We visited the Cobham Day Surgery and looked at the care and welfare of people who used the service. During the inspection we spoke with six members of staff and with four people who used the service. We also left questionnaires and received a total of eight responses.

We saw that there were arrangements in place for obtaining consent from people. All the people we spoke with felt their consent had been asked for before treatment was given. One person told us “The doctor and nurses talked me through the consent form and I signed it.” Another person told us “Yes, I was asked to give my consent and the treatment was well explained.”

People received care and welfare that met their needs. People told us “I received a super service, I felt very comfortable” Another person told us “Staff have been brilliant, very helpful and caring.” We saw that the service had plans in place for dealing with emergencies.

The provider had systems in place for managing cleanliness and infection control. We saw the surgery was clean and that cleaning was carried out regularly. One person told us “The rooms are all extremely clean and hygienic.” Another said “It is very clean and fresh here.”

We saw that records of qualifications, criminal record checks and professional registrations were up to date.

The majority of the people we spoke with were very happy with the service. We saw the provider had a system in place to respond appropriately to complaints.

We spoke to five patients during our visit and also reviewed a number of thank you cards received from patients over previous weeks. All spoke positively of their experiences and the care they had received from staff. One person told us "The nursing staff have been lovely and totally professional." Another person wrote "The service I received was absolutely superb."

We found that patients had been given full and clear information about the surgical procedures and been able to make informed decisions about their treatment. We saw that care plans were comprehensive and well maintained and provided evidence of a person centred approach to patient care.

We found that people were cared for in appropriate, tidy, clean and well maintained premises. Staff spoke to patients with courtesy and respected their confidentiality, privacy and dignity.

More than half of all clinical staff required training or refresher training on the subject of safeguarding of vulnerable adults. However when we spoke to staff we found that they were in fact very aware of the need to be alert to the signs of abuse.

Staff were qualified, trained and supported to provide the service and they received regular opportunities for professional development.

We found that the provider's written complaints procedure was not being followed and this meant the complaints system was not effective.

Patients said that the staff were caring and praised them highly. Procedures and processes, including consent to treatment, were explained to them in language they understood. They said that they were treated with dignity and that their privacy was respected.

We carried out a comprehensive inspection of Cobham Day Surgery on the 13 and 14 September 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgery and outpatients and diagnostic imaging as these incorporated the activity undertaken by the provider, Epsomedical Limited, at this location.

We rated the core service surgery as requiring improvement and outpatients and diagnostic services as good, with the hospital overall rated as good. Our concerns were that aspects of medicines management were not robust in surgery, some equipment was not consistently checked to ensure its safety and processes to ensure fit and proper persons were employed at board level did not meet the relevant regulations. Although some elements of the service required improvement, the overall standard of service provided outweighed those concerns. We have deviated from our usual aggregation of key question ratings to rate this service in a way that properly reflects our findings and avoids unfairness.

Are services safe at this unit?

We found improvements were required to minimise risks and promote safety as the management of medicines and equipment was not always robust.

However, we also found there were systems to report and investigate safety incidents and to learn from these. Risks to patients were understood and actions taken to mitigate them. The unit employed sufficient numbers of staff with the necessary skill, qualifications and experience to meet patients’ needs.

Are services effective at this unit?

Care was planned and delivered in accordance with current guidance, best practice and legislation. There was a programme of audit to ensure good practice was maintained and patients experienced good outcomes. Patients’ pain was well controlled.

Are services caring at this hospital?

Patients were treated with kindness and respect. Patients gave positive feedback and said they were treated with compassion and dignity.

Are services responsive at this hospital?

Services were planned to meet the needs of patients and give them a choice as to where they received their care and treatment. Patients referred to the unit were consistently seen and treated promptly within nationally set timescales. There were arrangements to ensure that the individual needs of patients were assessed and met. Complaints were appropriately investigated in a timely way.

Are services responsive at this hospital?

There were insufficient processes to ensure board members fulfilled the “fit and proper person” requirements. However, leaders were visible and were valued by staff and there was a clear vision of what the service aimed to achieve currently and in the future. Information technology was used innovatively to improve the efficient running of the service.

Our key findings were as follows:

• There were adequate systems to keep people safe and to learn from critical incidents.

• The hospital environment was visibly clean and well maintained and there were measures to prevent the spread of infection.

• There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patients’ needs and there were arrangements to ensure staff had the competency to do their jobs.

• There were arrangements to ensure that patients had access to suitable refreshments, including drinks, and were not starved pre-operatively longer than was necessary.

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.

• Arrangements for obtaining consent ensured legal requirements and national guidance were met, including where patients lacked capacity to make their own decisions.

• Patients could access care in a timely way without undue delay.

• The privacy and dignity of patients was upheld.

• The hospital management team were visible and were supported by the staff and there was appropriate management of quality and governance.

We noted the following examples of outstanding practice:

• The provider had direct access to electronic information held by community services, including GPs. This meant that unit staff could access up-to-date information about patients.

• Epsomedical Limited had invested in bespoke, integrated IT systems to ensure efficient management of staff, finances, other resources, clinical activity and governance.

• Specific procedures were separated by gender, with females undergoing the procedure on one day and males another day to ensure compliance with the Department of Health's same-sex accommodation guidance.

There were also areas of where the provider needs to make improvements.

Importantly, the provider must:

• Introduce systems to ensure the checking and availability of anaesthetic equipment.

• Introduce a robust system for the reconciliation, storage and monitoring of medicines.

• Introduce processes to ensure compliance with the ‘fit and proper person’ requirement.

In addition the provider should:

• Consider how to raise awareness of the complaints procedure for both staff and patients

• Review processes on assessing pain to ensure they meet best practice

• Take action to be assured all cleaning schedules are implemented and monitored.

• Improve awareness of the ‘duty of candour’ obligation amongst the management team.

Professor Sir Mike Richards

Chief Inspector of Hospitals