Prema

On this page

• 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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

This is the first assessment for this recently registered service. This key question has been rated good.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses in line with the provider’s policy. Leaders investigated incidents thoroughly and involved colleagues and patients in the process.

Staff understood the duty of candour and completed training in being open. Leaders would take the lead in any situation that required use of the duty of candour. Duty of candour is the legal and ethical obligation for healthcare services and staff to be open and honest with patients and their families when something goes wrong with their care.

The service clearly displayed information about how to raise a concern in patient areas and provided this information on the website.

Staff understood the policy on complaints and knew how to handle them. There had been 1 formal complaint to the service in the previous 12 months. The provider maintained an up-to-date complaints management policy, which ensured the service was prepared in the event of a complaint. The provider used information from complaints to improve their service. For example, they had made changes to consent documentation as a direct result of a complaint.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service 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 was consultant-led and patients were booked to be operated on by the consultant ophthalmologist who consented them for the procedure. This exceeded best practice guidelines for informed consent and showed high standards of continuity of care.

The service provided personalised care on a pre-planned basis and staff established clear communication with patients before the day of surgery. Staff reminded patients about appointments using their preferred method of contact, which meant it was rare for a patient to not attend a booked appointment. Where patients had a last-minute illness or emergency that meant they could not attend, the provider worked with them to be as flexible as possible.

Patients accessed the service through a range of options, including self-referral. The service accepted referrals from other private providers who had assessed patients but could not provide care at the level or complexity required. We also saw patients who had been referred through their employers following workplace injuries.

Staff could describe the process of how to refer a patient for specialist treatment if there were complications following surgery. There were detailed policies and documents available to staff to support internal referral and emergency triage. The internal referral system enabled clinical staff, such as optometrists and consultant ophthalmologists, to access a second opinion service quickly.

The service did not have a waiting list and arranged appointments to meet patient demand and clinical team availability. Clinics were held weekly and booking staff liaised with clinicians to arrange appointments in a timely way.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives, and we make sure we share concerns quickly and appropriately.

Quality Statement Score:

We scored the service as 2. The evidence showed some shortfalls. The service and staff understood how to recognise and respond to concerns. However, compliance with safeguarding adults training rates was low. While the service did not treat children we did not see evidence of staff training that reflected intercollegiate guidance.

Staff maintained training specific for their role on how to recognise and report abuse in line with best practice and local procedures. The service had a designated safeguarding lead.

All staff had the right knowledge and skills to recognise and act on safeguarding concerns. However, there was low compliance with safeguarding adults levels 1 (58% of eligible staff) and level 2 (36% of eligible staff). The service provided a detailed action plan, and specific timelines, to improve training compliance rates against their internal target.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. The provider kept up to date contact details for the local authority safeguarding team and staff knew how to secure advice and help.

Staff were knowledgeable about which patient groups were at heightened risk of abuse for their service type. Staff could give examples and showed an awareness about how to recognise abuse or neglect for living with patients with dementia, those who did not speak English as a first language and domestic violence.

Staff ensured there was a focus on ensuring the patient voice was heard in all discussions. This was evident in the conversations seen between staff and patients during the onsite inspection.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service 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.

Patients were informed about the risks of surgery during consultation with both the optometrist and the ophthalmic surgeon and provided with an information booklet to review in their own time. Patients could also call the service with any subsequent or additional questions they may have. At discharge, patients were given further instructional leaflets on how to self-administer new medications and how to recognise when to ask for help if their condition deteriorated. This was tailored to individual patient needs. We saw patients undergoing post operative follow up appointments that were tailored to the patient's level of need to ensure they felt as supported as they could be.

Staff placed a different coloured wristbands patients prior to each procedure. The identifier wristband was used to identify which eye was to be treated (left, right or bilateral). The wristband corresponded to the patient’s details on the treatment plan and WHO checklist. This was a good safety verification system to avoid the risk of wrong site surgeries or incorrect treatment.

The service used strict preassessment guidelines to ensure they only treated patients who could have their needs met at the location. These guidelines were informed by an internationally recognised anaesthesia risk tool, the American Society of Anaesthesiologists (ASA) physical status classification system, to specify which patients were suitable for the location. Patients cared for by the service received consultant ophthalmologist led care treated with topical anaesthesia only.

Staff managed postoperative issues in the clinic within the provider’s policy. This included complications such as an allergy to eye drops and unexpected soreness.

The service ensured there were enough staff trained to an appropriate level of life support, depending on their responsibilities. Emergency equipment for resuscitation and airway management was checked by staff weekly and were well maintained. Specialist equipment and medication for emergency anterior vitrectomy was immediately available, when staff were asked for it. An emergency anterior vitrectomy is a surgical procedure to remove prolapsed vitreous gel from the front of the eye, often performed during complicated cataract surgery to prevent future problems like retinal damage or vision loss.

Staff received extra training and competency assessments for more rare complications of surgery. These were detailed and role specific, covering topics like anatomy and physiology, step by step guides and escalation processes. This meant leaders could be assured staff had the knowledge to respond swiftly and appropriately when patients were at risk of deterioration.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider designed and equipped the clinical environment to follow national guidance and meet the requirements of their service, such as consideration to fire safety.

Corridors and storerooms were kept clean and tidy, free of clutter. Staff undertook monthly stock checks as part of routine deep clean processes. Items were identified 3 months in advance of expiry and proactively managed to ensure patients were safe.

The provider maintained equipment through a planned preventative programme. Staff had access to an on-call urgent engineering call out service. Staff reported faulty equipment to managers, and these were recorded to an equipment log. This was kept up to date by leaders, who recorded actions taken in response to this.

The operating theatre had clear signage for laser surgery above all entry points. Staff could describe the safety precautions used for managing safe use of lasers. Laser safety audits were undertaken monthly. In data we reviewed for January and February 2025, the clinic was fully compliant with laser safety checks including protective equipment availability, access security and usage reports for each laser unit. Records indicate that staff had performed these well, with clear records to show when any additional action had been undertaken.

Staff carried out safety checks of specialist equipment prior to treatment taking place. We checked a random sample of electrical equipment. Each item had evidence of a recent portable appliance testing (PAT) safety test.

The service had enough suitable equipment to help safely care for patients. Hand washing sinks were compliant with Department of Health and Social Care (DHSC) standards, and each sink had a poster displayed to depict best practice handwashing techniques.

We saw clinical waste was managed well. Staff disposed of clinical waste safely and used appropriate systems for the management of sharps. The service used service level agreements to manage waste streaming, including the storage and disposal of hazardous waste, in line with national standards. Processes were compliant with DHSC health technical memorandum (HTM) 07/01 in relation to the safe management and disposal of healthcare waste. There were clear clean and dirty sluice areas. These were well maintained and secure.

Cleaning and disinfection arrangements for the surgical theatre included continuous air filtration using specialist equipment. Staff used single-use equipment for minor surgery. They documented serial numbers in patient records, which meant items were fully traceable in line with national guidance. The provider had a service level agreement in place for the sterilisation of reusable equipment.

We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Consultants provided specialist care such as complex glaucoma work and ocular plastics. Consultants were supported by registered nurses and operating department practitioners (ODPs) who worked on bank or agency agreements.

There were enough staff, with the right skills, knowledge and training to deliver safe care and treatment. Staff had generally met their mandatory training requirements. Where there were shortfalls in compliance the provider had a plan to improve training rates. Staff were knowledgeable and had the right training and experience.

Surgical teams typically included a surgeon, a scrub nurse, and an ODP. The service adjusted teams based on the type and complexity of planned treatment.

Staff rotas for April 2025 showed the service consistently staffed operating theatre lists, admissions and discharge above their own minimum staffing standards. Staffing levels were above the best practice standards for safe staffing levels from the Association of Perioperative Practitioners (AfPP).

The service recruited staff safely. Leaders checked that staff continued to be suitable to work with patients, by maintaining a yearly professional registration review and ongoing 3 yearly criminal records check.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Clinical areas were clean and had suitable furnishings which were clean and well-maintained. Audits demonstrated the service performed well for cleanliness, including good hand hygiene and decontamination processes.

Staff were observed to be ‘bare below the elbow’ and following best practice guidelines for hand washing. There were adequate supplies of personal protective equipment and single use scrub suits available. Staff were observed wiping down equipment after patient contact and between patients. There were multiple large pieces of equipment in the operating room and these were kept clean, well maintained and dust free.

Staff worked effectively to prevent, identify, and treat surgical site infections. Staff checked sterilisation records before surgery took place and the provider maintained end-to-end tracking for surgical instruments sent off site for sterilisation. The service documented tracking details for consumables and reusables and for sterilised instruments in surgical records. This enabled tracing to take place in the event of a suspected infection.

The service used appropriate waste disposal methods depending on the type of waste. Cytotoxic medications were disposed of safely. A cytotoxic medication contains chemicals, which are toxic to cells. Specific cytotoxic waste bins were used, and we saw the registered nurse dispose of the waste safely.

Sharps bins in some clinic rooms were not always securely assembled and labelled with relevant information. Employers are legally required to assess risks from sharps injuries and put appropriate control measures in place in line with Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. The provider was made aware and immediately rectified this.

The service arranged an annual Legionella test of the water system from an external specialist organisation. Water management audits and water sampling demonstrated the service was safely managing microorganism risks and water quality met good levels.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

Quality Statement Score:

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed systems and processes to prescribe and administer medicines safely. Patients were counselled on what medications to continue taking or stop prior to surgery. Staff gave patients information and clear instructions on how to self-administer eye drops following surgery.

Staff communicated effectively to ensure they had the correct information about individual patient’s needs to safely dispense medications for home use. Staff could explain what medicines might interact with certain conditions or allergies.

Areas within the clinic where medicines were used or held, were appropriately temperature controlled. Medical gases were stored safely and securely. Empty and full oxygen cylinders were stored separately, ensuring these would not be easily mixed up.

Staff monitored patient’s pain levels during surgical procedures and adjusted pain relief when this was needed. Staff and leaders were able to describe how to safely manage off licence usage of medicines commonly used in refractive eye surgery. The service used ethanol and Mitomycin C for specific surgical procedures. Consultants carried out double checks before administering cytotoxic medicines and disposed of these in line with national standards. Staff completed medicines records accurately and kept them up to date as part of each patient’s record.

Most patients required only anaesthetic eye drops and post-operative antibiotic eye drops. Staff administered the first dose to each patient whilst they were in recovery to monitor them for side effects and ensure they could self-administer and tolerate the drops.

The service maintained an audit trail of the cold chain for chilled medicines. The provider had a clear escalation plan in the event of equipment failure or other events where storage temperatures exceeded the manufacturer’s safe limits.