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Centre for Sight Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 28 February 2018

Centre for Sight East Grinstead is an eye care centre located in Sussex. It was established by the medical director and principal surgeon in 1997.

Centre for Sight Limited operates as a single organisation managed centrally at the East Grinstead flagship location. The Surrey centre in Oxshott undertakes surgical procedures once a month. Oxshott and London centres are open for part of the week and staffed by an administrator at each location. These centres provide local access for patients. Most Centre for Sight staff were based at East Grinstead where all back-office support functions are located. Staff rotated between locations as required with centrally managed rotas.

Centre for Sight East Grinstead provides services for adults,children and young people.

The East Grinstead centre opened in 2010 and is a modern, bespoke building designed specifically for eye care. The centre is set over two-floors and has four consulting rooms, a reception area, two operating theatres, pre and post-operative areas, and an imaging/diagnostic suite.

Services provided include refractive lens exchange, cataract surgery, laser vision correction, corneal grafts, implantable contact lens and intraocular implants.

We inspected this service using our comprehensive inspection methodology. We have reported our inspection findings in the two core services of Surgery and Outpatients. We carried out an announced inspection on 11 October 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main services provided by this hospital was surgery and outpatients. Where our findings on surgery for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this centre as good overall. This was because:

  • Patients' said staff went the extra mile and the care they received exceeded their expectations.

  • The management team had a good knowledge of how services were provided and were quick to address any shortcomings that were identified. They accepted full responsibility and ownership of the quality of care and treatment within their centre and encouraged their staff to have a similar sense of pride in the centre.

  • The care delivered was planned and delivered in a way that promoted safety and ensured that peoples specific care needs were met.

  • Medical Advisory Committee (MAC) meetings were undertaken quarterly, MAC meeting minutes showed the meetings were used to discuss improvements to patient care and ensure care was evidence based.

  • The service had an effective governance framework in place.

  • There was an effective system for identifying and reporting risk. Staff were proactive in identifying risk and near misses.

  • There was a positive staff culture with many staff having worked at the hospital for a very long time. These core staff offered stability and continuity.

  • There were effective infection prevention and control measures. All areas within the centre were visibly clean.

  • Staff ensured the care and treatment was planned and delivered to meet the needs of patients. Patients could access the service in a timely manner when they needed care and treatment.

We found areas of outstanding practice in surgery:

  • Patients had access to a number of different forms of information, which ensured they were able to make an informed decision regarding treatment.

  • There were processes and equipment available in theatre in the event of an unexpected complication. Staff practiced scenarios involving unexpected complications.

  • World Health Organisation ‘Five Steps to Safer Surgery’ checklists in theatre were consistently thorough, with full staff engagement and consultant led.

  • There was thorough safety checking processes within theatre.

  • There were effective processes to monitor complications and patient outcomes. Patient outcomes were explained in terms patients could understand.

However, we also found areas for improvement:

  • The provider should review guidance on the use of capnography (measuring carbon dioxide) during intravenous sedation.

We found the following areas of good practice in relation to outpatient care:

  • Ninety-percent of patient records were electronic which met they could be accessed at any of the three Centre for Sight locations ensuring continuity of care.

  • Videos of operations could be viewed on site in the counselling room.

  • Each patient was allocated a coordinator who was the patient’s key worker throughout their treatment.

  • Patients received a thorough assessment of their vision needs which included hobbies, lifestyle and their post-surgery expectations.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 28 February 2018

We rated safe as good because:

  • Incidents were reported, investigated and learning evidenced. Learning was cascaded to all staff.

  • There were arrangements to prevent the spread of infection. There were no infections reported.

  • Patients were cared for in a visibly clean, modern environment that was well maintained.

  • There were processes for ensuring only patients whose needs could be met were treated at the centre.

  • The service had enough staff with the skills and experience to care for the number of patients and their level of need.

  • There were adequate supplies of appropriate equipment, which was maintained to deliver care and treatment, and staff were competent in its use.

  • Medicines were stored, managed and administered in line with relevant legislation and national guidance.

  • Staff were aware of their responsibilities with regard to the protection of people in vulnerable circumstances.

However, we also found the following issues that the service provider needs to improve:

  • The provider should review guidance on the use of capnography monitoring during intravenous sedation.

Effective

Good

Updated 28 February 2018

We rated effective as good because:

  • We found care and treatment reflected current national guidance.

  • There were formal systems for collecting comparative data regarding patient outcomes. Patient outcomes resulted in a significant improvement in vision and the ability to undertake day to day activities.

  • Patients provided informed, written consent before commencing their treatment.

  • Policies in use were in date, version controlled, and reflected current evidence based practice. Policies were accessible to all staff either electronically or in paper format.

  • Staff ensured that adequate pain relief was provided during surgery. Staff provided patients with further guidance and information regarding pain relief after discharge.

  • Staff had completed annual appraisals and were up to date with their mandatory training.

  • Managers oversaw staff competencies to ensure that staff remained competent to perform their role.

  • The staff demonstrated effective multidisciplinary working as part of a team.

Caring

Good

Updated 28 February 2018

We rated caring as good because:

  • There was a strong, visible patient-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted patients' dignity.

  • Patient feedback was positive and staff demonstrated commitment to continuous improvement.

  • Patients felt well informed and involved in their procedures and care, including their care after discharge.

  • Patients commented positively about the care provided from all staff they interacted with.

  • The service ensured that there were processes to maintain the patient's privacy and dignity.

Responsive

Good

Updated 28 February 2018

We rated responsive as good because:

  • Managers were driven to provide an efficient service.

  • Waiting times, delays and cancellations were minimal and well managed.

  • The complaints process was transparent and open with learning communicated across the centre.

  • The building had been purpose built to meet the needs of the patients, including those with mobility problems.

Well-led

Outstanding

Updated 28 February 2018

We rated well-led as outstanding because:

  • Staff worked well as a team and were engaged with the local vision, values and strategy to expand and improve the service.

  • Effective governance and risk management processes were in place.

  • There was a clear leadership and governance structure.

  • Surgical outcomes were benchmarked to contribute to continuing improvement.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 28 February 2018

We rated outpatients as good . This was because the service was safe, effective, caring responsive and well-led.

We found that:

Patients’ needs were assessed and their care and

treatment was delivered following local and national

guidance for best practice.

Safety concerns were identified and addressed.

Staff were clear with regards to the process to report

Incidents. There were effective infection control procedures in place. All areas were visibly clean and well organised.

There was effective communication between staff in the outpatient department.

Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice.

The facilities and equipment met the individual needs of patients.

Staffing levels were appropriate for the service

provision with minimal vacancies.

Consent processes were thorough with a variety of patient information available.

Safeguarding systems were in place and staff

knew how to respond to safeguarding concerns.


Surgery

Good

Updated 28 February 2018

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

We rated this service as good because it was safe, effective, responsive, caring and  well-led.

We found that:

Treatment and care promoted good quality of life and was based on best available evidence.

Openness and transparency about safety was

encouraged. Staff understood their responsibilities in

relation to incident reporting. Staff with appropriate

training investigated incidents.

Decision making about the care and treatment of a

patient was clearly documented.

Treatment and care was provided in

accordance with the National Institute of Health and

Care Excellence (NICE) evidence-based national

guidelines. Policies were evidence based and referenced national guidance. All policies were in date and easily accessible to staff.

There was a holistic approach to assessing, planning and delivering care and treatment.

High performance was recognised by credible external bodies.

Innovative and pioneering care and treatment was encouraged and undertaken safely.

There were high levels of staff satisfaction across all staff groups. Staff spoke highly of the culture.

There was a common focus on improving quality of care and people’s experiences.

All staff were actively engaged in activities to monitor and improve quality and outcomes.

Opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued.

The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care.

Staff were proactively supported to acquire new skills and share best practice.

Care and treatment arrangements fully reflect individual circumstances and preferences.

Patient outcomes exceeded patient expectations

Patient outcomes were effectively monitored.

Leadership was good and staff told us about being

supported and enjoying being part of a team.

Feedback from patients was continually positive about the way staff treated people. We saw staff treated patients with dignity, respect and kindness during all interactions.

There were systems, processes and standard operating procedures that were reliable and kept patients safe.

Theatre staff demonstrated effective multidisciplinary working as part of a cohesive team.

However, we found the following areas the service should improve:

The provider should review guidance on the use of capnography (measuring carbon dioxide) during intravenous sedation.