Hey Baby 4D Middlesbrough

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 means we looked for evidence that people were protected from abuse and avoidable harm, the service managed risk, the environment was well maintained and the service had enough qualified staff.

This is the first inspection for this service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

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 evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had no serious incidents in the last 12 months. There was an up-to-date Emergency and Significant Events policy. The policy outlined details of reportable events and a clear process for review. Staff understood how to report incidents. There was a comprehensive electronic incident reporting form available.

The registered manager and staff had access to learning from incidents across other Hey Baby 4D locations. We saw information was shared by email. There was regular communication between locations to share learning. Staff within the local service had regular planned time to hear about learning opportunities. We reviewed team meeting minutes and saw evidence of opportunities to share learning.

Staff understood the duty of candour. They were open and honest and gave people full explanations when concerns were raised.

The evidence showed a good standard. The service worked with people 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 people moved between different services.

The service had a criteria for refusal to scan, and all staff were familiar with this. The website provided information regarding the types of scans available and the timescales in pregnancy when each scan could be offered, for example, gender scans would be offered from 15 weeks onwards.

People self-referred to the service. Those who attended were paying customers. At the point of booking relevant information was collected to determine if individual needs could be safely met.

The referral form included an opportunity to include past history and any relevant concerns. This was a mandatory box to ensure people had seen the opportunity to provide additional information. This enabled staff to contact individuals in advance of appointments and direct them to NHS services if this was more appropriate.

Staff checked people’s age before scanning to ensure people were over 18 years old. Identification (ID) checks were carried out and staff gave examples of where they had turned people away who were under 18. Posters were clearly displayed stating people must provide ID.

Sonographers had clear criteria for when they should make a referral to NHS early pregnancy assessment units. There was an up-to-date Referral Policy. Staff told us referrals would be made via phone whilst the person was still present. The person was then able to leave with a card explaining the purpose of the referral and appointment details for the NHS service written on the card by the staff member making the referral. The referral policy outlined the appropriate contact details for all local NHS services including for out-of-hour referrals.

Following a referral to another service, staff made courtesy follow-up calls.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

At the time of inspection not all staff had completed children’s safeguarding training. They explained this had not previously been included as mandatory due to their inclusion criteria being over 18 years of age. Staff had identified they needed to ensure they considered the unborn baby and any children visiting the clinic with family. We reviewed the training matrix and saw the children’s safeguarding training had been recently included in the mandatory training list. One member of staff had completed the required level 2 training for the role. Two members of staff required level 3 training. Immediately following inspection both staff completed children’s safeguarding training to level 3. Staff had completed adult safeguarding training to level 3. Staff were able to give examples of when to make safeguarding alerts for both children and adults.

All staff had also completed training for learning disabilities and autism.

There was a Safeguarding Children Policy and Safeguarding Adult Policy. Both policies included a link to the relevant training and details of the local authority contact. Staff knew how to make safeguarding alerts to the local social care services. Staff knew where to find the contact details for the local services.

There was a safeguarding log in place to document referrals made, although this had not been needed to be used since the service had opened.

Staff were clear about protocols for children visiting with families. For example, they would ensure there was a family member remaining in the waiting area with a child if the person attending for the scan did not want the child in the scan room.

Staff understood domestic abuse and were equipped to support people experiencing difficulties. There was a discreet system in place that allowed individuals to seek help from staff without attracting attention. Staff were thorough in ensuring people received support if they needed it.

Information leaflets were placed in discreet areas of the service, for example, leaflets detailing support services for forced marriages, honor-based abuse and Female Genital Mutilation (FGM).

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

Staff communicated with people to ensure they understood the process of an ultrasound scan. When taking bloods staff clearly explained the procedure.

Staff were clear about the remit of the service and were able to clearly explain to people the importance of continuing to attend their NHS scans. Details on the website clearly outlined this and people signed a consent form to confirm they understood the remit of the scan as an addition to their routine NHS scans.

Staff made it clear to people that blood tests were processed by an external company solely responsible for any diagnosis and follow-up advice, guidance, or treatment.

The booking form asked about additional health concerns. This field was mandatory so had to be considered, however, people had the option to state ‘no concerns’. When people chose to share additional health concerns staff followed a standardised flow chart to ensure people knew where to go to seek appropriate help. For example, advice to see a General Practitioner and engage with the NHS antenatal team for gestational diabetes.

Scanning protocols were available for staff to follow for each type of scan. The protocols included every step of the process from checking and verifying ID, consent, ensuring appropriate communication and onwards referrals if needed. This ensured people were involved at all stages and understood their care.

Staff followed the ‘Pause and Check’ checklist devised by the British Medical Ultrasound Society (BMUS) and Society of Radiographers. A poster was displayed advising people the scan could be stopped at any time. Scan reports were completed immediately after the scans took place and shared with the person attending for the scan.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff and leaders had designed the environment with people in mind. Careful consideration had been given to a range of scenarios including sharing concerns.

The service was on the ground floor and was level access from the main road outside. Parking was located close by, and clear information was outlined on the website regarding the parking options.

The reception area was light and spacious. The service provided children’s play equipment in the waiting area. There was privacy screening on the windows in the play area and seated waiting area.

The bathroom facilities were adapted with grab rails and ramp for disabled access. A baby changing station was also available within the bathroom. However, the access to the bathroom was not wide enough for wheelchair access due to the original design of the building. The provider had identified the nearest wheelchair accessible toilet and noted this on the website for visitors to be aware.

There was a separate quiet room with chairs and desk for staff to take people who needed quiet time. This space was also used for making confidential calls when referrals needed to be made to NHS services. When designing the layout staff had ensured there was also an option to exit through a back door should people have received upsetting news and did not want to walk past others in the reception area.

The scan room was spacious and comfortable. There was an adjustable height couch with adjustable seating for staff. Comfortable seating was available for up to six additional people. Lighting could be dimmed and there was a large television screen positioned for people to see their scan in real time Additional privacy screening was available within the scan room itself. The door could also be locked to ensure privacy.

The scan machine was serviced, and daily checks were carried out. There was a support line available should the machine breakdown. The Health and Safety Policy outlined processes for carrying out checks. We saw completed daily check forms for the scan machine and couch.

Updated risk assessments regarding the environment were available. We saw fire and electrical safety checks were carried out by external agencies. PAT (Portable Appliance Test) testing was carried out.

All equipment was stored according to guidelines, for example, gels and blood taking equipment. The Control of Substances Hazardous to Health (COSHH) cupboard was clearly marked and secured.

Waste and sharps were disposed of in a way that kept people safe. Staff used appropriate systems to separate clinical and non-clinical waste.

The evidence showed a good standard. 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 people’s individual needs.

The service had a registered manager, sonographer and two reception staff. Staffing levels ensured there was no lone working and chaperones could always be provided if required. Reception staff had received training to chaperone people.

When additional cover was required for leave periods a locum sonographer was used. Appropriate checks were carried out prior to starting.

A Recruitment and Employment Policy was available. This outlined training requirements for all new starters within the first three months of employment.

Staff completed mandatory training through an online platform. Reminders were received when training was due to expire. We reviewed the training matrix and saw staff were up to date with all training.

We reviewed content of regular 1:1 meetings and saw training was discussed at each meeting.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Daily cleaning rotas were available and evidenced daily cleaning practices. We also saw monthly deep clean checklists completed. An external agency carried out a monthly deep clean. The registered manager maintained oversight of infection prevention and control (IPC) practices. The IPC policy set out clear responsibilities for each staff member.

Children’s play equipment was cleaned after each use.

All furnishings could be wiped down and were well maintained.

We saw that paper roll was used to cover the couch, and a dispenser was installed on the wall behind the couch for easy use. The couch was wiped down between each person and fresh paper laid.

Hand gel was available at reception on arrival and staff adhered to infection control principles. There was a sink for handwashing in the scan room.

Transducer heads were cleaned according to guidelines after transvaginal scans. All equipment for blood taking was stored securely and in individual sealed boxes. Management of sharps injuries was outlined in the IPC policy.

Spill kits were available for cleaning of any bodily fluids. Personal protective equipment (PPE) was available for use as required according to guidance in the providers own IPC policy. The provider had an Infectious Diseases, Blood and Airborne Viruses Policy.

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.