You are here

Reports


Inspection carried out on 5 March 2019

During a routine inspection

Window to the Womb Reading is operated by Divinity Ltd and operates under a franchise agreement with Window to The Womb (Franchise) Ltd. The service provides diagnostic pregnancy ultrasound services to self-funding women across Berkshire.

The service provides diagnostic imaging for children aged 16 years to 18 years and adults over the age of 18 years. It is registered to provide the regulated activity of diagnostic and screening procedures.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 5th March 2019. We gave staff two working days’ notice that we were coming to inspect to ensure the availability of the registered manager and clinics.

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 inspected this service. At this inspection we rated it as Good overall

We found the following areas of good practice:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care. Managers appraised staff’s work performance annually and checked to make sure staff had the right qualifications and professional registration for their roles.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

  • The environment was appropriate and met the needs of the range of people who accessed the service including toys for children to play with whilst waiting for parents’ appointments. The service controlled infection risks effectively.

  • Women could access services and appointments in a way and a time that suited them. The service used technology innovatively to ensure women had timely access to ultrasound scans.

  • The service provided care and treatment based on national guidance and could evidence its effectiveness. Managers monitored the effectiveness of care and treatment and used the findings to improve them. The service evaluated images to ensure they were of good quality.

  • The service treated concerns and complaints seriously. The registered manager completed comprehensive investigations and shared lessons learnt with all staff.

  • The service improved service quality and safeguarded high standards of care by creating an environment for good clinical care.

  • Staff were caring, compassionate, kind and engaged well with women and their families.

  • The service took account of patient’s individual needs for example if an early scan showed a miscarriage the women could exit the clinic via another exit rather than passing other waiting pregnant women.

  • Managers promoted a positive culture that supported and valued staff. Staff reported their team worked well together and staff trusted and respected each other.

  • The service collected, analysed, managed and used information to support all its activities, using secure electronic systems with security safeguards.

  • The service effectively managed risks and could cope with both the expected and the unexpected.

However, we also found the following issues that the service provider needs to improve:

  • The service’s policy folder detailed an out of date children and adults safeguarding policy from another organisation

  • The service’s children’s safeguarding policy did not reference child sexual exploitation and the staff had not received any training. This was against best practice.

  • The service offered to look after children during scans without completing risk assessments.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Dr Nigel Acheson

Chief Inspector of Hospitals (London and South)