Optyco Limited is a high street optician providing refractive eye surgery. The service is delivered from premises in the centre of Leicester. The ground floor houses the opticians service and the first floor the refractive eye surgery services. We did not look at the optician’s service as part of this inspection, as it does not fall within the scope of registration.

Refractive eye surgery facilities include one operating theatre and several consulting/treatment rooms. Optyco only routinely treats adults over the age of 21, however in exceptional circumstances would treat patients 18 years and over.

This inspection was a focussed inspection following our initial inspection on 11 and 13 June 2018 when we suspended services for three months. The inspection took place on 31 July 2018 and focussed on safety.

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.

We found the following areas of good practice:

• Staff had individual employment files and had attended the provider’s mandatory training.
• All areas were visibly clean with cleaning schedules and colour coded cleaning equipment was used.
• Medicines were managed in line with the provider’s policy and current best practice guidance and legal requirements. Emergency drugs including oxygen, were easily accessible.
• All sterile and non-sterile surgical equipment was stored correctly and was within expiry its date. There was a service level agreement with an external provider for the supply of sterile, single use surgical equipment.
• Products subject to Control of Substances Hazardous to Health legislation were stored correctly. Clinical and hazardous waste were disposed of safely. Electrical appliance testing had been carried out and there were maintenance schedules for specialist ophthalmic surgical equipment, we were unable to establish if these were followed as they have been newly implemented just prior to our re-inspection. The registered manager had oversight of this process.
• Information was shared with other medical staff such as GPs where patients gave their consent.
• Patient records and patient identifiable information was stored securely.

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

• Some documentation needed reviewing for clarity and completeness such as cleaning schedules, fridge temperature monitoring logs and hot water tap flushing.
• The drug fridge had a small amount of water in the bottom which could affect the integrity of the medicines packaging.
• The examination seat still needed recovering in order that it could be cleaned effectively according to infection prevention and control guidelines.
• There was broken glass in the vicinity of the fire exit which could present a hazard for staff and patients in the event of the fire escape being used.

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 are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)

We spoke with four people who had received laser eye surgery at the clinic. People told us they were very happy with the outcome of their treatment and were positive about the service they had received.

We visited the clinic, spoke with the provider and looked at a number of records in relation to the operation of the service. We found that the service was operated in a clean and pleasant environment. There were private rooms for consultation, screening, treatment and recovery as well as a patient waiting area.

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

Treatment was carried out by appropriately qualified professionals and there were effective recruitment procedures in place.

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

Optyco Ltd is a high street optician providing refractive eye surgery. The service is delivered from premises in the centre of Leicester over two floors. The ground floor houses the opticians service and the first floor the refractive eye surgery services. We did not look at the opticians service as part of this inspection, as it doesn’t not fall within the scope of registration.

Refractice eye surgery facilities on the first floor include one operation theatre and several consulting/treatment rooms. Optyco only treats adults over the age of 21.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 June 2018, along with an unannounced visit to the clinic on 13 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.

Services we do not rate

We regulate refractive eye surgery services 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 issues that the service provider needs to improve:

• Medicines were managed poorly. We saw unsecured medicines and out of date medicines. There was no system of ordering, stock control or disposal of unwanted/out of date medicines.

• Cleaning and sanitising products were not stored according to Control of Substances Hazardous to Health regulations.

• The providers version of the World Health Organisations Safer Surgery checklist was not completed fully.

• The authorised user had not attended core of knowledge training.

• Patients records and information were not stored securely.

• Electrical equipment was not serviced and maintained according to Health and Safety Executive guidelines. Seating in clinical areas was unsuitable and could not be cleaned effectively.

• Cleanliness and hygiene throughout the service was below the level expected for delivering clinical services. There were no cleaning schedules and cleaning equipment was not colour coded or fit for purpose.

• Single us sterile equipment was out of date which meant there was a potential for unsterile equipment to be used during laser surgery.

• There was no hot water in any of the sinks including the operation theatre which meant good and hygiene could not be achieved.

• The environment was unsuitable for the delivery of clinical services, there were broken windows in two of the rooms we inspected and exposed plaster in another two areas.

• The operation room did not have a working hazard warning light to indicate when the laser was in use and the door was not lockable.

• There were no functioning fire extinguishers throughout the building.

• There was no access to the refractive eye surgery service area for people with reduced mobility.

• Policies and procedures were in place but not implemented and did not always relate to the Optyco refractive eye surgery service.

• There was no option for surgical information to be sent to patients GP’s.

• Employees did not have personal staff files containing recruitment details, personal details and the routine employment check details to ensure safe recruitment procedures were in place.

However we found the following areas of good practice:

• Patients were positive about their experience at Optyco Limited.

• Patient records were complete, timely and legible.

• An effective uninterrupted power supply was in place in order to complete a laser session in the event of a power failure.

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 took urgent action as a result of this inspection, this included suspending the services registration for three months, details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)