Optimised Care Limited

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. We rated this key question good, which meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service facilitated a proactive learning culture that empowered staff to learn. It led to improved safety standards and patient outcomes.

Staff reported incidents using an electronic system that monitored trends and themes. The senior team used data to improve the learning culture.

A patient safety lead maintained oversight of the incident reporting system. They carried out an initial review, established the level of harm, and categorised the incident to enable the most appropriate team to investigate. The manager audited incidents and outcomes monthly and shared updates and learning through various communication channels with staff.

The service reported less than 1 incident per 100 patient visits in the previous 12 months, which was in line with expected standards.

The service reported 1 incident with serious harm in the previous 12 months. The senior team carried out a root cause analysis including benchmarking the care delivered against National Institute for Clinical Excellence (NICE) guidance. The investigation found the incident had been unavoidable and the operating surgeon worked with colleagues at the referring NHS trust to make sure post-operative care met the individual’s needs.

The service reported 1 post-operative infection in the previous 12 months. The investigation found the patient had removed their bandage after they were discharged before attending a follow-up appointment with their referring trust. While staff had documented their instructions to the patient regarding post-operative care, they added additional steps to make sure patients understood this as a result of the incident.

Staff worked together to act on new or changing risks. For example, they secured an independent medical gas supply after interference from a previous tenant in the building. The team reviewed and updated flood risk and fire safety training and standard operating procedures to mitigate concerns with the estate.

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.

Patients had access to an on-call surgeon and manager, including overnight and at weekends, after discharge. Staff provided contact details and a clear procedure for patients to get support for unexpected side effects or complications. This included what to do in an emergency.

Staff used safety audits to assess standards of practice. Audits included slips, trips and falls, blood traceability, and safe sharps. Safe systems were in place for the management of sterile surgical equipment. Results reflected consistently good standards of practice.

Most surgery was scheduled to take place on a day-case basis and staffing was scheduled as such. Plans were in place to accommodate patients overnight in the event they were unwell. Staff said this was rare but where it had happened, they felt plans worked well and patients had been safe and well cared for.

Managers and team leaders held a daily briefing to identify and address risks, such as delays in receiving sterilised surgical equipment from the contractor.

The provider had a service level agreement (SLA) with a nearby NHS hospital to provide direct admission to the emergency department in the event a patient deteriorated and could not be managed on site. The SLA included an agreed handover structure.

Radiographers, who provided diagnostic imaging to patients under an SLA, facilitated good standards of radiation safety. They used national diagnostic reference levels (DRLs) to optimise radiation doses. DRLs were within acceptable safe thresholds. This provided assurance that patients received minimal exposure.

The theatre manager designated roles in the daily resuscitation team before the start of service. The resident medical officer (RMO) coordinated any emergency response. RMOs are qualified doctors who usually work for agencies and provide on-demand clinical care to patients in settings where consultants are not always present.

The service 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 abuse, avoidable harm, and neglect.

All staff had up to date training in safeguarding adults and children to level 2 and senior staff had training to level 3. The safeguarding lead provided guidance and oversight for safeguarding challenges. Although the hospital did not provide care to people under the age of 18, staff completed safeguarding for young people in line with good practice.

Staff who provided care to patients under the provider’s registration but worked substantively elsewhere, such as anaesthetists and radiographers, held the same level of safeguarding training as employed colleagues.

Staff understood how to escalate safeguarding concerns, including in urgent circumstances. They had good knowledge of the action to take if they suspected safeguarding needs relating to female genital mutilation (FGM) and radicalisation.

Staff worked with patients living with the early stages of dementia to make sure they could safely undergo procedures. They completed risk assessments to keep people safe during their post-operative recovery.

Staff 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.

Staff took appropriate action when patients presented with previously undiagnosed conditions on the day of surgery that could impact safety. For example, staff carried out a urine test when a patient complained of pain and found an infection. They followed the provider’s policy, prescribed antibiotics, and referred the patient to their NHS trust for management. This kept the patient safe and meant they could return for surgery once their infection had cleared.

The provider used admission criteria in line with guidance from the Royal College of Anaesthetists and the American Society of Anesthesiologists. Staff worked with patients to fully understand their medical history and any current risk factors, involving other professionals in more complex cases.

Staff audited a sample of patient records each month to review documentation of risk assessments and evidence of communication with patients. Results were consistently good, and the senior team worked with staff to address minor issues.

Theatre staff used the World Health Organisation (WHO) surgical safety checklist before starting procedures. The checklist is an international standard proven to improve safety in theatres. We saw this process involved the whole team, with operating department assistants taking a lead role in ensuring the right patient was being prepared for the right surgery. Monthly audits demonstrated 100% compliance in the previous 6 months.

During the pre-assessment process, staff discussed risk with patients based on their condition and potential side effects from treatment. For example, physiotherapists worked with patients to help them understand the recovery process and the impact this would have on their daily activities.

Staff had access to well maintained equipment and facilities to keep patients safe.

The service was equipped with emergency equipment appropriate to the environment and nature of care. This included resuscitation equipment with a range of airway masks, emergency oxygen, a defibrillator, an anaphylaxis kit, a hypoglycaemia kit, and biohazard spill kits. A difficult airway trolley was located next to the theatre. Staff documented regular checks.

We found room for improvement in the consistency of managing the environment. We saw staff stored oxygen cylinders and sharps bins on the floor in some areas, which was not good practice. We spoke with staff at the time who said they would address these issues.

Staff used ward opening and closing checklists to monitor standards of maintenance, infection control, and stock. We reviewed a sample of 19 checklists completed in the previous 6 months and found consistent standards of completion and action to correct problems.

The provider had acted quickly to mitigate risks in the environment caused by the exit of the previous building operator from the hospital. This included improvements to fire safety, the theatre air exchange system, and repairs to damaged doors and flooring that presented an infection control risk. The provider also arranged a water system and Legionella check following discrepancies in assessments provided by the building operator.

The service complied with the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R), including the use of lead aprons for staff, with tracked and monitored exposure data. The radiation control area was marked in line with national guidance. A radiation protection advisor, medical physics experts, and radiation protection supervisor audited the service annually to assess compliance with IR(ME)R. The most recent audit found full compliance. The service had replaced the X-ray machine with a new model and was implementing updated policies and procedures.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support and development. They worked together to provide safe care that met people’s needs.

A team of 13 permanent and 46 bank staff worked in the service. All theatre, administrative staff, and team leaders were employed permanently. Bank staff included ward nurses and healthcare assistants. A senior physiotherapist provided post-operative care for patients treated on an orthopaedic pathway with support from a bank colleague.

All staff held either basic life support or immediate life support training dependent on their role. Anaesthetists, surgeons, the RMO and the director of clinical services (DCS) held advanced life support training.

Staffing levels were based on Association for Perioperative Practice guidance for the theatre and on NICE guidance for the ward.

The housekeeping manager had a joint catering role and had training in food safety and hygiene to level 3. A team of bank housekeepers provided support worked flexibly to maintain cleanliness based on demand and use of the ward.

Staffing levels were stable, with little turnover and no long-term vacancies. The provider had steadily increased the number of permanent staff to reflect increased patient demand and new contracts.

All staff, including external radiographers, completed mandatory training modules and were fully up to date with all training.

All permanent staff had completed an appraisal in the previous 12 months and bank staff completed periodic supervisions.

RMOs worked for a third-party company and provided cover in the hospital whenever patients were present. They maintained their skills in line with a competency framework.

Wards typically operated with a nurse-to-patient ratio of 1:2 during the day and 1:4 overnight. The service planned additional nursing staff in advance where patients were booked for procedures that required more intensive post-operative care.

The medical advisory committee monitored surgeons and anaesthetists working under practising privilege arrangements and ensured they had evidence of appraisals in their substantive post.

Staff worked well to reduce the risk of infections. The environment was visibly clean, and patients reported good standards of hygiene.

The service performed consistently well in infection prevention and control (IPC) audits. Audits showed the staff were working to provider policies. Housekeeping audits reflected consistently good standards in each area. Senior staff took action to improve areas of inconsistency, such as staff working under practising privileges who did not always follow good hand hygiene standards.

The DCS was the IPC lead and provided guidance and coaching to staff. They monitored standards of practice across all staff teams, including those working under SLAs.

The service shared a recovery suite with another provider. The other provider was responsible for cleanliness and maintenance of the recovery facility but had not acted on damage to the environment that increased the risk of infection. The Optimised Care team implemented addition risk management strategies to reduce the risk to their patients and staff. During our inspection process the other provider left the hospital and the Optimised Care team began the process of refurbishment and repair.

Staff used the Department of Health and Social Care (DHSC) guidance for the screening and risk management of Methicillin-Resistant Staphylococcus aureus (MRSA) and other infections. Where patients tested positive pre-operatively, the service arranged the procedure to take place at the end of the list to reduce the risk of contamination in theatres.

The service reported a surgical site infection rate of 0.5% in the previous 12 months. This was better than the national benchmark.

The service made sure that medicines and treatments were safe and met people’s needs.

The provider had a service level agreement with a pharmacy to supply and manage medicines. CDs are medicines requiring more control due to their potential for abuse. Staff stored controlled drugs (CDs) safely and securely with restricted access and were compliant with national standards

Staff planned medicines for patients ‘to take away’ after their operation in advance of surgery in line with the treatment plan. Processes were in place to ensure people received their medicines as prescribed.

We reviewed 10 medicine records in patient treatment records. The information we looked at showed people received their medicines as prescribed.

The medicines management group met every 3 months to review stock control, prescribing, and risk. The pharmacy supplier joined meetings periodically to review standards of practice and policies, which helped keep staff up to date.

Safe medicines audits reflected consistently good practice, with 100% compliance in the previous 6 months.