Exeter Eye LLP @ Admiral House

Updated 12 April 2022

Exeter Eye LLP @ Admiral House is operated by Exeter Eye LLP. The service has been operating since March 2005. The service primarily serves the communities of the South West but accepts referrals from across the country. They are a Limited Liability Partnership (a small business company) of seven partners and one associate member who are all consultant ophthalmic surgeons. All consultants hold substantive contracts with the local NHS trust.

The most commonly performed surgeries were cataract removal and replacement lens implant, as well as intravitreal injections. (Intravitreal is a route of administration of a drug, or other substance, in which the substance is delivered into the vitreous humor or clear gel that fills the space between the lens and the retina of the eye).

In the outpatient clinic, the most commonly performed treatment was laser capsulotomy. (It is a laser treatment applied on the capsule that supports the artificial lens in the eye after cataract surgery).

The service is registered with the Care Quality Commission to provide the following regulated activities:

• Diagnostic and screening procedures

• Surgical procedures

• Treatment of disease, disorder or injury.

All surgery is undertaken under local anaesthesia. Surgery usually takes place on a Monday, with some on Tuesdays and Thursdays. The service has operated on some occasional Saturdays to meet the needs of patients.

There was a registered manager who had been registered with the CQC since November 2017.

The service also carries out surgery at Royal Devon and Exeter NHS Trust, Northern Devon Healthcare NHS Trust and Nuffield Hospital, Exeter. They have identified these as satellite clinics. We did not inspect these services as part of this inspection.

Activity

In the reporting period from 1 January 2021 to 31 December 2021; the most common operation was cataract removal with 1,095 operations performed and 35 Refractive Lens Exchange operations performed.

In the same period there were 4,420 patients who attended outpatient appointments. The majority of these patients were seen as part of the surgery pathway for pre- and post-operative appointments.

Services provided under service level agreement by the host hospital to Exeter Eye LLP.

Reception areas, theatre, anaesthetic room, recovery room and day case waiting area.

Use of necessary equipment for the purpose of providing medical eye care.

Management of building.

Consumables (including lens prostheses) and medicines used in theatre and for discharge of patients.

Clinical and non-clinical waste arrangements.

Equipment in theatres maintenance and servicing.

Theatre staff.

Consultant Anaesthetists.

Track record on safety for the period from 1 January 2021 to 31 December 2021

One Never Event had happened - the wrong lens was inserted into a patient’s eye. A never event is a serious incident that is wholly preventable as guidance, or safety recommendations providing strong systemic protective barriers, are available at a national level, and should have been implemented by all providers. They have the potential to cause serious patient harm or death, has occurred in the past and is easily recognisable and clearly defined.

No external review or investigations have been undertaken.

There were no incidences of healthcare acquired infections.

The service received eight formal complaints.

Updated 12 April 2022

We carried out a comprehensive inspection of Exeter Eye LLP @ Admiral House on 5 and 6 January 2022. The service was last inspected in January 2018 and was rated as requires improvement.

Exeter Eye LLP @ Admiral House is operated by Exeter Eye LLP. The service provides ophthalmic surgery and outpatient clinics for private adult patients from Admiral House in Exeter.

Admiral House is owned by another organisation (further referred to as the host hospital) and Exeter Eye LLP rent rooms from the host hospital to provide their outpatient and diagnostic services. These include waiting areas, consultation rooms, a laser room and office space for secretarial staff. Exeter Eye LLP has an agreement with the host hospital to access theatre space, staff and equipment to carry out surgical procedures within Admiral House.

Facilities include an anaesthetic room, recovery room and an operating theatre. The service has no overnight beds. Types of surgery carried out include cataract removal, lens replacement and laser capsulotomy treatment. Ophthalmic (eye) surgical procedures are undertaken as day cases. They also provide ophthalmic consultations, diagnosis, treatment and management of long-term ophthalmic conditions.

Surgery is the main service provided. Our findings on surgery, for example, management arrangements also apply to other services, therefore, we have not repeated the information, but cross-referred to the surgery service.

At this inspection we inspected our five key questions: safe, effective, caring, responsive and well led. Before the inspection we reviewed information we had about the location, including information we received and intelligence available. The inspection was announced due to being immediately after the New Year and to check they would be offering their full range of services.

We rated safe, caring and responsive as good in surgery and outpatients. Effective was rated as good in surgery but is not rated in outpatients. Well led was rated as requires improvement in surgery and outpatients.

Our rating of this location since the last inspection had improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in most key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Patients were assessed for their suitability for surgery. Staff kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave them pain relief when they needed it during surgery. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients. Patients had access to good information about key conditions relating to eyes. Out of hours service for patient who had undergone surgery or treatment was available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients to plan and manage services and all staff were committed to improving services continually.

However:

• The main leader was not able to fulfil the role of registered manager due to time constraints and other working commitments. They had also not completed additional training for their other lead roles.
• Governance arrangement had improved since our last inspection but there were still areas where improvements were needed. Assessment of risks was still reactive and had also not identified potential risks to the service provision.
• The safeguarding lead did not have the required level of safeguarding training to provide support and guidance to staff. The service vulnerable adults’ policy was not up to date with the latest legislation. This was identified at our last inspection. The safety briefing in theatre did not always take place without the distraction of the radio playing in the background which could mean not all staff would have been able to hear the important information.
• There was no system to monitor or record when all staff had completed training and when it was next due.
• There was no list of when audits would be completed to monitor the quality of service provision.
• When new staff were considered for a post not all references were obtained from other employers who did not work for Exeter Eye LLP.

Updated 12 April 2022

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in most key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. The service was compliant with the safety requirements for the use of lasers.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• There was no safeguarding lead trained to level 4 to support staff with any allegations of abuse or any potentially referrals to the local council. The infection prevention and control lead had not undertaken additional training for this role.
• Hand hygiene audits were completed but they lacked any detail and frequency. Medicines audit was more of a monthly stock control and didn’t look at all areas to make sure medicines were managed safely.
• The main leader for the service did not have the time to meet the requirements of the registered managers role. Risks to the service provision had not been identified on their risk register and therefore no business continuity plan had been devised. There was no documented system to record the use of audits necessary to monitor the quality of service provision, or the timeframe for when these would be completed.
• When recruiting proposed staff they did not always obtain information about their conduct or references from previous employers who also did not work for Exeter Eye LLP.

Outpatients is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, caring and responsive, although leadership requires improvement. Effective is not rated in outpatients.

Updated 12 April 2022

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had some training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Patients who had undergone treatment or surgery were able to contact the consultant in an emergency seven days per week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The safeguarding lead had not completed safeguarding training to level four to support staff with any allegations of abuse or any potentially referrals to the local authority. The infection prevention control lead had not completed any additional training for this role. The radio was on during the safety brief in theatres therefore this could mean some staff may not hear the important information.
• The main leader for the service did not have the time to meet the requirements of the registered managers role. They had also not completed additional training for their other roles. Risks to the service provision had not been identified on their risk register and therefore no business continuity plan had been devised. There was no documented system to record the use of audits necessary to monitor the quality of service provision, or the time frame for when these would be completed.
• When recruiting proposed staff, they did not always obtain information about their conduct or references from previous employers who also did not work for Exeter Eye LLP.