Background to this inspection
Updated
14 November 2019
R. B Imaging Ltd (Ultrasound Direct Heathrow) is operated by R. B Imaging Ltd. The service opened in 2015. It operates under a franchise agreement with Ultra Sound Direct (Franchise) Ltd. The service is an independent healthcare provider offering ultrasound imaging and diagnostic services to self-funding or private patients aged over 16 years of age. The hospital primarily serves the communities of Surrey, Buckinghamshire, Middlesex and East Sussex It also accepts patient referrals from outside this area.
The service has had a registered manager in post since 2015.
We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection at Ultrasound Direct Heathrow on 10 September 2019. We had concerns about what we found at this site, so we carried out two further unannounced inspections at Ultrasound Direct Brighton and Bourne End on the 24th September 2019.
Updated
14 November 2019
R. B Imaging Ltd (Ultrasound Direct Heathrow) is operated by R. B Imaging Ltd. The main location is Ultrasound Direct Heathrow. The service operates under a franchise agreement with Ultra Sound Direct (Franchise) Ltd. A franchise business is a business in which the owners, or franchisors, sell the rights to their business logo, name, and model to third party retail outlets, owned by independent, third party operators, called franchisees. The service provides a general ultra sound service for men and women and a baby scanning service which includes early pregnancy scans and gender confirmation scans.
We inspected diagnostic imaging services as this was the only regulated activity the service provided. We inspected this service using our comprehensive inspection methodology. Prior to our inspection we send out a provider information request to gain information about the service and its performance. We asked provider for this document on three occasions over the 12 months prior to our inspection and did not receive one. It is a requirement to provide information to the CQC when requested and the lack of response prompted us to undertake the inspection, as we saw it as a risk.
We carried out an announced inspection at Ultrasound Direct Heathrow on 10 September 2019. We had concerns about what we found at this location, so we carried out two further unannounced inspections at the satellite sites Ultrasound Direct Brighton and Ultrasound Direct Bourne End on the 24th September 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.
Services we rate
We have not previously rated this service. At this inspection we rated the service as Inadequate overall because;
The service did not control infection risk well. We saw varied use of infection control policies, some of which put patients at very high risk of avoidable harm.
The service did not routinely provide mandatory training in key skills to all staff or monitor this to ensure training was regularly completed.
Not all of the clinic sites were safe and suitable for their purpose.
Although most staff understood how to protect patients from abuse, not all staff had undertaken adequate levels of safeguarding training.
Equipment was not consistently well maintained or regularly serviced.
We did not find lessons learned from incidents were always shared with the wider team. There was no formal log of incidents and these were not regularly reviewed for trends and themes.
The service did not regularly review staff records to ensure staff were competent for their roles. Managers did not hold regular appraisals to monitor staff’s work performance. We saw no evidence of supervision meetings with staff to provide support and monitor the effectiveness of the service.
Managers did not monitor the effectiveness of care and treatment and therefore could not use the findings to improve this.
Staff were not following guidance and policy in regard to some aspects of infection control and safeguarding. Managers were not effective in ensuring staff understood local policies and guidance.
The service did not always consider patient’s individual needs regarding communication.
The service reviewed concerns and complaints and investigated them, however, these were not monitored for trends and themes and we saw little evidence of complaints being shared with all staff members.
The service had a vision for what it wanted to achieve but no strategy to turn it into action. We did not see that the leaders and staff understood the vision and strategy or how to apply them and monitor progress or had support from the franchise to deliver them.
Leaders operated poor governance processes throughout the service. Staff at all levels were not clear about their roles and accountabilities and did not have regular opportunities to meet, discuss and learn from the performance of the service.
Leaders and teams had poor systems to manage performance effectively. Risks were not identified and escalated to reduce their impact.
There were no plans to cope with unexpected events. There was no evidence that staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
There was no evidence that the service collected reliable data and analysed it. Therefore, the was little understanding of performance, which could be used to make decisions and improvements.
However, we also saw some good practice;
Staff completed and updated risk assessments for each patient and removed or minimised risks.
The service provided a flexible service taking into account the needs of patients. People could access the service when they needed it.
Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
Staff provided emotional support to patients to minimise their distress and involved patients and those close to them in decisions about their care and treatment.
Information systems were integrated and secure.
Following this inspection, we followed CQC process regarding the significant safety concerns and told the provider to suspend the regulated activities at the satellite sites of Ultrasound direct Heathrow, Ultrasound Direct Banstead, Ultrasound Direct Bourne End, Ultrasound Direct Kingston, Ultrasound Direct Brighton, Ultrasound Direct Hayes for a period of six weeks. After this time, they will be re-inspected to ensure that they have met all the required regulations to deliver safe care and treatment. We also issued the provider with five requirement notices. Details of these are at the end of the report.
Nigel Acheson
Deputy Chief Inspector of Hospitals (South-East)