Overall summary
Window to the Womb is operated by Divinity MK Scans Ltd. and operates under a franchise agreement with Window to the Womb (Franchise) Ltd. The service provides diagnostic pregnancy ultrasound services to self-funding women living in Milton Keynes and surrounding areas, including Northampton, Oxford, Bletchley, Banbury, Kettering and Bedford.
We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 13 August 2019. We gave staff two working days’ notice that we were coming to inspect, to ensure the availability of the registered manager.
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.
Services we rate
We have not previously inspected this service. We rated it as Good overall.
We found areas of good practice:
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The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
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The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
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Staff monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other Window to the Womb clinics to learn from them.
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The service made sure staff were competent for their roles.
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Staff cared for women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from women and their families confirmed staff treated them well and with kindness.
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Women could access services and appointments in a way and at a time that suited them. Technology was used innovatively to ensure women had timely access to treatment, support and care.
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The service had a clear vision and strategy for what they wanted to achieve, with quality and sustainability as the top priorities.
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The service had governance arrangements to ensure high standards of care were maintained.
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The service engaged well with women and staff to plan and manage appropriate services, and collaborated with partner organisations effectively.
We found areas of outstanding practice:
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Window to the Womb had invested in technology and equipment which it used to enhance the delivery of effective care and treatment. They had developed a mobile phone application (‘app’). The app enabled women to document and share week-by-week images of their pregnancy bump with their family and friends and create a time-lapse video of their pregnancy journey. Any scan image taken during a Window to the Womb appointment was also saved on the app, which allowed women to have instant access to their scan images. Women could also book scan appointments through the app.
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Window to the Womb had developed a continued professional development platform which sonographers could access to enhance their knowledge and skills.
However, we also found the following issues that the service provider needs to improve:
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Not all training records included details of the date and staff members name on every page
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Not all staff were fully aware of their reporting duties in relation to female genital mutilation (FGM)
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Not all staff were fully aware of the term “duty of candour” so we were unclear on how to ensure it was met
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Keys for the locked records cabinet were stored in a removable storage box
Following this inspection, that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.
Name of signatory
Heidi Smoult
Deputy Chief Inspector of Hospitals