Optical Express - Sheffield (Meadowhall) Clinic is operated by Optical Express Limited. It is a nationwide company offering general optometric services. The clinic provides laser correction procedures for adults aged 18 years and over. The clinic is based in a shopping centre in Sheffield. The service provides general optometric services, which are outside of the scope of registration and refractive eye surgery. We inspected refractive eye surgery only at this service.

The refractive eye surgery service has dedicated clinical space, located on the first floor of the Optical Express optometric shop, and is accessible either by stairs or by lift. Both services share some facilities on the ground floor, including a scan room.

We inspected this service using our comprehensive inspection methodology. The inspection was announced and took place on the 1 December 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 service understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate refractive eye surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The service had systems in place for reporting, monitoring and learning from incidents. Staff knew how to report incidents.
• Staff used an adapted ‘five steps to safer surgery’ World Health Organisation (WHO) checklist to minimise errors in treatment, by carrying out a number of safety checks before, during, and after each procedure. During our inspection, we observed three patient procedures where the WHO checklist was used correctly, and we reviewed other patient notes that showed the WHO check had been completed.
• There was sufficient, experienced and skilled staff to provide care and treatment to patients. Additional training was provided to staff that used laser eye equipment, which ensured patient procedures were carried out safely.
• Care and treatment was delivered in line with current legislation and nationally recognised evidence-based guidance. Policies and guidelines were in line with national guidelines and standards.
• The service had a clear leadership structure, which mirrored the organisation’s leadership structure. There was effective teamwork and good local level leadership, which created a positive culture.
• There were governance, risk, and quality systems in place, and staff we spoke with understood governance and risk arrangements.
• The service had systems in place for the identification and management of adults and children at risk of abuse.
• Staff we spoke with and training records viewed showed staff had completed mandatory training.
• Staff were aware of their responsibilities in relation to infection prevention and control. We observed that staff followed Infection prevention and control procedures and the clinic was visibly clean.
• There were systems in place that ensured clinical outcomes of surgeon were measured and monitored on an annual basis.
• We observed consistent positive interactions between patients and staff. All patients we spoke with were very happy with the care they had received. There was a system in place for obtaining patient feedback; this enabled staff to benchmark the service against other clinics across the organisation. The clinic had not received any specific feedback highlighting the need for changes to the service; but they had used feedback from other clinics to improve the service offered.
• Medicines were stored safely and staff administered medicines in accordance with the clinic’s policy.
• The service had systems in place for the reporting, monitoring and learning from complaints. Complaints about the clinic were dealt with in a timely manner and information relating to complaints was shared with staff.
• Equipment we reviewed was serviced regularly and electrical tests had been completed and were in date. There were measures in place to manage the safety of lasers.
• The organisation recognised and rewarded staff through their weekly staff reward scheme.

However, we found the following issues that the provider needs to improve:

• The consent policy did not reflect Royal college of Ophthalmologists guidance 2017 for a seven day cooling off period between the initial consent meeting with the surgeon and the final consent by the surgeon.

• Patient information leaflets were not available in different languages.
• The organisation did not conduct staff surveys.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details of these are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals