Ultrasound-Care Bromsgrove

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating had improved to good.

At our last inspection we rated this key question requires improvement. The service was in breach of legal regulation in relation to Mental Capacity Act and Learning Disability and Autism training; clinical risks did not include mitigation. The service has made improvements. We saw risk assessments clearly detailed actions to be taken. At this assessment the rating has improved to good.

Not all staff had completed all mandatory training, and clinical supervision was not embedded into practice. However, the centre was appropriate to the needs of the service and kept clean. Patient risks were routinely checked prior to appointments, which facilitated preparation and patient comfort. There were clear and robust pathways for escalation of findings, and staff made sure patients understood the risks and next steps before they left. Staffing was appropriate to the needs and there was flexibility across roles which enabled the service to run effectively.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The provider promoted a positive culture of safety, based on openness and honesty. However, staff mandatory training was not always completed, and appraisals and supervision were not embedded.

The provider promoted a positive culture of safety, based on openness and honesty. However, staff mandatory training was not always completed, and appraisals and supervision were not embedded.

The service had no incidents relating to patient safety in the year up to the inspection. However, processes were in place to manage patient safety incidents if they occurred. Staff could recognise incidents and near misses and knew how to report any concerns. The service described how incidents from other sites would be shared with the team for learning and how senior managers would take prompt action if something went wrong. For example, we saw how cancellations due to bad weather had been discussed at the joint team meeting and actions agreed for all sites to ensure parity.

The service had a current incident reporting and reviewing policy, which reflected provider and national guidance. Staff would report any incident to the senior managers who would complete an assessment and act if necessary.

There had been no reported never events in the previous year. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed.

Themes from client feedback were analysed to identify trends or themes, and potential links to individual practitioners. The main feedback related to the quality of images. Senior managers ensured that staff were aware of the limitations to image quality and prompted staff to discuss these during client appointments.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring. Senior managers were visible and responsive to calls from staff.

Staff understood the duty of candour and were aware of the need to be transparent and open, giving a full explanation when things went wrong. Staff received feedback from investigations of incidents at other sites.

The service provided mandatory training in key skills to all employed staff. Those working within the centre as self-employed (sonographers) were responsible for their own training and compliance was checked by the employer. Sonography staff were fully compliant.

We saw some gaps in mandatory training with an overall compliance of 73%. There were gaps in fire safety training, manual handling, and information governance. Training was provided by an external company who also checked competency. Training was monitored by the senior managers and training arranged.

Clinical staff completed training on recognising patients with mental health needs and learning disabilities. We were given examples of how needs were assessed at the initial booking phase, to book appointments at a suitable time and with the relevant support in place. For example, women with sensory overload, were provided with appointments at the start or end of clinic lists to reduce triggers.

The lead sonographer ensured that policies were amended to reflect national guidance and was in the process of introducing supervision sessions to identify gaps in learning. Non sonography staff were assessed every month by senior managers. They reviewed competency in areas such as communication, infection control and maintaining confidentiality.

The provider collaborated with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

Safety was a priority throughout the women’s care pathway. Women were assessed prior to the appointment and images were planned. A detailed checklist was completed at the point of referral to determine what was needed. This ensured that the appropriate clinician, sufficient time, and suitable environment was available. In addition to pregnancy related scanning, the service also completed scans following referrals by GPs, physiotherapists and other clinicians. These were completed by the relevant clinicians and reports shared with the referrer.

There was a referral criterion for all women to minimise the risks to the women, other service users, and the team. For example, people with contagious infections were not seen and were signposted to their midwives or GP for further advice.

Patients attending for diagnostic scans and investigations were given enough information to enable them to understand the procedure. Staff took time to explain scans and what actions were required after their appointment.

There were systems and processes to ensure the correct patients were treated throughout the patient journey and that they only received the procedure which was intended. Staff said they understood what action to take if concerns were raised. Suitably skilled and qualified staff undertook the required diagnostic procedure and accompanied patients in all areas. Chaperones were used for all appointments.

Patient records were a mixture of electronic, and paper based and were kept securely. The information technology connectivity was consistently available across the service to meet the needs of staff completing the records. The service was in the process of identifying a fully electronic system which would prevent the use of paper.

When anomalies were identified or there were concerns relating to the scans, women were advised to contact the relevant clinician. For example, we saw advice given to contact the early pregnancy unit following an anomaly identified in a scan. Advice for escalation was clearly recorded on the scan report, along with details of the concerns identified.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

At our last inspection, staff did not always know who to escalate safeguarding concerns too. At this inspection, staff knew who to inform if they had concerns and there was clear guidance available. All staff were trained in safeguarding adults and children to level 2, with senior managers trained to level 3. If there was a concern about safety, the senior managers would seek support from the GP or contact the safeguarding team. There were safeguarding posters in the women’s toilets highlighting contact numbers if they wanted support.

Staff knew how to identify adults at risk and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The registered manager had oversight of safeguarding within the service, and any concerns were discussed at management meetings. There had been no concerns for escalation in the year preceding the inspection.

Women referred to the service were treated in line with national guidance for their pregnancy, irrelevant of any protected characteristics. Pathways followed national guidance.

Staff followed safe procedures for visitors attending the centre. The service had an up-to-date chaperone policy, and all attendees were supported by a chaperone.

Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Staff explained the potential side effects and how and when to escalate concerns. All women over 18 years of age were expected to have a chaperone. If women were not accompanied and there was potential bad news, staff ensured the woman had contacted someone to accompany them or meet them.

When women expressed needs or distress, staff supported them positively and protected their rights and dignity. We saw that woman’s welfare was the priority of the team. They took steps to ensure that women were comfortable, informed and supported.

Patients were informed of options, risks and signposted to support, as necessary. Records reflected any foreseeable risks and steps to be taken to address these. Sonographers were experienced staff who were able to determine risks associated with the scans and therefore signposted appropriately to other services or clinicians.

If a pregnancy was suspected to be outside the uterus, the woman was referred to the acute trust for further investigations. The senior managers were clear that the team did not make a diagnosis if any anomalies were identified. Sonographers would refer to an appropriate clinician. This was the same for non-pregnancy related scans or blood tests. Patients were informed to seek GP or requesting clinician support to interpret results.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities, premises and equipment kept people safe. The centre had a large reception which was manned when the service was open. There was one large scanning room, printing room, staff room, storage and toilets on the ground floor, and a large waiting area, therapy room, office, and store on the first floor. Women attending for scanning used the ground floor only, unless additional space was required for large groups.

Staff were trained to use the equipment and to manage different types of waste safely. The ultrasound equipment had recently been replaced, and staff had received training by the manufacturer to ensure competence.

The design of the environment followed national guidance and where required, areas were secure and afforded protection to patients. Access was restricted and doors locked when rooms were in use.

The scanning room was large enough to allow patients to prepare for their scan and privacy screens were provided. When intimate scanning was required, women were provided with privacy and modesty covers.

Staff were clear about their responsibilities regarding premises and equipment. They used equipment correctly to meet statutory requirements and supported people to stay safe. We saw that all single use sterile equipment was disposed of safely and all equipment stored was within date.

There were external contracts in place for the maintenance and testing of equipment. For example, all electrical equipment was assessed prior to use by an electrician. If any issues were identified with equipment, external engineers or manufacturers were contacted. There was a spare ultrasound machine available onsite in case of equipment failure and staff were able to access another site in the event of whole centre disruption.

There was suitable equipment provided and it was used correctly.

Patient mobility was checked prior to the appointment to enable staff to prepare for patients who needed assistance. This included the use of a temporary ramp to access the building if necessary. Staff conducted daily safety checks of specialist equipment.

Facilities, equipment, and technology were well-maintained, used for their intended purpose and consistently supported staff to deliver safe and effective care. Equipment was checked regularly to ensure it was safe to use. Senior managers-maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to conduct their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair or replacement of broken or missing equipment.

There were effective fire safety procedures in place. We saw that fire evacuation signs were visible and fire extinguishers available. Staff completed training on emergency procedures and checked emergency equipment daily. Fire exits were clear and free from obstruction.

The service had suitable facilities to meet the needs of patients’ families when necessary. Rooms were sufficiently sized to enable larger families to attend appointments and there were two large waiting rooms which could accommodate larger groups.

All rooms met infection control and prevention guidance for clinical areas.

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled. The service had an external contract in place for the safe removal and disposal of clinical waste.

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff including sonographers and support staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff told us the team were always willing to cover any gaps due to sickness or holidays, which meant the service could run planned operational hours.

Sonographers were self-employed and worked set fixed hours per week this enabled the service to plan appointments according to sonographer availability and skills. For example, some sonographers were competent in upper limb scanning or abdominal scanning in addition to pregnancy related scans. The provider employed all other suitably trained staff directly.

Senior managers ensured training was completed and assured competency prior to using the clinician in clinics. References and experience was checked, along with Health and Care Professional registration details. At our last inspection, senior managers did not always check Disclosure and Barring (DBS) clearance for all staff. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable. We saw at this inspection that senior managers had access to DBS records and checked compliance before employing the staff member.

The service had introduced a senior sonographer who was assisting with the auditing and assessments of staff, including quarterly audits of scans for quality and competency checks prior to employment. All staff had a trial period before being confirmed in a role and employed by the service.

All non- sonography staff were trained in all areas of the service such as reception and chaperone cover. This ensured that there was suitably trained staff to cover all the required aspects of care and also made non-sonography roles more interesting. Non sonography staff were supported through an induction by one of the senior managers, who ensured exposure to all aspects of the roles, and confirmed training and competency. Sonographers worked with a buddy at the commencement in post, to ensure practice was as expected and the staff member was aware of local policies and procedures.

The service had external trainers for all clinical skills and mandatory training, such as manual handling, safeguarding and infection prevention and control. Staff were also able to complete phlebotomy training and competency was checked by an external provider.

The service did not employ any medical staff. The registered manager confirmed there had been discussions about providing radiologist cover, but this had not been formalised at the time of inspection.

New staff had a full induction tailored to their role before they started work. Managers supported most staff to develop through constructive and recorded annual appraisals, and constructive clinical supervision of their work.

The service did not use temporary bank or agency workers. Substantive or known sonographers were able to cover any gaps in the service. Senior managers confirmed gaps rarely occurred and a closed social media site was used to discuss any planned leave and cover was always found. Senior managers were able to step into any non-sonography roles without cover at the last minute.

Managers reviewed the number of clinical staff, assistants and other key roles, needed for each shift, ensuring there were sufficient staff for each clinical session.

Staff spoken to said they felt the service was safe. They were able to take breaks during their shift. Patients spoken with felt their needs were met in a timely manner. Patients told us they felt comfortable and were engaged in conversations, and there was sufficient staff.

The service supported the learning and development needs of staff and made sure they received any specialist training for their role. Managers identified training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. For example, staff were able to complete phlebotomy training. As sonographers were self-employed, they were not provided with additional training in scanning.

Managers made sure staff attended team meetings or had access to the information shared when they could not attend. At our last inspection, staff were not always provided the opportunity to feedback, and team meetings were not regular. At this inspection we saw that team meetings were held monthly via a social media network. And attended by staff across all sites. Meetings were completed remotely due to the large number of staff and ensuring the availability of as many as possible. We saw notes from team meetings, and other general information was shared on notice boards.

Managers supported staff and had implemented a programme of supervision. If poor staff performance was identified this was dealt with in a supportive way, with a view to improvement. For example, staff able to be shadowed by one of the senior managers to help develop additional skills or competency.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.

There was a provider infection, prevention, and control (IPC) policy and supporting guidance that was accessible to staff. Patients were screened prior to attending to identify any infection risks. Those identified as having an infection, were not allocated an appointment and were signposted elsewhere, or asked to return when the infection had cleared.

The centre was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. There was a cleaning checklist completed daily which was checked for completion. We saw that staff were reminded to keep the centre clean during team meetings, and the service completed monthly audits to confirm cleaning had taken place. Staff IPC was checked through audits of uniforms and handwashing.

Staff cleaned equipment after patient contact and at the end of each working day. We saw checklists that confirmed cleaning had been completed. All equipment appeared clean. Personal protective equipment (PPE) was available to use.

Staff supported infection prevention and control measures by following the uniform policy. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination. Reminders about uniform were seen in team meeting minutes.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.