Cotton Exchange

We have not previously rated this location. We rated it as requires improvement because:

• The service did not monitor mandatory training in key skills. This meant the provider could not be assured staff training was up to date. The service did not always control infection risk well. The service did not always use control measures to protect women, themselves, and others from infection. The service did not always ensure specialist equipment was maintained. The service did not manage clinical waste well. The service did not complete and update risk assessments for women to remove or minimise risks. The service did not complete risk assessments for women at risk of deterioration. The service employed one person to undertake both the registered manager and sonographer role. This meant that many tasks and duties expected of a registered manager were not completed.
• The service did not always check to make sure policies were regularly reviewed and in line with the most up-to-date best practice guidelines. The service did not always collect outcome data or monitor the effectiveness of care. The service did not always assess the quality of scans. The service did not provide staff appraisals for work performance or supervision meetings to provide support and development. The service did not always work together as a team. The service did not always give women practical support and advice to lead healthier lives. The service did not support women to make informed decisions about their care and treatment. They did not follow national guidance to gain women’s consent.
• The service did not always take account of women's individual needs and preferences. It was not always easy for people to find information on how to raise a concern. The service did not have an effective complaints policy in place to respond to concerns and complaints appropriately.
• Leaders did not always have the capacity to manage priorities effectively or in a timely way. Leaders did not always operate effective governance processes. Staff did not have formal meetings to discuss and learn from the performance of the service. Leaders did not always have systems to manage performance effectively. They did not always identify and escalate relevant risks and issues and identify actions to reduce their impact. The service did not always collect reliable data and analyse it to understand performance, make decisions and improvements.

However:

• The registered manager understood how to protect women from abuse and the service worked well with other agencies to do so. The service kept equipment and the premises visibly clean. The service had suitable facilities to meet the needs of women and their families. The registered manager made appropriate referrals in a timely manner when risk was identified. The service had enough staff to provide care and they were able to adapt the clinic times according to availability. The service kept detailed records of women's care and treatment. Records were clear, up-to-date, stored securely and easily available. The registered manager recognised incidents and knew how to report them appropriately.
• The service had an experienced and qualified lead sonographer who performed all the scans. The service worked with other stakeholders to benefit women. Services were available five days each week.
• The registered manager treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. The registered manager provided emotional support to women, families, and carers to minimise their distress and took account of their individual needs. The registered manager supported women, families, and carers to understand their condition.
• The service planned and provided care in a way that met the needs of some local people and the communities served. People could access the service when they needed it and received the right care promptly. Reasonable adjustments were made to help women engage with the service. Lessons learnt from complaints were identified and action was taken to prevent similar complaints happening.
• Leaders demonstrated that they had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action. The registered manager felt respected, supported, and valued. They were focused on the needs of women receiving care. The information systems were secure. Staff actively and openly engaged with women to plan and manage services. Staff were committed to continually learning and improving services.