Cocoon Harrogate

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

This is the first assessment for this service. This key question has been rated good. This meant women were safe and protected from avoidable harm.

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked women were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

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 service did not always have a proactive and positive culture of safety based on openness and honesty. They listened to concerns about safety and investigated these concerns. Lessons were not always learnt to continually identify and embed good practice.

Staff and leaders told us staff received individual verbal or written feedback from any incidents or complaints. The service had no process for sharing findings from incidents with the wider team. Owing to most staff only working one day a week, the service did not have regular meetings to discuss incidents.

Staff were able to clearly describe the process they would follow if an incident occurred. They demonstrated an understanding of incident reporting procedures and explained how they would investigate, escalate, and learn from incidents to support safe care.

Leaders acknowledged gaps in establishing a robust learning culture. They told us they were introducing a new process which included maintaining an incident and significant event log. Leaders explained they would review this log as a standing agenda item at a new monthly clinical governance meeting to promote learning, identify trends, and support continuous improvement.

Women said they felt safe and had not needed to raise any issues with the staff.

Leaders told us there had been no clinical safety incidents reported. The digital and systems lead told us there had been no incidents when they had migrated the service users data onto a new electronic platform.

Leaders understood Duty of Candour, they told us they were open and transparent and gave women a full explanation when things went wrong. They were able to provide an example of this.

The service had up to date policies to support a leaning culture. However, there were no audits or monitoring undertaken of these policies to ensure they were effective.

The service worked with women and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when women moved between different services.

Women told us they were provided with information about what to do if they required urgent help from regional NHS maternity units or their doctor.

Staff we able to describe the process they took to ensure safe transfer of women who required continuity of care or urgent NHS treatment and how they recorded this in women’s notes.

The Registered Manager told us there was strong working relationships with NHS obstetric teams and smooth patient transitions. Informal processes were in place with local maternity units and primary care services. The service had tried to establish formal transfer arrangements with local NHS trusts, but this had not been possible. The service had clear clinical escalation pathways which ensured staff transferred women who required urgent assessment or emergency care safely and without delay.

The service had clinical polices in place to ensure they could provide a safe service to women who referred themselves. This helped staff determine whether the service could meet each woman's needs and ensured they made informed decisions about care.

When the service recently migrated women’s records to a new electronic system, staff manually reviewed and individually checked future appointments to ensure no women were missed during the transfer process. This approach helped maintain continuity of care and reduced the risk of appointments being overlooked. The system enabled staff to send secure communications to external partners, such as the pathology laboratory responsible for checking blood samples.

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

The Registered Manager told us there was a positive safeguarding culture and gave examples of concerns being discussed promptly and acted upon.

The service had an up to date safeguarding policy and staff discussed safeguarding at one to one meetings, if required. A safeguarding log was maintained and reviewed on the same basis.

The service safeguarding lead, and all staff, were trained to the appropriate level in both adult and children's safeguarding as determined by national guidance. Two staff were trained in Child Sexual Exploitation (CSE) and Female Genital Mutilation (FGM), an illegal practice in England.

All staff were able to tell us who the safeguarding lead was for the service and told us how they would identify, respond to, and escalate safeguarding concerns effectively, including female genital mutilation.

The safeguarding lead notified staff in advance of appointments when safeguarding concerns had previously been raised about a person, enabling staff to take appropriate action and provide safe care.

The service worked with women to understand and manage risks by thinking holistically. Staff provided care to meet women’s needs that was safe, supportive and enabled women to do the things that mattered to them.

Women told us they had not been asked to provide feedback on the service they had received. They said staff had explained all the risks, screening options and results to them in a way they understood.

We saw staff explaining clearly what was to happen to women undergoing a scan and/or blood test procedures.

The service clearly explained the care it provided and explicitly informed women that they still needed to attend their NHS maternity appointments. Staff told us the process they followed if a concern was identified as part of the scan to ensure women were seen promptly by NHS or Primary care specialists. The service had guidelines in place to support the staff with these decisions.

The service used the most up to date national guidance for scanning procedures to ensure the service was safe and effective.

Leaders ensured all scanning equipment was serviced and maintained.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff did not keep the Control of Substances Hazardous to Health (COSHH) cupboards locked, which increased the risk of harm to vulnerable people and children and, therefore, did not meet safety requirements. Leaders acknowledged this was an issue and said they would rectify this.

The service used a video doorbell to control access; however, the service had not displayed signage to inform women CCTV surveillance was in operation. Leaders acknowledged this and rectified it straight away.

CQC registration details were not visible to women. Leaders acknowledged this and rectified it straight away.

We found blood testing bottles out of date. However, no blood samples had been rejected by the blood testing service because of an expired blood testing bottle. We informed leaders whilst on site. Following the visit, leaders put a new process in place to monitor stock monthly.

We observed the sharps box was open, there was no date informing when it had been opened, and it was placed on the floor, which is a safety issue for children who visit with women.

Women told us the environment was clean and tidy. They said the building was easy to get to and parking was available.

The location was clearly signposted, with a comfortable, clean waiting area. The environment was clean and tidy on the day we inspected. However, there was no environmental temperature control and the scanning room was hot.

Facilities and premises were appropriate for both the scanning and NIPT services being delivered, with policies available for both services to support staff and women.

Staff undertook routine visual checks of ultrasound equipment before use, including checking cables, probes and overall functioning. Staff feedback regarding equipment quality had resulted in the purchase of a new ultrasound machine, which staff reported had significantly improved image quality and service delivery.[

We saw evidence that legionella and water safety process were in place, supported by the building landlord.

We saw the service had secure, locked clinical waste bins outside the building. Staff had the correct clinical wate bins in the scanning rooms and staff disposed of clinical waste effectively.

Some electric equipment had not been checked since 2024. However, a review date was in the diary for the month after the assessment. The electric installation condition report was in date. All staff were trained in using electrical non clinical and clinical equipment.

The staff used privacy door signage when busy scanning. Privacy screening was on all windows and blinds in clinic rooms.

Fire exits were clearly signposted and the service had two fire wardens in place.

The service 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 women’s individual needs.

Women said staff were able to answer all of the questions they asked in a way they could understand. Women described the team as responsive, supportive and professional.

The service had an induction programme in place to support new starters, covering expectations and support for the first year in their role, with clearly defined process and measurements. The service had an employee handbook in place to support staff.

Staff told us they had received an up to date appraisal. We reviewed staff records, which confirmed this.

The service had sufficient and appropriately qualified and trained staff to keep women safe. However, the current process if a staff member rang in sick, resulted in a gap in the service provision and, on occasions, cancellation of the scans for that day. Leaders told us this was rare.

All sonographer staff were advanced practitioners and worked in the NHS as well as the service which meant they were experienced, qualified and had the right skills and knowledge to meet the needs of women. The service did not use bank or agency staff.

Staff had completed 95% of their mandatory training, which meant staff were up to date to deliver high quality care to women.

The Registered Manager told us there was no structured continuous professional development programme for the service, however, if staff asked they would be supported to undergo any extra training.

The service had no vacancies, with all staff having worked there for three years.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

The service had an up to date Infection Control and Waste Management Policy in place which stated that women should advise them and consider rearranging appointments if they have and infections illness or disease. However, he Registered Manager told us the service relied on women telling them of any infection control issues, rather than formal assessment. Leaders told us they did not routinely collect information from women about any infections they may have prior to or on arrival at their appointment. There was no information on the website about notifying the service prior to a visit if women did have an infection. The service informed us, following the on-site visit, they had added an infection control screening question into their pre-procedure questionnaire.

The service had a standard operating procedure (SOP) which required staff to discard the gel used in the scanning process one week after opening it. However, staff had not dated the gel bottle when they first opened it, so they could not confirm they had disposed of it within the required timescale.

Staff told us they cleaned equipment and clinical areas between appointments by using cleaning wipes, decontaminated transvaginal (TV) probes before and after each use, and changed examination couch coverings and towels between women. No documentation was recorded of this cleaning.

The service did not maintain a separate audit record for the decontamination of transvaginal scan probes. As a result, if an infection prevention and control issue occurred, staff would need to review individual patient records retrospectively to identify which women had undergone a TV scan using the probe.

The public toilet was clean with hand hygiene posters in place. However, staff had not completed the cleaning checklist for the public toilet, and the checklist did not specify how often staff should check and clean the toilet.

Most women said they observed staff washing their hands both before and after their procedure.

There had been no infection prevention and control incidents within the service.

A monthly cleaning schedule was in place, with a fully completed checklist with no gaps available therefore providing assurance.

The scanning rooms were well equipped, with a sink in the room for hand washing and a hand hygiene poster in place. We observed staff adhering to infection control principles, including handwashing.

All staff wore uniforms and were bare below the elbows to reduce infection control contamination.

The service did not stock or administer medicines or contrast media for any scanning procedures. These were not required for the type of service offered.