The Day Surgery Unit is operated by Day Case UK LLP. It is a partnership between Yeovil District Hospital NHS Foundation Trust and Ambulatory Surgery International. Facilities include two operating theatres, a recovery suite, a ward area with seven patient cubicles and an endoscopy unit. The service is operational over five days from 8am to 6pm with occasional planned endoscopy lists on Saturdays as required.

The service offers day surgery procedures in cardiology, dermatology, ear/ nose and throat (ENT), general surgery including some laparoscopic (keyhole) procedures, oral and dental procedures, ophthalmology, orthopaedics, plastic surgery and urology (function of and disorders of the urinary system).

This was our first inspection of the Day Surgery 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 the announced part of the inspection on 23 and 24 May 2018, followed by an unannounced visit to the hospital on 6 June 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 including safeguarding training, to the appropriate level relevant to their role and responsibilities.
• There was a good safety track record.
• There were systems and processes to ensure the safe use and maintenance of equipment.
• Risk assessments, in line with national guidance, were used to keep patients safe.
• 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.
• Staff had access to policies, standard operating procedures and guidelines reflecting evidence-based care and treatment, which had been developed in line with national guidance.
• Staff monitored patients for signs of pain and ensured additional pain relief was administered if required.
• Staff had the skills, knowledge and experience to deliver effective care and treatment to patients.
• There were effective processes for obtaining valid consent.
• Staff showed an encouraging, sensitive and supportive attitude to patients and their relatives.
• 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, coordinated and delivered to consider patients with complex needs to optimise care, treatment and access to services.
• 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, risks and outcomes to provide safe, good quality care.
• Governance and risk management processes were fit for purpose.
• 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:

• Staff did not always comply with infection prevention and control standards.
• Training compliance for dementia awareness, Mental Capacity Act and Deprivation of Liberty Safeguards did not meet local target.
• The full attention of staff was not always given during the ‘sign out’ stage of the ‘five steps to safer surgery’ checklist.
• Patient records were not stored to provide confidentiality when staff admitted children and young people on the paediatric ward.
• Staff did not always follow national guidance for the receipt of controlled medicines.
• There was no standardised template for incident investigations.
• There was limited data collected and reviewed to allow for comparison against similar services nationally.
• Comfort scores for patients receiving endoscopy procedures were not always completed in line with national guidance.
• There was no effective audit process to show how many patients were admitted to the local NHS trust after their procedure because of complications.
• The 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)