Every person we spoke with had positive experiences of the surgery and the way they were supported to make a decision about whether to have it, or not.

Examples of comments people told us included, “I have such confidence in my surgeon”, “I have found them excellent”, and “the surgeon is really friendly and they listen to you", “I was so impressed, the surgery went very well and my surgeon was very professional”, “the surgery went very very well and they were fine”, and “there was no pressure on me to make a decision”.

People were properly supported and given the necessary information so that they were able to make an informed decision about whether they proceeded to have surgery or not.

People received support and surgery from staff who were suitably qualified to provide them with safe and effective treatment.

The quality of the surgery and overall experience for people who used the service was monitored to ensure it was safe and suitable. When improvements were identified action was taken to ensure that these matters were properly addressed.

We spoke with three people using the service about their experiences. We also spoke with three personal assistants who supported the consultants, the human resource administration officer, the finance officer, the registered manager and one consultant.

We looked at seven records of people who use the service along with six staff records. These confirmed that all people using the service had signed consent forms and agreed to the treatment that they had received.

One person told us "I was given information and then time to decide. I then signed a form to agree to the treatment."

Another person said "The care is good" and "I can ask for any information and if they can they give me this they do".

We saw that the clinic was clean and that posters about hand washing were in the toilets and at the sinks in the clinics. A person using the service told us "It is always clean and tidy here." A member of staff said "It is important that we all understand cross infection. This keeps everyone safe."

The registered manager told us that there were enough staff available to ensure that the experience of people using the service is professional. They also said that this meant that people have had a good experience. We saw records of monthly audits asking people using the service about their experience. This showed an overall good experience. One person using the service told us “I like the consistency" and "I am happy with the care and never have to wait too long".

Consultant Eye Surgeons Partnership (Bristol) LLP is operated by South West Eye Surgeons LLP. Facilities include three consultation rooms and a treatment room.

The service provides outpatients for adults and a small proportion of children and young people.

We inspected this service using our focused inspection methodology. We carried out the unnanounced part of the inspection on 24 and 25 July 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.

The CQC issued a warning notice against the provider South West Eye Surgeons LLP in October 2017. During this inspection we found areas which required significant improvement included:

• The provider having safe and effective systems and processes to assess, monitor and improve the quality and safety of the service.
• The provider having assurance that staff have qualifications, competence, skills and experience to undertake their role.
• The provider not having oversight of the risks associated to patients undergoing surgery at the hospital.
• The provider not having oversight of records relating to people carrying on the regulated activity by persons employed.

During this inspection we found:

• Although there were cleaning audits found during this inspection, we found they were not being used properly.
• The arrangements for managing waste did not always keep people safe.
• We found a selection of consumables which were out of date which meant that the arrangements for storing this equipment did not always keep people safe.
• We found a large selection of medicines which were out of date which meant the arrangements for managing and storing medicines did not always keep people safe.
• Incidents were not used effectively to inform learning and improvement within the service was limited.
• The service did not identify learning from complaints.
• We are not assured that the registered manager had the appropriate support or training to understand their responsibilities, and did not have oversight of the quality and safety of the service.
• Despite some improvements, for example the collection of information for auditing purposes we found there was no effective review or analysis of this information which could be used to improve the service.
• Assurance systems were not comprehensive which meant performance issues were not escalated appropriately and were not improved as a result.

We found good practice in relation to outpatient care:

• During the last inspection we found that the provider did not maintain a full record of mandatory training completed by staff. We found this to be improved during this inspection.
• During the last inspection we found the provider could not demonstrate that safeguarding training had been undertaken by staff. During this inspection we found the evidence was available.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. We also issued the provider with four requirement notice(s) that affected the provider. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals