We spoke to two people who were using the service on the day of our visit. Both were very satisfied with the outcome of the treatment they had received and the way in which it was provided. One person said 'the treatment was very good. I would be happy to recommend Advanced Visioncare to anyone.' The other person told us that they worked in the field themselves and that they were confident about the standard of treatment on offer. They also said 'it’s a nice environment. The service was faultless. Good information and great aftercare.'

We looked at the files on six people who had used the service, we observed two staff advising people on the phone and we talked to the two clinical staff and the counsellor who worked at the service.

We found that people were treated with respect and that their views about their treatment were taken account of. We saw that Advanced Visioncare ensured that people understood their treatment options and the risks associated with these and that people had provided informed consent for their treatment.

We found that people were protected from the risks associated with medicines used at the clinic and that treatment was provided by staff who were qualified and experienced in their work.

We saw that the provider had a system for collecting and responding to comments and any complaints about the service.

We were unable to speak to people who use services on this occasion as they left the clinic after receiving treatments. However we observed patients being treated with respect by staff when arriving at the service. Evidence from the clinic's quality assurance audits carried out between November 2011 to October 2012 and written feedback from patients showed that people were happy with the treatment received and the aftercare and support provided.

People were very positive about the service provided to them, they were fully involved in their treatment and all areas of risk and choices available to them were discussed at the consultation with the opticians and with the surgeon.

We were unable to speak to people who use services on this occasion. However we observed patients being treated with respect by staff. Evidence from the clinic’s quality assurance audits carried out between January 2010 - September 2011 and feedback from patients showed that people were happy with the treatment received and the aftercare and support provided. People who use services were very positive about the service provided to them, they are fully involved in their treatment and all areas of risk and choices available to them were discussed at the consultation with the optician and with the surgeon.

Advanced Visioncare is operated by Advanced Visioncare Limited. The service provides refractive eye surgery for self-funded patients over 18 years old. Facilities include two surgical theatres, two assessment rooms, a consultation room, recovery room and diagnostic facilities.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 September 2017 along with an unannounced visit on 10 October 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.

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 issues that the service provider needs to improve:

• Medicines were not stored safely and staff were not following the service’s own policy on medicines management.
• The access to theatres was not secure; this could give access to unauthorised individuals and medication could be tampered with or stolen.
• Patient information leaflets, documents, and consent forms were only provided in English.
• There were no formal interpreting services available. Patients were advised to bring their own interpreter to the clinic, or use a family member.
• There was no organisational vision or strategy.
• The consent policy did not state a “cooling off” period prior to procedure. The new Professional Standards for Refractive surgery (April 2017) recommends a “cooling off” period of one week, less so in exceptional circumstances. However, the service provided patients with a terms and conditions document, which supplied information on the procedures available and the associated risks and benefits which patients took away with them. We also saw there was a period of a day between the confirmed consent with the surgeon and actual treatment.

However, we also found the following areas of good practice:

• Patients received care in visibly clean and suitably maintained premises and their care was supported with the right equipment.
• The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks.
• All staff had completed their mandatory training and annual appraisals. Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team.
• There was clear visible leadership within the services. Staff were positive about the culture within the service and the level of support they received.

Following this inspection, we issued the provider with a Warning Notice for breaches of the Health and Social Care Act 2008 Regulations. We told the provider that it must take action to comply with the regulations by 1 December 2017.

We also 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.

Following the Warning Notice, the provider submitted evidence of improvement to the CQC and we returned to review progress and found these improvements had been made.

Amanda Stanford

Deputy Chief Inspector of Hospitals