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This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 19 October 2018

Ultrasound Direct Ltd is operated by Ultrasound Direct Limited. The service had one registered location with 32 satellite clinics located around England. Two satellite clinics was based in Ireland (Belfast and Newry).

The service provides diagnostic imaging services (ultrasound scans) to the local community. We inspected diagnostic imaging services at this location and a selection of satellite clinics.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 14 August 2018 and six short notice announced visits to satellite clinics across England between 15 August to 23 August 2018.

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.

The only service provided at this location was diagnostic imaging.

Services we rate

We previously did not have the authority to rate this service, however we now have the authority to rate these services. We rated it as good overall.

We found the following areas of good practice:

  • There was a system and process in place for identifying and reporting potential abuse. Staff could provide examples where they had needed to escalate concerns.

  • The service had a positive approach to learning from incidents and complaints. They reviewed all incidents regardless of level of harm and complaints to identify if any learning opportunities were evident.

  • There was a robust process in place for the escalation of unexpected findings during ultrasound scans. The service had developed links with local acute healthcare providers to enable a seamless onward referral for patients experiencing complications with pregnancy, as well as a well embedded referral process for non-pregnancy related complications. We saw examples of staff escalating unexpected findings during our inspection.

  • There was a proactive approach to training and continuous professional development for staff who worked at the service. The introduction of the Ultrasound School was an innovative way of ensuring staff remained clinically up to date and competent whilst giving staff the opportunity to develop new skills and competencies.

  • Patients were cared for by clinically competent and professionally adept staff. The service took competency seriously and the processes for overviewing competency seriously and had entered staff with no professional registration on to the Society of Radiographers register.

  • Feedback from patients was overwhelmingly positive during our inspection and we observed some examples of high quality care and treatment provided to patients. Patients were engaged with and encouraged to be partners in their care and treatment provided.

  • Clinical environments were visibly clean and tidy, and were suitable and appropriate to meet the needs of the patients who attended for appointments, as well as relatives and children who accompanied them.

  • Appointments were scheduled to meet the needs and demands of the patients who required their services. Throughout the regions which the service covered, they had arranged for seven-day services to be available, with a wide range of appointment times to suit patients. Same day appointments were also available for patients who required them.

  • The vision and values were understood and well embedded in staff’s daily work. Staff felt supported by a leadership team who were credible, approachable and visible. Staff were proud to work at the service and there were high levels of satisfaction across all staff groups.

  • There were governance systems in place to monitor the high-quality and sustainable care being provided to patients.

  • The service had systems in place to acquire feedback from staff and patients to enable them to continually improve the service being provided.

However, we found areas of practice that the service needed to improve:

  • We found issues regarding the environment of some of the clinical locations which did not fully support good infection prevention and control practices. Some locations did not have a handwashing sink immediately available for staff and some locations had carpeted floors in the ultrasound scanning room.

  • The clinical assistant staff group had not previously been required to complete mandatory training. Senior management had recognised this as an issue and had implemented a training programme for all clinical assistants to complete. This programme was due for completion by November 2018. We saw this was on trajectory at the time of our inspection.

  • The service had minimal processes in place to demonstrate patient outcomes. Senior management had already identified this and had recently implemented an annual audit programme and audit meeting for oversight of this.

  • The human resources (HR) process were being changed to a new system at the time of our inspection, this made viewing staffing files difficult. The staff files we did review were not all complete, however some of this was related to the transfer from the old HR system to the new.

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.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)

Inspection areas

Safe

Good

Updated 19 October 2018

We rated safe as good because:

  • There was a robust safeguarding process at the service and staff knowledge was also positive. Staff could provide examples of how they had identified and handled previous safeguarding concerns.
  • There was a process in place for staff to follow when escalating unexpected findings from the procedures. Staff were knowledgeable of this process and could give examples of when they had needed to do this.
  • All practitioners completing pregnancy related scans believed they had a professional responsibility to complete well-being checks of the baby prioritising this over the souvenir scanning which took place.
  • Mandatory training levels for managerial staff, administration staff and sonographers was recorded at 100% against their internal target of 100%.
  • The service had a positive safety track record. There were no reported never events or serious incidents and there was a low number of incidents reported by staff.
  • There was an incident reporting policy and procedure in place which all staff were aware of. The service had a positive approach to incident reporting and learning from all incidents, regardless of level of harm.

However, we also found

  • There was a lack of handwashing sinks in some of the satellite clinics, with the nearest available sinks being some distance away from the scanning room in some locations. However, the provider had ordered portable sinks for all these locations and were awaiting delivery.
  • There were carpeted floors in some of the clinical locations. Staff were aware of the risks and tried to mitigate the risk during clinical activity until modification of the environment could take place.
  • Clinical assistants (both salaried and sessional) had not previously been required to complete any of the mandatory training topics. Senior staff had identified this as an issue and had implemented a training programme for this staff group which was due to be completed by November 2018. At the time of our inspection, 16% of clinical assistants had completed the training programme.

Effective

Updated 19 October 2018

Caring

Good

Updated 19 October 2018

We rated caring as good because:

  • Patients we spoke with were all positive about the service they received and the staff who provided the service.
  • We observed 25 episodes of care during our inspection and all were extremely positive. Staff were compassionate, respectful and provided appropriate emotional support to patients who required this.
  • Staff ensured patients received relevant information about their ultrasound scan and gave patients many opportunities to ask questions if they needed further explanation. Language and terminology was adapted to the patient involved to ensure they understood.
  • The service had invested in the staff by providing specific training to ensure they were prepared to deliver bad news and could provide the appropriate support to patients.
  • There were systems in place for the service to receive feedback from patients on a regular basis. Feedback received from patients was largely positive.

However,

  • Clinical assistants provided a chaperone role if patients requested one or the ultrasound was of an intimate nature, however they had received no specific training to act as a chaperone.

Responsive

Good

Updated 19 October 2018

We rated responsive as good because:

  • The clinical environments were suitable and appropriate to meet the needs of the patients.
  • The service ensured there were appointments available to meet the needs of the patients. Clinics were organised to ensure availability in all regions was seven days per week, with a range of appointment times.
  • There was an opportunity for patients to receive a same day appointment if they contact the service by telephone.
  • Interpretation services were available for patients whose first language was not English.
  • The service had a positive approach to the complaints they received and the management of complaints. There was an operational manager who led the complaints handling process.

However,

  • All clinical locations had minimal patient information leaflets available for patients to take away. The leaflets that were available were only available in English with no variation in print size for patients who may be visually impaired.

Well-led

Good

Updated 19 October 2018

We rated well-led as good because:

  • Staff were complimentary about the leaders of the service. Immediate leaders were approachable, visible and supportive to staff. Senior management were relatively visible considering the geographical spread, but all staff said they were approachable.

  • There was a positive culture amongst all staff. Staff enjoyed working for the service and would recommend this as a place to work.

  • There was a vision and strategy in place which staff were aware of and aligned to.

  • Governance systems were in place which all staff were aware of and involved in. There was evidence of information and issues being escalated upwards, as well as information being cascaded downwards through the system.

  • There was a process in place to identify and assess risks in the service, with ongoing monitoring of them through the governance system.

However,

  • We found staff files did not contain all the required documentation under schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the service was undergoing a change in human resources systems at the time which impacted on the ability to review staff files.
Checks on specific services

Endoscopy

Good

Updated 19 October 2018

The provision of ultrasound scanning services, which is classified under the diagnostic imaging and endoscopy core service was the only core service provided at this service. We rated this core service as good overall because patients were protected from avoidable harm and abuse. Care and treatment was provided based on best practice and provided by competent staff. Feedback from patients was positive and we ourselves observed positive examples of compassionate care. Patients could access care and treatment in a timely way and there were flexible appointment times to meet patient needs. There was strong leadership team who provided values based vision and strategy which staff were aware of and aligned with. Governance processes were in place to provide adequate assurances of service provision and drive improvement.