care for patients and keep them safe.
A report from an inspection in August found staff handing medication to patients who felt anxious, customers being threatened with legal actions for complaining, and managers not medically qualified to sign off on health checks.
Inspectors also found cabinets storing hazardous substances and operating theatres left unlocked, no evidence of when equipment was last cleaned, used linen left on beds and "illegible" patient notes.
They also found a communication breakdown between senior leadership and junior staff and workers who didn’t know how to report an incident. Inspectors did, however, praise staff for treating patients compassionately.
Signature Clinic is calling for an independent review of the report over what it claims are "inaccuracies" and said the rating does not reflect "high quality of service provided".
The clinic said it has made significant improvements to its process and procedures to ensure full compliance with industry acknowledged best practice.
A spokesperson for the clinic said the comments made by the CQC reflect historic working practices that were not in place at the time of the August 2023 inspection and that in some circumstances, untrained staff handed medication to patients where they were prescribed by a registered clinical practitioner.
They said that at no point were untrained staff ever able to prescribe or dispense medication. They also welcome another inspection by the CQC.
Inspectors visited the premises after being tipped off by patients who said they were threatened with legal action for complaining.
They told inspectors they felt rushed in and out of surgery and experienced an "underestimated" level of pain.
Inspectors said they saw the consent process was "well explained" to patients during their visit but found staff did not make sure customers had all the information available before consenting to surgery.
Inspectors added: "We were not assured that all patients were given a two-week cooling off period as the surgeon had told two CQC inspectors that treatment plans could be adapted on the day of the procedure. This included removing parts of the surgery already consented to and adding on parts to the surgery with ill formed consent."
They found staff were discreet and responsive to customers, taking time to interact with patients and meeting their needs.
But, inspectors said they were concerned staff were providing patients with medicine which did not reflect dosage guidelines by the British National Formulary.
They said staff were cut off from important information and were paid to take basic life support training at home and after work.
They also found the clinic manager, who was new and currently being trained, was not medically qualified to approve health assessments carried out by junior staff and was not aware of Female Genital Mutilation (FGM).
They said the company’s safeguarding policy failed to mention modern slavery or FGM. The clinic has since updated its safeguarding policy.
Inspectors raised concerns about surgeons not referring to patients’ consultation notes before appointments and how patient records were stored on a laptop with an automatically automated password.
They also said all staff used the same log-in credential, which make it difficult to trace employee actions. They also found a surgeon who could not explain why he had emergency medication on them.
The report read: "We were provided with numerous evidence that the provider failed to follow their own policy as well as national medication guidelines. We looked at the medical documentation audit which was a tick box exercise. There was no space for notes or actions taken and there were no identifiers to indicate what had been checked."
A spokesperson for Signature Clinic said: "We have asked the CQC for a ratings review and an independent review of the report as we believe that there are multiple inaccuracies in it despite the factual accuracy check done. We believe that the current rating does not reflect the high quality of service provided.
"We have made significant improvements to our process and procedures to ensure we are in full compliance with industry acknowledged best practice. At a previous inspection at a different location in March 2022, the service was rated ‘Good’ when using unregistered practitioners who had in-house training and competency assessments for scrub duties.
"This practice was not questioned at the time. A requirement was made by CQC in July 2023 to have registered practitioners undertaking scrub duties and this change was implemented. The comments made by CQC reflect historic working practices not in effect at the time of the August 2023 inspection. We have made it clear to the CQC that at no point have untrained staff ever been able to prescribe or dispense medication.
"Untrained staff have, in some circumstances, handed medication to patients where they were prescribed by a registered clinical practitioner. We have made significant improvements to both our infection control procedure – with the appointment of a dedicated infection control nurse who carries out regular audits – and governance processes, with a governance team, comprising of several highly qualified clinical staff, having been formed.
"A new training and appraisal regime for staff of all levels has also now been implemented. It is not standard practice to suspend patient aftercare due to only negative reviews.
"This is a last resort when relationships have broken down and there has been ongoing harassment of staff, which we will not tolerate. This has been made clear to the CQC."
