3 November 2021
During a routine inspection
This was our first inspection of this service. We rated it as requires improvement because:
- The service did not always control infection risk well. The risk of cross-contamination was not always mitigated. We did not see evidence of hand hygiene audits during our inspection.
- Staff did not carry out quality assurance checks on the ultrasound equipment. The service did not have any arrangements for peer review of scans and reports. Performance was not monitored, and the service did not check the results provided to women were reliable.
- The service did not have a referral pathway for women potentially identified as experiencing mental health crises or acute anxiety. The service did not have a clear process for reporting, investigating and learning from safety incidents.
- The service did not have any vision or values. The service did not have a robust governance framework to support the delivery of good quality care. Risks were not always identified, reviewed or mitigated. The registered manager did not have full oversight of the performance and safety of the service.
However:
- Staff received training in key skills, understood how to protect women from abuse and kept detailed records of women’s care and treatment.
- Staff worked together as a team to benefit women and those who accompanied them and supported women to make informed decisions about their care and treatment.
- Staff treated women with compassion, kindness and respected their privacy and dignity. They provided emotional support to women and those who accompanied them and took time to explain the procedure before and during the scan.