Optimax Laser Eye Clinics - London is operated by Optimax Clinics Limited. The clinic operates from the first two floors of a three storey building.

The ground floor has a reception area, main waiting room, topography room, YAG laser room and two consultation rooms. On the first floor there is a staff changing room, reception waiting area, managers’, office, storeroom, laser preparation and treatment room, recovery room, doctor’s consultation room and counselling room.

On the second floor of the building is Optimax’s head office.

The service provides refractive eye surgery only. If patients required further care or surgery using anaesthesia or sedation, as an example, lens replacement surgery, patients are referred for private surgery to another Optimax branch. If patients have lens surgery in another branch the London location provided pre and post-operative care. We inspected refractive eye surgery.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 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 provider 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 rate them 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:

• We observed that all areas we looked at were clean and tidy. Records confirmed that equipment was suitably maintained and monitored in order to provide a safe environment for patients.
• The service collected information about the outcomes of patients’ care and treatment. This was audited annually and reviewed across the service to ensure patients received quality care and effective outcomes.
• Patients we spoke with reported that all staff members were kind, caring and respectful. Results from the patient feedback survey undertaken by the service indicated patients were satisfied with the care they received.
• There was a clear leadership structure from service level to senior management level. All staff we spoke with reported they had good relationships with local and corporate management.

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

• The arrangements for dispensing medicines were not sufficient to provide safe management of medicines. Not all staff had received the appropriate competency training for staff to ensure that they had the correct skills to carry out their role.
• The service lacked an effective competency assessment process to ensure staff had the adequate skills and knowledge to care for patients. Non-medical staff performed extended roles without evidence of appropriate supervision or competency assessment.
• Not all staff had completed the required mandatory training. Training information was not available for employed staff and those working with practicing privileges. Specific training information was not available in all personnel files.
• The service had a local surgery checklist in place however, this was not fit for purpose and staff did not understand the purpose of the process.
• Some of the organisation’s policies, including the organisation's safeguarding policy, were not up to date with current legislation or guidelines.
• We were not assured that processes to ensure informed consent was obtained from patients were effective. Not all patients were given the recommended seven-days cooling off period.
• There was a lack of oversight of the recruitment and practicing privileges processes. Practicing privileges files for surgeons did not include any evidence on training and it was not clear how oversight of the practicing privileges process was maintained.
• Systems to identify, record and control risks were not well embedded. It was not clear how oversight of risks was being maintained as there was limited evidence of discussion on risk taking place at governance meetings. We were not assured that risks were always identified and addressed in a timely way.

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 four requirement notice for breaches of regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). Details are at the end of the report.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals London

We found that Optimax Laser Eye Clinics - London had appropriate arrangements in place to ensure that patients received treatment that reflected their needs. Patients were given information relevant to their needs to make informed decisions about their treatment. We noted that patients had signed to indicate that they consented to their treatment.

People told us that the clinic was clean and “all right”. There were systems in place to ensure that the risk of infections was minimised.

Pre-employment checks had been carried out for all staff this ensured that patients were treated by experienced, trained and vetted staff. We noted that patients’ complaints were investigated and, where possible, resolved by the manager.

People told us that they had been given enough information, including the options available to them, regarding their treatment. People thought staff asked them the right questions and gave them useful advice which enabled them to make decisions about their treatment.

People felt that staff were generally “courteous”. However, some people indicated that they did not have a good experience with some staff. The manager told us she was addressing people’s concerns by providing staff support and equality and diversity training but this needed to be extended to staff from the providers' other clinics as they might also work across the different clinics at times..

People felt they were safe in the premises. We noted that the manager had arrangements in place for auditing the systems and facilities to ensure that the service met people’s needs.

People who use the service told us that they understood the care and treatment options available to them and were given choices about their treatment. They said they felt safe using the service and praised the staff who had cared for and treated them.