The Castleton Day Unit is operated by Day Case UK LLP. Day Case UK LLP is a partnership between Yeovil District Hospital NHS Foundation Trust and Ambulatory Surgery International. Facilities include one operating theatres, a theatre waiting area with eight chairs, a treatment room and a ward area with 27 chairs.

Day Case UK LLP (DCUK) leases facilities, through a local NHS trust, within the community hospital in Sherborne. DCUK shares the Castleton Day Unit with the Ophthalmology outpatient service from the local NHS trust. This is intended to provide local people with comprehensive ophthalmology services.

This was our first inspection of the Castleton Day Unit since it was registered with the Care Quality Commission (CQC) in March 2017. We inspected this service using our comprehensive inspection methodology. Please note that in this report, some dates refer to data provided for February 2017. The service was run by Yeovil District Hospital in that month, and Day Case UK LLP from March 2017. We carried out our inspection on 24 May 2018.

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.

We rated this service as good overall because:

• Staff received mandatory training and regular updates, including safeguarding training to the appropriate level of their role and responsibilities.
• There was a good safety track record. There had been no never events and no serious incidents during the report time.
• There were systems and processes to ensure the safe use and maintenance of equipment.
• Risk assessments were used to keep patients safe in line with national guidance.
• Staff demonstrated good compliance with the World Health Organisation’s (WHO) five steps to safer surgery checklist.
• There were adequate nursing staff levels to safely meet the needs of patients.
• Patient care records were written and managed in a way that protected people from avoidable harm.
• Medicines prescribing and administration were safe and in accordance with local policy.
• Staff were open, transparent and honest about reporting incidents. There were systems to make sure incidents were reported and investigated appropriately.
• Staff had access to policies, standard operating standards and guidelines reflecting evidence based care and treatment, which had been developed in line with national guidance.
• Regular local audits were carried out to monitor performance and to maintain standards.
• Staff monitored patients for signs of pain and ensured additional local anaesthesia was administered if required.
• Staff had the skills, knowledge and experience to deliver effective care and treatment to patients.
• There were processes for obtaining consent.
• We observed caring, respectful and compassionate interactions between staff and patients and their relatives.
• Services were planned and delivered in a way that met the needs of the local population.
• Services were planned, co-ordinated and delivered to consider patients with complex needs to optimise care, treatment and access to services.
• Staff used technology to monitor and thus enhance the delivery of care and treatment.
• The service had policies and processes to appropriately investigate, monitor and evaluate complaints.
• The leadership team of the service had the skills, knowledge and integrity to lead the service.
• There was a culture of openness, candour and honesty amongst staff.
• Staff felt valued and empowered to suggest and be involved with service improvement initiatives.
• There were effective governance structures to monitor performance and risks to provide safe, good quality care.
• There were systems and arrangements to identify, record and manage risks.
• There were systems to engage with patients and the public to ensure regular feedback on services.
• There was a clear focus on looking for potential innovative solutions to continue to ensure the delivery of high quality care.

However, we found areas of practice that require improvement:

• Training compliance for dementia awareness, Mental Capacity Act and Deprivation of Liberty Safeguards did not meet local target.
• Processes to meet laser safety did not always meet national guidance.
• The fabric of the building and some equipment was old and described as not always fit for purpose.
• Processes to identify patients' communication needs were limited. This meant the service was not fully compliant with the Accessible Information Standards. These standards became obligatory in 2016 for all NHS care providers.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London and South)