We spoke with two people who had received laser eye surgery at the clinic and were attending follow up appointments on the day of our inspection. People told us they were very happy with the outcome of their treatment and were positive about the service they had received.

We found that treatment had been planned and delivered in a way that ensured people’s welfare and safety. People had been given verbal and written information about the procedures involved so they could make an informed choice.

Staff we spoke with were knowledgeable and had been appropriately supported by the provider to carry out their roles effectively.

There was an appropriate quality assurance system that ensured people’s views about the service were being taken into account and that risks to people’s health and safety were managed.

There was no-one using the service on the day of our inspection visit. We spoke over the telephone with three people who had used the service in the previous week. They all told us they had very detailed assessments before making a decision about treatment. One person commented the checks they had were: “Quite extensive.” People generally said they had been given enough information and: “Lots of time to ask questions if needed.” They told us they had been given a written profile of the surgeon who would be carrying out their treatment. We saw that information about doctors employed by the provider was also available on the provider’s website.

Two of the people we spoke with thought they had been given all the information they needed to give informed consent. One person thought they could have been given more information. They had sought information from other people using the service before deciding to have treatment. We saw the provider had effective systems for ensuring people gave informed consent before having treatment.

None of the people we spoke with had been given information about how to comment or complain about the service. The provider dealt effectively with complaints, but they could improve the way information about making complaints is given to people.

Optimax Laser Eye Clinics Leicester is operated by Optimax Clinics Limited. Facilities are available on one level, accessible by a flight of stairs. There is a stair lift for patients with reduced mobility. Facilities include a spacious waiting area, two consultation rooms, a topography room, a preparation room, one treatment room, where surgery takes place, and a recovery room.

Optimax laser Eye Clinics Leicester provides laser vision correction treatment and intra ocular surgery for the treatment of cataracts under topical anaesthetic to adults only.

Patients are self-referring and self-funded and have visual problems caused by cataract or visual acuity deteriorating over time (failing eyesight). Visual acuity deterioration is not classed as a medical condition so is not treated by the NHS.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 September 2017. An unannounced visit took place on 15 September 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, but we do not currently have a legal duty to ratethem when they are provided as a single specialty service. 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:

• Staff understood their responsibilities to report incidents.
• Staff received adequate induction and refresher training.
• Laser safety measures were in place and were monitored.
• The clinic was visibly clean and staff followed procedures to prevent and control infection.
• Medicines were managed safely and staff were competent to administer and dispense medicines.

• Policies, procedures and treatments were based on recognised national standards and guidance.

• Patients receiving care at the service were screened for suitability to ensure correct laser surgery was provided.

• The patient pathway was undertaken in line with national standards and guidance.
• Advertising and marketing was appropriate and responsible.
• Staff were competent to carry out the duties allocated to them.
• Laser staff had additional training to carry out their duties safely.
• Procedures for obtaining consent were robust and in line with national standards and guidance.
• Without exception, care was delivered in a compassionate manner.
• Patients were involved in discussions about their treatment options.
• Staff recognised when patients were anxious and offered reassurance.
• Privacy and dignity was preserved at all times.

• The service was accessible and appointments were easy to book.
• Interpreter services were available if patients did not speak English as their first language.
• Complaints were managed in line with the provider’s policy by the clinic.

• There was a clear leadership structure from service level to senior management level.
• Staff were aware of the corporate management structure and were clear about lines of reporting.
• Patient feedback was encouraged and was used to improve the service.
• When informed of concerns throughout our inspection the service took timely action to mitigate risks.

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

• The service did not have an incident reporting policy to guide staff in relation to incident reporting.
• The service did not have a duty of candour policy and the duty of candour requirements were not embedded within the service. At the time of our inspection, staff had limited understanding about the duty of candour requirements. Only the registered manager had undertaken this training at the time of our inspection.
• The service did not contribute to the National Ophthalmic Database Audit (NODA).
• Patient outcomes were not benchmarked with other services.
• Patient information leaflets were not available in different languages or formats.
• There was no clear vision or strategy within the service.
• There was a lack of oversight in relation to some risks within the service and risk assessments had not been undertaken in relation to some risks.
• Staff engagement surveys were not undertaken within the service.
• The service was not following its human resources policy in relation to staff who had worked within the service for a long period of time and the frequency of which disclosure and barring service (DBS) checks should be undertaken.

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. We also issued the provider with one requirement notice for regulations breached. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals