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Marie Stopes International Essex Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 5 December 2018

Marie Stopes International (MSI) Essex Centre is operated by Marie Stopes International UK (MSI UK). MSI UK is a not for profit organization that was founded in 1976, to provide safe legal abortion services following the Abortion Act 1967. The service registered on the 1 October 1990. Facilities include four consulting rooms, one treatment room, diagnostic services, and 14 reclining chairs.

The Essex centre provides consultations, ultrasound scans, medical termination of pregnancy to nine weeks + three days, surgical termination of pregnancy to 23 weeks + six days and counselling and support for people who use the service. Surgical termination is carried out either under general anaesthetic, conscious sedation, by vacuum aspiration or dilatation and evacuation or no anaesthetic according to individual choice and needs. In addition, vasectomy (male sterilisation) under local anaesthetic, long acting reversible contraception (LARC) and sexually transmitted infection (STI) testing and screening are offered.

We inspected this service using our comprehensive inspection methodology. We carried out unannounced inspections on 11 and 20 September 2018.

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 our inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

At our previous inspection on 14 June 2017 we found breaches in regulations which we followed up as part of this inspection. The breaches were in respect of:

  • Regulation 17 (1) (2) (a) (b) Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance.

At this inspection we found the provider had not met all the requirements of this regulation.

We found breaches in respect of:

  • Regulation 17 (1) Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance.

Our rating of this service is good overall.

We found good practice in relation to:

  • Staff were helpful and caring and treated patients with dignity and respect.

  • Equipment maintenance and service records were fully itemised, organised and maintained.

  • There was a clear process in place for staff to report any incidents.

  • The policies reviewed were up to date and in line with the latest guidance and staff were able to access these easily.

  • Processes and procedures for daily infection prevention and control (IPC) and cleaning checks were maintained.

  • Translation services were available for patients who did not have English as a first language.

However, we also found areas of practice that the service provider needs to improve:

  • Surgical staff were unable to decontaminate their hands in the sluice area.

  • Clinical waste pedal bins within the theatre environment were broken. These had been replaced on our return visit.

  • In a three-month period, there were 17 days were the fridge checks were not recorded.

  • The provider had a management of Fetal Tissue Policy in place however practice observed during the inspection did not comply with the policy. There was no local oversight on the storage and disposal of pregnancy tissue.

  • Environmental concerns were highlighted as the outside bins were overfilled and the lids were unsecured. On our return visit, removal of domestic waste had been addressed.

  • There were a large number of empty blue plastic containers by the emergency exit, which could impede access/ exit from the building. On our return visit these had been removed.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 5 December 2018

We rated safe as good because:

  • The service had a good track record for safety. There had been no never events or serious incidents reported between August 2017 to July 2018.

  • The process and documentation of the World Health Organisation (WHO) and five steps to safer surgery checklist for surgical termination was completed appropriately.

  • Equipment maintenance and service records were fully itemised, organised and maintained.

  • Staff recognised how to respond to patient risk and there were arrangements to identify and care for deteriorating patients. There were processes and policies in place for the safe transfer of patients requiring transfers to a NHS facility and staff were able to describe the process to us.

  • Staff were aware of their responsibility to safeguard vulnerable adults from abuse. There were clear internal processes to support staff to raise concerns.

  • Patient records were well maintained, legible and up to date. We saw that they were stored securely.

  • Medicine management audit results for March 2018 to July 2018 were 100%.

However, we also found the following issues that the service provider needs to improve:

  • Staff were unable to decontaminate their hands in the sluice area.

  • Environmental concerns were highlighted as the outside bins were overfilled and the lids were unsecured. This could encourage pests and insects. On our return visit the removal of domestic waste had been addressed.

  • There were a large number of empty blue plastic containers by the emergency exit which could impede access/exit from the building. On our return visit these had been removed.

Effective

Good

Updated 5 December 2018

We rated effective as good because:

  • Patients received care and treatment in line with evidence based standards and best practice.

  • Staff were aware of the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards.

  • The staff worked effectively as a team providing delivering evidence based care to patients undergoing termination of pregnancy.

  • The service audited patient outcomes through feedback from patients accessing the service.

Caring

Good

Updated 5 December 2018

We rated caring as good because:

  • Privacy and dignity was maintained and patients wishes were respected.

  • We saw positive interactions between staff and patients undergoing termination of pregnancy.

  • Staff cared for patients undergoing termination of pregnancy with compassion.

  • All patients we spoke with informed us they were fully prepared and were involved in decisions about their care and treatment.

Responsive

Good

Updated 5 December 2018

We rated responsive as good because:

  • MSI Essex had facilities that included a small private room where young people and people in vulnerable circumstances could be taken; ensuring a discreet service and the room was purposefully ‘non-clinical’.

  • Staff stated there was easy access to interpreters when English was not the patient’s first language. This service was advertised on the website in addition to the availability of over 90 languages via the Google translate service.

  • A personal identification number and a password was given to each patient, and this was checked at every communication to ensure information was given to the correct person.

  • The service had direct access to electronic information held by community services, including general practitioners, which meant that MSI Essex staff could access up-to-date information about patients accessing the service.

Well-led

Requires improvement

Updated 5 December 2018

We rated well-led as requires improvement because:

  • Staff were unable to explain the providers’ visions and values.

  • The provider had A Management of Fetal Tissue Policy in place however practice did not reflect the policy. There was no local oversight on the storage and disposal of pregnancy tissue.

However;

  • The centre had a well-led framework with improvement action plans which were developed and in progress.

  • MSI Essex was supported by a Regional Manager (Operations), Matron, Governance Partner, Human Resource (HR) Partner and Finance Partner.

Checks on specific services

Termination of pregnancy

Good

Updated 5 December 2018

Marie Stopes International (MSI) Essex Centre is part of the provider Marie Stopes International UK (MSI UK). The main service provided is medical and surgical termination of pregnancy (TOP). The centre provides medical termination up to nine weeks plus three days and surgical termination of pregnancy up to 23 weeks plus six days. Surgical termination is carried out either under general anaesthetic, conscious sedation, by vacuum aspiration or dilatation and evacuation or no anaesthetic according to individual choice and needs. Counselling and support is provided for people who use the service. In addition, vasectomy (male sterilisation), performed under local anaesthetic, long acting reversible contraception (LARC) and sexually transmitted infection (STI) testing and screening are offered.