Midlands Ultrasound and Medical Services (MUMS) Limited is a private clinic that has been in operation since November 2003 and provides diagnostic and screening services to pregnant women in the Solihull area of the West Midlands. The service provides a total pregnancy care package, during which they take on the responsibility of managing all medical and midwifery elements of pregnancy care including taking relevant blood tests, ultrasound examinations, screening for conditions which might complicate the pregnancy as well as undertaking the delivery of the baby in a hospital setting and postnatal care.
MUMS Limited also offers gynaecological services, including advice regarding for example ovarian cysts or endometriosis (a condition where tissue that behaves like the lining of the womb (endometrium) is found in other parts of the body). The practice also offers physiotherapy services to support gynaecological care.
The service uses the latest technology 3D and 4D ultrasound machines which can give the highest resolution images for use in obstetrics and gynaecology. A 3D ultrasound takes thousands of pictures or photos of the baby and provides a three-dimensional image of the baby while a 4D ultrasound test is a way of reproducing a moving image of the baby inside the womb.
The service was previously inspected in January 2013, where we found the service met all the standards inspected under the Health and Social Care Act 2008 (Regulated Activities).
We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 10 January 2020. We gave one weeks’ notice of our inspection to ensure the availability of the registered manager and that clinics were running.
To get to the heart of womens’ 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 rate
We have not previously rated this service. We rated it as Inadequate overall.
We found areas of practice that were inadequate:
- Staff did not have training in key skills, and medicines were not always managed well. The service did not manage safety incidents or learned from them. Staff did not collect safety information or use it to improve the service.
- Leaders ran services without reliable information systems and did not support staff to develop their skills. Staff did not understand the service’s vision or values and did not know how to apply them in their work. Staff were not clear about their roles and accountabilities. The service did not engage with women and the community to plan and manage services.
We found areas of practice that require improvement:
- The service did not always have staff on site to support deteriorating women, and record keeping standards were not monitored.
- Managers did not monitor the effectiveness of the service or made sure staff were competent. Consent was not routinely obtained.
- The service did not always take account of women’s individual needs or make it easy for people to give feedback.
We found good practice:
- The service had enough staff to care for women and keep them safe. They understood how to protect women from abuse and managed safety well. The service controlled infection risk well. Staff assessed risks to women and kept good care records.
- Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Staff worked together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available six days a week.
- Staff treated women 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 women, families and carers.
- The service planned care to meet the needs of local people, who could access the service when they need it and did not have to wait too long for treatment.
- Staff felt respected, supported and valued. They were focused on the needs of women receiving care.
We found the following issues that the service provider needs to improve:
- There were no staff training records or processes to confirm staff had the right qualifications, skills, training, competencies and experience. Staff had not received any additional training since induction which ranged from five to 12 years.
- There were no systems in place to ensure an effective recruitment and selection process, with four out of eight staff records reviewed missing key documents including Disclosure and Barring Service checks.
- Policies and procedures which included medicines, consent, incidents and complaints were dated 2008 and were significantly past their review date. They did not reflect current guidance or legislation.
- There was no system to record and monitor incidents and complaints. There were no team meetings to ensure staff had up to date information and the opportunity to share and learn from incidents and complaints.
- There was no systematic programme of clinical/internal audit to monitor quality and safety of the service.
- There were no processes to manage current or future performance.
- The service did not have a risk register to manage any identified risk.
- The provider did not have a process to account for medicines held. We were also not assured that those staff administering medications were qualified as staff records were incomplete.
- The provider did not have an effective recruitment and selection procedures. Records seen did not have any Disclosure and Barring Service checks or references to ensure they were of good character. We reviewed eight staff records and found four were missing these key documents.
- We did not see any records to ensure that employees had the appropriate qualification(s), competence, skills and experience required. We saw no records kept verifying this.
- The provider did not have processes in place to ensure that staff complied with the European Working Time Directive as most staffs first employment was NHS services.
- The provider did not have a system in place to assess the competence of employees before they work unsupervised in a role. There was no evidence of any supervision until the person was deemed competent to carry out their role.
- The provider did not have a system to monitor the quality of scans taken to ensure staff were competent in their role.
Following this inspection, we told the provider that it must take actions to comply with the regulations. We also issued the provider with a warning notice that affected the diagnostic imaging service. Details are at the end of the report.
On the basis of this inspection, the Chief Inspector of Hospital has placed the service into special measures.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Heidi Smoult
Deputy Chief Inspector of Hospitals