Babyface4d is operated by Pregnancy Ultrasound ltd. The service is located in Bromsgrove and provides diagnostic pregnancy ultrasound scans to privately funded women across Worcestershire and its surrounding areas. The service operates a satellite clinic in Chelmsley Wood, Birmingham. We did not inspect the satellite service.

We inspected this service using our comprehensive inspection methodology. We undertook a short-notice announced inspection on 12 February 2019. We gave one weeks’ notice of our inspection 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. At this inspection in February 2019 we rated the service as Requires improvement overall.

We found areas of practice that required improvement

• We were not assured that sufficient governance arrangements were in place to ensure high standards of care were maintained. There was no system in place monitor the quality of diagnostic reports, and no peer reviews or audits were carried out. Incidents, complaints and risks were not monitored, and there were limited policies and procedures in place.
• Not all infection risks were controlled well. Hand hygiene was not carried out in line with national guidance.
• While the registered manager had the skills, knowledge, and experience to conduct ultrasound scans, they had not establishedsuitable and effective policies and procedures to fulfil the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). We were not assured that the provider could keep people safe from avoidable harm at all times.
• There was no system in place to identify training needs and monitor compliance to training.
• While the registered manager understood the need to protect people from abuse, and had completed safeguarding adults and children training, the receptionist had not received any training in safeguarding adults or children.
• The registered manager did not give women a written record of their findings if they found a suspected concern and needed to refer them to NHS services.
• Informed consent was not appropriately gained from women who did not have English as their first language.
• There was limited engagement with women, those close to them and the public, and we found limited evidence of changes made following comments or feedback received.
• The registered manager did not carry out peer reviews to ensure the quality of its work.
• Although services provided reflected the needs of the population served, not all individual needs were taken into account. There was no translation service or chaperone service available to women.

We found areas of good practice

• Staff cared for women with compassion, kindness and respect. They involved women and those close to them in decisions about their care and treatment.
• The registered manager promoted a positive culture.
• The registered manager checked the clarity of scan images for baby keepsakes and offered free rescans if the image quality was poor, or if the baby’s face could not be seen clearly.
• Women could access services and appointments in a way and time that suited them.
• The registered manager understood how and when to assess whether a woman had the capacity to make decisions about their care.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected Bayface4d diagnostic imaging. Details are at the end of the report.

Amanda Stamford

Deputy Chief Inspector of Hospitals (Central)