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Inspection carried out on 13 and 14 September 2016

During a routine inspection

We carried out a comprehensive inspection of Epsom Day Surgery on the 13 and 14 September 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgery and outpatients and diagnostic imaging as these incorporated the activity undertaken by the provider, Epsomedical Limited, at this location.

We rated the core services of surgery and outpatients and diagnostic services as good, and  the hospital overall as good. We rated well-led as required improvement as there were no processes to ensure fit and proper persons were employed at board level which met the relevant regulations.

Are services safe at this unit?

We found improvements were required to minimise risks and promote safety as the management of medicines and equipment was not always robust.

However, we also found there were systems to report and investigate safety incidents and to learn from these. Risks to patients were understood and actions taken to mitigate them. The unit employed sufficient numbers of staff with the necessary skill, qualifications and experience to meet patients’ needs.

Are services effective at this unit?

Care was planned and delivered in accordance with current guidance, best practice and legislation. There was a programme of audit to ensure good practice was maintained and patients experienced good outcomes. Patients’ pain was well controlled.

Are services caring at this hospital?

Patients were treated with kindness and respect. Patients gave positive feedback and said they were treated with compassion and dignity.

Are services responsive at this hospital?

Services were planned to meet the needs of patients and give them a choice as to where they received their care and treatment. Patients referred to the unit were consistently seen and treated promptly within nationally set timescales. There were arrangements to ensure that the individual needs of patients were assessed and met. Complaints were appropriately investigated in a timely way.

Are services responsive at this hospital?

There were insufficient processes to ensure board members fulfilled the “fit and proper person” requirements. However, leaders were visible and were valued by staff and there was a clear vision of what the service aimed to achieve currently and in the future. Information technology was used innovatively to improve the efficient running of the service.

Our key findings were as follows:

  • There were adequate systems to keep people safe and to learn from critical incidents.
  • The hospital environment was visibly clean and well maintained and there were measures to prevent the spread of infection.
  • There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patients’ needs and there were arrangements to ensure staff had the competency to do their jobs.
  • There were arrangements to ensure patients had access to suitable refreshments, including drinks, and were not fasted pre-operatively longer than was necessary.
  • Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.
  • Arrangements for obtaining consent ensured legal requirements and national guidance were met, including where patients lacked capacity to make their own decisions.
  • Patients could access care in a timely way without undue delay.
  • The privacy and dignity of patients was upheld.
  • The hospital management team were visible and were supported by the staff and there was appropriate management of quality and governance.

We noted the following examples of outstanding practice:

  • The provider had direct access to electronic information held by community services, including GPs. This meant the unit staff could access up-to-date information about patients.
  • Epsomedical Limited had invested in bespoke, integrated IT systems to ensure efficient management of staff, finances, other resources, clinical activity and governance.

There were also areas of where the provider needs to make improvements.

Importantly, the provider must:

  • Introduce processes to ensure compliance with the ‘fit and proper person’ requirement.

In addition the provider should:

  • Introduce a robust system for the reconciliation, storage and monitoring of medicines.
  • Consider how contemporaneous safety record checks of anaesthetic machines are maintained.
  • Improve awareness of the duty of candour obligation amongst the management team.

Professor Sir Mike RichardsChief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 16 January 2014

During a routine inspection

When we visited the provider we spoke to four patients, three members of staff and three visiting healthcare professionals.

The patients we spoke to told us that they felt well cared for in the clinic. One told us �I am happy with the service�. Another said they felt �well looked after�. People told us that the staff were friendly and caring. One said �they are very thorough�. Another said �they are all very kind�.

The visiting healthcare professionals told us that they enjoyed working at the clinic. Staff also told us that they enjoyed their work and felt well supported by the clinic managers. We found that staff were qualified and well trained to carry out their roles.

We found that the provider had taken steps to ensure that patients, staff and visitors were safe when attending the clinic.

The provider had systems in place to monitor the quality of care through audits and customer feedback, and took action to make improvements based on the information they gathered.

Inspection carried out on 16 March 2013

During a routine inspection

During our visit we spoke with three patients, one health care professional and six members of staff. We spent time observing how staff interacted with and supported patients.

We saw staff treated patients with care and respect, for example pulling curtains round patients' beds to provide dignity and providing patients with hot drinks and snacks after their surgery. Staff and patients on the ward appeared happy and relaxed.

One patient told us that they thought the staff were �Brilliant and superb.�

The patients we spoke with told us that they understood the treatments that were provided. They all said that any questions they had were fully answered by the staff at the hospital.

We found that most staff were not aware of procedures around safeguarding vulnerable adults. Most of the staff could not recall whether they had received any safeguarding training at the service. We were told by the interim manager that most staff had not received training.

We found that appropriate checks were not always undertaken before staff started work at the service. We looked at staff files that confirmed this.

The hospital had systems in place to monitor the quality of the service and to identify when things needed to be improved. However there were not clear actions plans to address any concerns raised.

Inspection carried out on 2 February 2012

During a routine inspection

People were very pleased with the quality of care. They said that the care was good and they felt the staff were caring. A person said they felt lucky to have this local facility. Another person said that the care they received was excellent.

People said that their procedures had been explained to them and they felt reassured. The information that they were provided was good. They said that the hospital provided a clean and pleasant environment.