HELLO BABY

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• 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

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

The service had systems and processes in place to keep people safe. Staff had completed mandatory training including safeguarding training. Equipment was maintained and serviced as per manufacturer’s guidelines. There were appropriate infection control measures in place. The service did not store or prescribe any medicines.

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.

We scored the service as 3. 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 registered manager was able to demonstrate a clear knowledge of reporting, investigating, and the process of sharing incidents with staff. Staff understood their responsibility to report any notifiable incidents. Any incidents and complaints were discussed in regular staff meetings.

During our assessment we saw 2 incidents had been reported in the last 12 months. The incidents were reviewed by the registered manager and learning was shared with staff at team meetings. Staff told us they used reflective practice following incidents and they provided examples of how this had helped to make improvements to their practice.

We saw 4 complaints were received in the past 12 months. The registered manager spoke with the complainants, offered resolutions and shared lessons with staff in line with their complaints policy. The service clearly displayed information, including on their website, about how to raise a concern or complaint directly with the provider.

A duty of candour policy was in place, and staff described a no-blame culture. Staff had received training and understood what it was and how to apply it appropriately including giving women and families a full explanation, showing openness and honesty when things went wrong.

We scored the service as 3. 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 used the ‘Pause and Check’ guidelines set out by the British Medical Ultrasound Society (BMUS) and followed the As low as reasonably achievable (ALARA) principle.

Women completed a pre-scan questionnaire on arrival to the clinic, which included pregnancy history and a signed declaration confirming NHS care and consent to share medical information if required. The ultrasound technician completed checks during scans, which included confirming the woman’s identity, ensuring consent, and providing clear information and instructions.

The service had a clear documented pathway for early pregnancy referrals to support should they find an anomaly during pregnancy scans. Staff understood the referral process.

Women were advised to attend their local NHS early pregnancy unit or hospital and were provided with a scan report detailing the findings. The service supported women by giving them the contact information of the local NHS service, they made an appointment for them if they had been given permission to do so. The registered manager followed up with women after a few days to ensure they have been seen. Staff told us they would call 999 if emergency medical treatment was needed.

The service offered gender blood tests. The tests were conducted at the Hello Baby location but carried out by a trained phlebotomist who worked for a different organisation. There was a service level agreement in place which outlined clear responsibilities for each provider. Hello Baby provided the space, booked the appointments, posted the samples to the laboratory and emails were sent to women with result.

We scored the service as 3. 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. The service shared concerns quickly and appropriately.

The registered manager was the safeguarding lead for the service and trained to level 3 adults and children safeguarding. The service had a safeguarding policy in place which was in date and reflected national guidance. Staff were trained in safeguarding level 2 adults and children, they knew how to make a safeguarding referral and how to contact the local authority if required.

Staff ensured that any children accompanying families to the service were appropriately supervised by a responsible adult. This requirement was clearly communicated on the service website.

The registered manager shared an example of when they identified a safeguarding concern. They had appropriately completed a safeguarding referral and worked in partnership with other agencies to keep people safe.

Employment checks for staff included Enhanced Disclosure and Barring service (DBS) checks. These had been completed and documented for all staff.

The service delivered care to people aged 18 years and over. The date of birth was confirmed at booking, and staff performed identification checks when people arrived for appointments. The ultrasound technician then confirmed age and consent prior to performing the scan.

The service had information about support services for domestic violence and abuse on display in the toilet.

We scored the service as 3. 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 were aware of their responsibilities in documenting scan type and frequency and in advising women about the potential risks of ultrasound overexposure. Scanning time was limited and in line with BMUS guidelines. Staff adhered to the ALARA principle. Women were advised to book extra time when attending appointments to read about the risks of ultrasound scans. Women were able to change their mind and withdraw from the scan at any time if they wished.

Staff advised women about the importance of still attending their NHS scans and appointments. The ultrasound technician made sure people understood that the ultrasound scans they performed were in addition to the routine care they received as part of their maternity pathway. The terms and conditions for the service clearly explained this.

We scored the service as 3. 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.

The service had appropriate facilities and sufficient equipment to meet the needs of women and visitors.

The environment had been adapted to meet the needs of people who use the service. For example, doorways and walkways were wide enough to accommodate wheelchairs, there were assistance handles in the toilet. There were seating areas for people to wait and a children’s waiting area where they could play with toys and watch DVDs. People had access to a water machine whilst they waited. Information leaflets such as Hello Baby scans, mental health, anxiety, pregnancy, childbirth and breastfeeding were available. The reception area was clean and well-maintained, and staff maintained a clear line of sight at all times.

In the scanning room, a clean, adjustable scanning couch that met recommended standards was available. We saw individual ultrasound gel bottles that were in date. There was a television on the wall which mirrored the ultrasound machine and was positioned so people could see the images of their baby.

The ultrasound technician closed the clinic room door during the ultrasound scans to promote privacy and dignity.

Hand sanitiser gels were readily available in the service. Staff completed daily cleaning checks, with signed and dated records audited by the registered manager.

Staff ensured waste was disposed of in line with guidance. Waste was disposed of safely, in secure bins. Collection was provided under a contract with a waste company.

The service had systems in place to identify and mitigate risks. We saw evidence of up-to-date risk assessments for fire safety, health and safety, hand hygiene and Control of Substances Hazardous to Health (COSHH). These clearly identified risks, control measures and named staff responsible for monitoring. The service also had policies and procedures such as an emergency action plan and evacuation procedures.

Records confirmed safety and maintenance checks of equipment were carried out as per manufacturer’s recommendation. This included the scanning machine, portable appliance testing and fire extinguishers. The service had a fire risk assessment completed by an external company. Fire extinguishers were accessible and correctly stored, with clear fire exit signage. Environmental audits were in place, including checks on fire extinguishers, fire alarm testing, and evacuation drills.

We scored the service as 3. 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.

We saw that staffing levels were appropriate to the service being provided, with no vacancies at the time of our assessment. The registered manager was the only ultrasound technician and the service had four receptionists. The ultrasound technician was required to work as a ‘lone worker’ but followed the lone working policy.

The registered manager monitored mandatory training compliance to ensure this was completed and reminded staff when updates were required. All staff had received nationally recognised and mandated training including supporting people with learning disabilities and autism. Training completion was up-to-date and was appropriate for the patient group using the service.

All staff had received six monthly appraisals, and the registered manager had their clinical supervision and appraisals from an external sonographer.

The registered manager worked together with the staff to plan and maintain safe staffing levels dependant on service demand. The registered manager told us that another ultrasound technician supported staffing cover when staff were on annual leave.

The service had a chaperone policy in place. Chaperoning arrangements were made during booking process and women were asked to notify the service in advance to plan for additional staff.

We scored the service as 3. 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.

The waiting room was clean and situated adjacent to the reception and scanning room. The rooms were visibly clean; furniture was well-maintained and clean.

Staff adhered to infection control policies. Hand sanitiser gel was in place in appropriate dispensers for people to use. Face masks were also available. We observed the ultrasound technician was bare below the elbows and washed their hands before and after each scan. Handwashing facilities were available adjacent to the scanning room. Staff had received handwashing training and there were handwashing posters displayed.

Staff cleaned equipment after patient contact as per manufacturer’s guidance and the provider’s infection prevention and control (IPC) policy. Transabdominal probes were cleaned with sanitising wipes after each scan. The ultrasound technician was observed carrying out transabdominal ultrasound scans, which are non‑intimate examinations performed externally on intact skin.

Informed verbal consent was obtained prior to each examination, with infection control procedures clearly explained to women.

The ultrasound technician demonstrated appropriate consideration of safeguarding and patient dignity, maintaining professional boundaries throughout the examination. Women could request a chaperone if they choose.

Cleaning records were completed. The registered manager monitored and audited IPC and cleaning practices at the service. Learning and improvements identified from IPC and cleaning audits were shared with staff.

Waste was well managed. The service had a contract with a waste company.

A dedicated COSHH cupboard was securely locked, and chemicals were stored in line with legislation.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.