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Marie Stopes International West London Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 1 August 2019

Marie Stopes International West London Centre is operated by Marie Stopes International. Facilities at the centre include two treatment rooms, five consulting rooms, ultrasound facilities, a waiting room and three day rooms including a recovery room with reclining chairs.

The service provides surgical termination of pregnancy procedures up to 23 weeks and six days gestation as well as early medical abortion and medical termination of pregnancy up to nine weeks and six days gestation. Surgical termination of pregnancy is carried out under general anaesthetic, sedation, by vacuum aspiration or dilatation and evacuation or no anaesthesia for up to 10 weeks according to the patient’s choice or needs. The service also provides consultations, ultrasound scans, contraception advice including fitting of long acting reversible contraception (LARC) and screening services for sexually transmitted infections. There is also a vasectomy service (male sterilisation) provided at the centre. MSI West London Centre also manages five early medical unit (EMU) satellite clinics located in the community, where early medical abortion and consultations in the early stages of pregnancy are provided in a private consultation room.

We inspected this service using our comprehensive inspection methodology. We carried out unannounced inspections on 21 and 22 of May 2019.

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.

At our previous inspection on 6 and 7 July 2017 we found a breach in regulation and we served a requirement notice in respect of:

Regulation 12 Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment.

At this inspection we checked that action had been implemented to address this breach and we found that improvements had been made.

Services we rate:

We rated this service as good overall. We found good practice in relation to:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They provided emotional support to patients.

  • The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

    However:

  • Hand hygiene compliance rates were low and we observed isolated occasions where staff did not wash their hands after touching computer keyboards when treating a patient.

  • There was no record of stock levels for medicines such as mifepristone and misoprostol which meant the service was not following the provider’s medicines management policy and it would not be possible to check if there were discrepancies in stock levels.

Following this inspection, we told the provider 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.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 1 August 2019

We rated it as Good because:

We found the following areas of good practice:

  • Compliance around the use of The World Health Organisation (WHO) and five steps to safer surgery checklist had improved. We saw in records, and observed during surgical procedures, that the surgery checklist was now being completed appropriately at each stage. Audits were also now being undertaken.

  • Staff knowledge and awareness of the duty of candour had improved since the last inspection.

  • Mandatory training was now up to date and tracked through a new electronic learning and development platform.

  • There was a good culture of incident reporting and staff at the early medical unit satellite clinics now received feedback and learning from incidents that had happened at the centre.

However:

  • Hand hygiene audit results were low and we observed isolated occasions where staff did not wash their hands after touching computer keyboards when treating a patient.

  • We found a cleaning cupboard which was left unlocked and contained passwords to the keypad lock for the door pinned on the wall within the cupboard. However, when we notified the operations manager, this was rectified immediately. 

Effective

Good

Updated 1 August 2019

We rated it as Good because:

We found the following areas of good practice:

  • At our last inspection we found policies that were not up to date. At this inspection, policies we reviewed were up to date and accessible by staff on the provider’s intranet. Policies made appropriate reference to national guidance and best practice.

  • Staff assessed and monitored patients regularly and gave pain relief in a timely way. Pain assessment tools were used and records we reviewed showed pain scores were documented.

  • The service now had a comprehensive compliance monitoring programme. Key indicators such as training compliance rates, audit results and complaints were monitored on a dashboard. The early medical unit satellite clinics were audited every six months by clinical team leaders and the deputy clinical services matron.

  • The service had been training a member of staff to be a dedicated contraception and sexual health (CASH) champion to provide training to nursing staff to achieve a higher rate of uptake for long acting reversible contraception.

However:

  • Health promotion information was limited, although there were some examples of health promotion information such as posters displaying information about cervical screening.

Caring

Good

Updated 1 August 2019

We rated it as Good because:

We found the following areas of good practice:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • We observed consultations and saw that staff were respectful and compassionate with patients.

  • Staff we spoke with were passionate about their work and delivering patient centred care.

  • We observed clinical and non-clinical staff talking sensitively to patients.

  • We observed nurses introducing themselves to patients and taking the time to explain to patients about procedures. 

Responsive

Good

Updated 1 August 2019

We rated it as Good because:

We found the following areas of good practice:

  • The service had now implemented a five minute gap in between consultation times to allow staff the flexibility to spend more time with a patient if needed.

  • There was access to both telephone and face-to- face interpreters and staff told us they could be requested easily.

  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. All complaints received were responded to within 20 days which was in line with the service’s complaints policy.

  • Telephone counselling was offered to patients including patients who had vasectomy procedures. If a patient requested face-to-face counselling, the service referred the patient to the south and central London MSI centres.

Well-led

Good

Updated 1 August 2019

We rated it as Good because:

We found the following areas of good practice:

  • MSI West London Centre and the five early medical unit satellite clinics were managed by an operations manager and deputy clinical services matron which meant that there was now full oversight by a dedicated on-site manager for operational and clinical issues.

  • Staff spoke highly of the visibility, involvement and support from the operations manager and deputy clinical services matron.

  • Staff were passionate about their work and spoke of good teamwork in a patient-centred environment.

  • There was now a clear governance system for the organisation and senior staff explained to us how information was shared up to board level and down to staff at the centre. Managers told us they felt that the process was more embedded since the last inspection and there was more visibility from the clinical director.

However:

  • We reviewed the provider’s medicines management policy which stated that the registered manager should be notified of any discrepancies between stock records and levels of medicines. While stock records and levels were recorded for controlled drugs, there was no record kept for medicines such as mifepristone and misoprostol which meant the service was not following the medicines management policy and it would not be possible to check if there were discrepancies in stock levels.

Checks on specific services

Termination of pregnancy

Good

Updated 1 August 2019

Marie Stopes International West London Centre provides surgical termination of pregnancy up to 23 weeks and six days gestation and medical termination of pregnancy up to nine weeks and six days gestation. The centre also has five satellite clinics in the community providing medical termination up to nine weeks and three days gestation. The service also provides contraception advice including the fitting of long acting reversible contraception (LARC) as well as vasectomy (male sterilisation services.

We rated this service as good overall.

Safe, effective, caring, responsive and well led were rated as good.