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Marie Stopes International West London Centre Good

Reports


Inspection carried out on 21 and 22 May 2019

During a routine inspection

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 carried out on 6 & 7 July 2017

During a routine inspection

The Marie Stopes West London Centre is operated by Marie Stopes UK International, which is a specialist reproductive healthcare organisation and registered charity. The West London centre is based in Ealing.

The service provides medical and surgical termination of pregnancy services, screening for sexually transmitted diseases, contraception advice and counselling.

The service provides surgical terminations up to 23 weeks plus six days gestation, and medical abortions up to nine weeks plus four days gestation. They also perform non-scalpel vasectomies. The service treats NHS and private patients.

We inspected this service using our comprehensive inspection methodology under Section 60 of the Health and Social Care Act 2008. The provider was given 23 days’ notice of this inspection. We carried out the announced inspection on 6 and 7 July 2017. We also visited one early medical pregnancy unit (EMU) providing satellite services at Wembley on 6 July 2017. At the time of our inspection, the operations manager was in the process of registering as the registered manager with the CQC.

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?

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

CQC undertook enforcement action, following an inspection of the governance systems at the MSI corporate (provider) level in late July and August 2016. There were several breaches in regulation that were relevant to this location, which we have followed up as part of this inspection.

The breaches were in respect of:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

Regulation 17 HSCA (RA) Regulations 2014 Good governance.

Services we do not rate

We regulate termination of pregnancy but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Processes and procedures for daily infection prevention and control (IPC) were in place with regular cleaning checks introduced.
  • The policies in place to ensure optimum standards of care and patient safety had been updated and were in line with the latest guidance. Staff were able to access these easily.
  • Staff on the ward were passionate about their job and believed in what they did. They spoke to patients in a manner in which they would like to be spoken to and were caring and compassionate.
  • Staff communication with one another and with the public was good. Staff had a good understanding of safeguarding and female genital mutilation (FGM).
  • We found management responsive to issues raised at the inspection and we found that managers had made improvements to processes since the last inspection.
  • A revised audit programme had been introduced since the last inspection. We saw individual examples of improvements made and team meeting minutes included discussions of audit scores and arising actions.

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

  • Staff had variable knowledge of the duty of candour.

  • Some staff expressed concern about the availability of training.

  • Usage of the World Health Organisation (WHO) and ‘five steps to safer surgery’ checklist was not always consistent.

  • Although improvements had been made to local governance this was hampered by some disjointed and poor communication from corporate management.

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 to help the service improve. We issued a requirement notices in relation to the World Health Organisation (WHO) and ‘five steps to safer surgery’ checklist. Details are at the end of this report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

Inspection carried out on 7 8 13 June 2016

During a routine inspection

Overall, we found patients received a responsive level of service, delivered by caring staff. However, improvements were required to ensure a safe and effective service was always provided, and to improve overall leadership. This was due to:

  • Infection prevention control (IPC) procedures did not always adhere to The Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance or associated national guidelines. Systems to risk assess, manage, and monitor the prevention and control of infection were not fully implemented and acted upon in the operating theatre.

  • Operating theatre staff did not follow the recommended dress code practices as outlined by The ‘Association for Perioperative Practice’ guidance (2011). Staff did not follow IPC practices in the operating theatre in terms of dress code and use of personal protective equipment.

  • Although staff had a good understanding of safeguarding and how to report incidents, they were only trained to safeguarding adults and children level two, which was not in line with best practice outlined in the ‘Intercollegiate Document’ (Royal College of Paediatrics and Child health 2014). Recommendations state level three training for staff working with children in this type of service.

  • Local management were not fully engaged in mitigating risks and due to hierarchical governance, local managers were not empowered to make decisions and changes.

  • Patients were not given information for the disposal of pregnancy remains in line with the Human Tissue Authority guidelines 2015, prior to their treatment. Staff were unaware of the correct procedures to follow. They told us they did not provide information and options unless the patient requested.

  • The theatre procedures list was often delayed at the beginning of the day due to the late arrival of staff. This caused unnecessary delays for patients.

  • Staff did not complete the pre-operative and post-operative briefings in accordance with The World Health Organisation (WHO) ‘five steps to safer surgery’.

  • Staff were frustrated with the last minute changes made to their rosters, which led to low staff morale.

  • Not all equipment was serviced regularly and labelled correctly to show that safety and maintenance checks had been undertaken.

  • The covers on the patient recovery chairs were unclean. There was dust on the covers and staff told us they were difficult to clean. The covers were removable but were difficult to replace once washed.

  • Staff trained to advanced life support (ALS), often left the premises when patients were still in recovery. This meant no ALS staff were present and available should a patient require further assistance.

However positive findings included:

  • Sufficient staff were available to support the service. Staff were able to work at different locations, which allowed flexibility for staffing cover.

  • Records adhered to national guidelines and were correctly completed.

  • Staff demonstrated compassionate and kind care. They were sensitive to the patients’ needs and made non-judgemental decisions.

  • The privacy of patients was respected throughout their pathway of care.

  • The staff we observed offered the appropriate pain relief for patients and managed this well even though a pain score was not recorded in patients records. They were able to offer good advice to support patients when they were discharged from the centre.

  • A good selection of information was available to patients on support services and the treatments provided at the centre. They had a good variety of leaflets, were able to have face-to-face discussions and access to their website.

  • The service was open six days a week and patients were often able to choose an appointment time that suited their needs. Good arrangements were in place for out of hours’ access with a 24-hour contact line. Patients had the opportunity to provide feedback and make suggestions on the service and care they received from the centre.

Inspection carried out on 2 December 2013

During a routine inspection

People using the service were provided clear information on treatment options and follow up care. Consultations were conducted privately and provided advice and counselling as well as medical examination and treatment. We saw that equality and diversity had been taken into account.

Signed consent to treatment was obtained in all cases after consultation and after an informed decision had been made about treatment.

We spoke to one person who told us that she felt well informed and was given clear explanations about treatment options and risks, follow up care and contraception. She told us that all the staff at the clinic were caring and supportive, saying, �They�re very kind, really nice. They give you all the information you need�

There were suitable arrangements for clinical emergencies with rapid response alarms, staff training in life support and appropriate fire safety procedures at the premises.

Infection control policies and procedures were in place to monitor and audit infection control and minimise the risk of infection to those using the service, and adequate standards of hygiene and cleanliness were apparent.

Staff had appropriate induction and training with a system of regular staff appraisals.

The provider had systems in place to monitor and assure the quality of the service, including regular audits, satisfaction surveys and a clear complaints procedure. Results of a recent survey showed very high levels of satisfaction with the service.

Inspection carried out on 3 January 2013

During a routine inspection

During our visit we spoke with one person who uses the service and six staff. We also looked at feedback the service had received from people who had completed a survey about their experiences of using the service. The service asked people to complete this prior to leaving the centre following their treatment.

Feedback from people who use the service was that they generally felt the staff were friendly and made them feel comfortable. They said that their treatment was explained to them and they were informed of any risks involved. We saw staff being respectful towards people and speaking to people calmly and discreetly.

Inspection carried out on 20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 1 December 2011

During a routine inspection

Patients using the service did not wish to speak to us when we carried out the inspection. We have therefore used our observations and patient feedback and responses in the Provider satisfaction survey to give their views of the service.

The majority of patients were satisfied they were treated with dignity and respect; one person commented �I was treated with the utmost respect from all members of staff�. Patients did feedback that they experienced long waits for their appointments and treatment which caused them additional anxiety.

Patient feedback on the service included statements on how safe and supported patients felt during their care and treatment at the centre. They made comments such as �they made me feel very at ease, explained everything and were very compassionate� and �all staff are very professional and friendly�.

Reports under our old system of regulation (including those from before CQC was created)