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

We spoke with people who use the service, but were unable to observe treatments as there were no booked procedures on the day of the inspection. People were happy with the service they received, and told us “I knew what to expect as there was a lot of information on the website”, and “The staff so far have been great”.

We reviewed care records and found evidence that people consented to a specific procedure, after having discussed the risks and benefits of the procedure with their doctor. We found that care records followed a nationally recognised surgical care pathway, with recommended care interventions for the periods before, during and after the person’s surgical procedure.

We spoke with five staff members and the manager, and reviewed staff recruitment records. We found evidence of initial vetting and verification of staff and their qualifications, as well as continuous supervision of the staff. Staff told us that they felt well supported in their roles.

We reviewed the arrangements for ordering, storing, dispensing and disposal of medicines, and found that there were policies and procedures in place which referenced current guidance. Staff told us that they were able to access the policies and procedures and found them useful and helpful. We found that medicines were stored appropriately, and audits carried out to ensure that stock was accurate.

We reviewed the complaints log, and found that information on complaints received was appropriate. We saw that there was information readily available for people on how to complain, and what to expect from the process. People told us that they had no reason to complain, but would be happy to raise any issues of concern with staff or the manager.

During our inspection we spoke with the provider and members of staff at the surgery. We also spoke with people who used the service and reviewed records, policies and cleaning schedules.

People were happy with the care that they received and told us “I had everything fully explained to me and felt reassured all through my treatment. I would recommend the service”. We saw questionnaires that had been completed by people after their treatment. The majority of feedback was very good.

People were given leaflets around their conditions and the details of what the service provided including the costs. The provider had a website with contact details and information about different procedures.

We looked around the service and saw that public and staff areas were clean and had adequate washing facilities. There were arrangements in place to ensure that the clinical areas were kept clean and free from infection.