Babysteps

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. This is the first assessment for this newly registered service. This key question has been rated Inadequate. This meant services were not planned or delivered in ways that met people’s needs. The service was in breach of legal regulation in relation to people’s safe care and treatment. For example, we found the service not to be person centred and did not provide people with necessary information.

We have not awarded this service a score for Responsive.

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

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure people were at the centre of their care and treatment choices, and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The responsible individual could not demonstrate any processes or recorded conversations where customer needs and preferences were documented or considered. We observed women who attended the service were not assessed, and information was not exchanged regarding consent. Women using the service did not provide informed consent and were not given clear information about their treatment, which included how the service would respond to changes in people’s needs.

The responsible individual said they did not have women's files demonstrating any conversations that had taken place to ensure the care people received was person-centred. This included women who had used the service more than once and had previous difficulties in pregnancy.

We scored the service as 1. The evidence showed significant shortfalls. There were significant shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible, or supportive of choice and continuity.

We observed that, due to the lack of structured systems and processes, women’s care and treatment were not coordinated and responsive, or delivered in a way that met individual needs. There was no demonstrable consistency in continuity in people’s care and treatment because services were not flexible and joined up. We saw delays in referring women to NHS services, and unless the women had shared identifiable information, they may be put at risk, as the person’s identity would remain unknown.

Delivering and co-ordinating services considers the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. People’s needs were not always met in ways to protect their equality characteristics. The responsible individual stated that if there were communication barriers and a woman could not understand information given to them, they would not attempt to provide alternatives and would rely on people accompanying them to support.

We scored the service as 1. The evidence showed significant shortfalls. The service did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was a lack of transparent information provided to all women, and whilst the responsible individual understood the need to provide information to gain consent, these principles were not followed.

We saw evidence of a third party communication application being used on a mobile telephone to relay scan images. The use of this was not secure and failed to comply with, protect people’s data or meet the needs of the women using the service. We observed conversations on the responsible individual’s telephone that demonstrated escalated anxiety in women when replies were not timely.

Although the responsible individual made telephone notifications to the NHS, this was not always done on the same day, which left some women feeling anxious. People received no information on what to expect should their care need to be escalated to the NHS. No additional information was shared, where women could be signposted for emotional support.

The responsible individual could not demonstrate the service complied with the Accessible Information Standard. The standard requires services to provide information in understandable formats and communication support for people with disabilities, impairments, or sensory loss. It mandates identifying, recording, flagging, sharing and meeting the specific needs of a person, for example, such as providing Easy Read versions of information.

Information on the service was not available in different languages, and the responsible individual was not able to tell us how they would do this should the need arise.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. They did not involve people in decisions about their care or tell them what had changed as a result.

When registering the service, the responsible individual stated they would get feedback through promoting search engine reviews or similar. It was stated that a link for concerns or complaints from the website was to be provided for women, but this was never added. We were told the service had not received any complaints, but when we reviewed messages on the mobile phone, it was clear customers were not always happy with the service. This wasn’t captured because they did not have a formal process to follow to review feedback. This meant when women raised concerns, they did not receive feedback, and the information they had given wasn’t acted upon.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it. People could access appointments online through the provider website, by telephone or by calling into the premises. The main entrance was wheelchair accessible, but the bathroom was not.

The responsible individual could not evidence they could provide equitable access to their service because they did not undertake any comprehensive assessments.

The responsible individual was not up to date with training in manual handling and, therefore, was unable to support women who required help with transferring out of a wheelchair and onto a bed.

We scored the service as 1. The evidence showed significant shortfalls. Leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

The service did not promote a culture in which the people using the service felt empowered to give their views. There were limited and restricted opportunities for people who used the service to give feedback on their experience.

The provider had not undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

The responsible individual had not received training in equality, diversity, inclusion and human rights.

We scored the service as 1. The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Women were not supported to make informed choices about their care and plan their future care while they had the capacity to do so.

Women's decisions and what matters to them were not delivered through personalised care plans that are shared with others who may be informed.