SpaMedica Truro

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service managed patient safety incidents well. Staff knew what incidents to report and how to report them, this included near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. Managers ensured actions from patient safety alerts were addressed and progress was monitored. Staff advised how they were informed of updates.

The service had a current incident reporting and reviewing policy, which reflected the provider and national guidance. Staff raised concerns and reported incidents and near misses in line with provider policy. We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence.

Incidents are monitored at a national and local level; all are discussed at monthly hospital meetings amongst the team. Safety bulletins from national safety organisations, such as the Medicines and Healthcare products Regulatory Agency (MHRA) were shared with all staff within the wider organisation. This was through electronic safety updates and shared with staff at team meetings.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. During the last 12 months prior to the inspection, 146 incidents were reported, though none were moderate harm or above, with most recorded as no physical harm. Staff were encouraged to report all incidents by management and staff felt safe and supported to report.

There was a provider level Duty of Candour (DOC) policy, and this could be accessed by all staff. Staff understood their responsibilities around DOC and were open and transparent and gave patients and families a full explanation if things went wrong.

The evidence showed good standard. The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had a referral and admission process. This ensured all essential information about the patient was received to determine if the patient’s needs could safely be met. At the time of our assessment, most patients receiving treatment were NHS funded. The service received referrals from a range of Ophthalmic providers and patients’ own GPs.

There was an admission criterion for both NHS and private patients. These criteria set out where they had limitations in services and therefore minimised risks by appropriately excluding some patients.

Safety and continuity of care was a priority throughout people’s care pathway. Patients were assessed prior to surgery and findings considered when planning care and treatment.

There were systems and processes to ensure the correct patients were treated throughout the patient journey. We tracked the patient journey and patient care from pre- assessment, admission, operating theatre and to recovery. We observed handover of patient information including all related identification checking processes. Once in theatre, the World Health Organisation (WHO) surgical safety check list was used to avoid harm and improve team communication.

Patient records were a mixture of electronic, and paper based and were kept securely.

The provider operated a support line for patients to contact if they had additional questions or post treatment. This was available 24 hours a day and advice was provided by ophthalmic clinicians. We spoke to a patient who had used this service and had found it helpful.

The evidence showed a good standard. The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The service had up-to-date policies and procedures to keep people safe from abuse or improper treatment. Staff followed processes to report concerns. Staff had access to the policy, available online. There were safeguarding pathways on display in all areas clearly instructing staff on how to raise safeguarding concerns.

Staff understood their responsibilities to keep people safe from abuse or improper treatment. A staff member shared with us a recent example of raising a concern to her manager regarding a patient and a safeguarding referral was made. We reviewed training, all staff were Level 2 trained in safeguarding, the manager was Level 3. The Safeguarding Lead was Level 4 trained and supported staff in escalating concerns.

Patients were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. Staff understood the importance of supporting equality and diversity and ensured care and treatment was in accordance with the Act.

The hospital had a defined recruitment pathway and procedures to help ensure the relevant recruitment checks had been completed for all staff. These included a disclosure and barring service (DBS) check, occupational health clearance, references, qualification and professional registration checks. We looked at 5 staff records and found these were all complete.

The evidence showed a good standard. The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service worked with patients to understand and manage risks. Treatment and care met patients' needs in a way which was safe and supportive and enabled them to do the things that mattered to them. Staff spoke about their role in removing barriers to care by ensuring they could support all patients.

There was a balanced and proportionate approach to risk that supported patients and respected the choices they made about their care. Risk assessments about care were person centred, proportionate and regularly reviewed with the person, where possible.

Patients had all treatment under local anaesthetic; the provider did not use general anaesthesia. Staff worked closely with other clinicians, including opticians and GPs to ensure they understood the patient risks. Patients were informed about any risks and how to keep themselves safe. Staff assessed risks in collaboration with patients.The patients we spoke with stated they were involved in their care and treatment, and the staff had explained the risks involved with their treatment.

The staff completed a team brief with all the staff at the beginning of each shift followed by a team brief in theatre.

The service took risks to patients seriously and ensured patients who had surgery were safe. We followed a patient journey from admission to discharge and saw safety checks were completed diligently, and patient risks were checked multiple times.

Staff responded promptly to any sudden deterioration in a patient’s health. There was an escalation policy directing staff to call 999 to transfer patients to an acute NHS hospital. Staff practiced an emergency scenario every 6 months. A resuscitation trolley was available, this was regularly cleaned and checked by staff. As well as frequent internal audits, an external company had also completed an audit and checked the trolley was complete. There were sepsis posters around the hospital to alert staff and patients to the signs and symptoms of sepsis.

The evidence showed a good standard. The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Facilities, premises and equipment were purpose-built and used to meet the needs of all patients who used the service. The building was modern, and the service was located on the ground floor. The admission area, theatres and recovery area were designed to allow transfer between the different areas.

The service was fully aware of all potential risks in the care environment and controlled them well. Staff made sure equipment, facilities and technology supported the delivery of safe care.

The building was bright, spacious and clean with sufficient ventilation and heating. The open waiting area had sufficient seating. There was CCTV which was monitored from the main reception desk.

There was a comprehensive system to proactively manage the safety, maintenance and repair of facilities, premises and equipment. Back-up generators were available in the event of a power failure. Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction. We witnessed the fire alarm being tested.

There was a site risk register in line with the Risk Management Policy which was reviewed monthly. A general site/environmental risk assessment was recently completed. Regular clinical risk audits were completed on a rolling programme. We reviewed 5 months of these and found them to be comprehensive. There was a named Laser Protection Advisor and laser safety audits were regularly conducted. There was a laminated sign used when the laser was being operated.

Stock was regularly rotated and we checked several consumable items and found them all to be in date and stored correctly. Stock was in a secure area and stored off the floor. Equipment that required sterilisation was sent twice weekly to an outside contractor.

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with policy. The risk of sharps injuries was minimised because of the safe management of sharp implements.

We checked the COSHH (Control of Substances Hazardous to Health) cupboard which was secure. We found two items past their expiry date. The staff member informed advised they would immediately address this.

The provider had some shortfalls in this area. There were not always enough qualified, skilled and experienced staff. Staffing gaps were covered by bringing in staff from other locations to cover shortfalls to bring in line with their staffing policy. They did always make sure staff received effective support, supervision and development. Staff worked together to provide safe care that met people’s individual needs.

The service employed permanent and bank staff. There has been a 33% turnover in staff, which is higher than their company average. There had been a loss of the lead registered nurse and lead healthcare technician, though these roles were actively being recruited to at the time of the inspection.

To ensure sufficient staffing levels and skill mix, and to make sure patients received safe care, staff had been utilised between various SpaMedica sites. There was significant travel to Truro from other sites, and staff travelled in working hours, this resulted in the start and end of some shifts being short staffed.

Truro was innovative in addressing shortfalls of optometrists by offering a remote slit lamp examination so patients could receive the same level of consultation when there was not an optometrist onsite through a remote video consultation process.

Some of the staff we spoke with raised concerns regarding staffing levels. We spoke with members of the senior leadership team; they said staffing was safe and aligned with the Clinical Safer Staffing Levels Standard Operating Procedure. We reviewed this policy and saw that it outlined clear staffing levels and drew standards from Association for Perioperative Practice (AfPP) and Royal College of Ophthalmologist.

Safer recruitment processes were followed; we reviewed 5 staff files and found no concerns. Staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop, and where needed, professional revalidation. Data showed 100% of staff had an up-to-date appraisal. All staff competencies were aligned with the system which only allocated staff to clinics based on their competency. Competencies were updated every 3 years; we reviewed some of these and there were no concerns. We were told there had been a delay for some new staff being assessed as competent so they could not undertake certain tasks.

Staff had received and were up to date with appropriate mandatory training. Staff we spoke with said they had received their appraisal. Nurses’ revalidation was monitored. Surgeons worked under practising privileges.

The evidence showed a good standard. The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. Patients were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. Patients we spoke with commented how clean the premises were.

Staff completed daily cleaning checklists to record compliance with cleaning schedules and standards. An audit in September 2025 had identified a shortfall in the checklist and an action plan was promptly instigated.

Staff followed infection control principles including the use of personal protective equipment. Staff had up to date infection prevention training. Hand-washing and sanitising facilities were available for staff and visitors throughout and we observed staff practising effective hand hygiene. Hand hygiene audits showed 100% compliance.

Staff followed protocols regarding decontamination, reusables were managed well and then instruments were sent to an external contractor for sterilisation.

The evidence showed a good standard. The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff followed good practice in medicines management and in line with national guidance. The service always made sure medicines and treatments were safe and met patients’ needs, capacities and preferences.

Staff followed systems and processes to prescribe and administer medicines safely. Patients’ medicines were appropriately prescribed, supplied and administered in line with the relevant legislation, current national guidance or best available evidence. Medication records were paper based, but information was also recorded on an electronic system.

Patients were appropriately involved in decisions about their medicines. Patients were involved with assessments and reviews about the level of support they needed to manage their medicines safely and to make sure their preferences were considered. Allergies were clearly recorded.

Medication was all securely stored and restricted to appropriate staff. The service had medication stored in a temperature-controlled room. Those medicines which required refrigeration were stored in fridges and the temperatures were monitored daily.

There were appropriate arrangements for the safe management, use and oversight of controlled drugs.