During our inspection we spoke with two people who used the service, observed the consultation process and discharge procedure following treatment.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that risks, complications and alternative treatment options were discussed and explained to people before they gave consent to treatment. Staff were aware of the consent procedures for children under 16. They had a good understanding of assessing whether the young person had the maturity to make their own decisions and to understand the implications of those decisions.

People experienced care, treatment and support that met their needs and protected their rights. People had detailed care and treatment plans relating to all aspects of their care needs. People we spoke with were positive about the service. One person said, "Care was good, staff were kind and treated me well." We also looked at a sample of feedback forms. The comments included, "Excellent service" "Care and stay fantastic" and "Great, welcoming and supportive."

People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. People we spoke with had no concerns with the cleanliness of the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Medicines were prescribed and given to people appropriately.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff started work. This included being registered with the relevant professional bodies.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We found arrangements were in place so people's privacy and dignity was maintained. People told us they had been treated respectfully and their confidentiality had been maintained.

People who used the service understood the care and treatment choices available to them. Staff told us people were given a period of time between their consultation and treatment. This enabled them time to consider all of the information they had been given, before deciding whether to go ahead with the treatment or not.

People who used the service experienced care, treatment and support that met their needs and protected their rights. They had detailed care plans relating to their care needs. People were very positive about the service. One person said, "The care has been excellent."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff we spoke with were aware of safeguarding policies and procedures.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The staff we spoke with demonstrated a good knowledge of the people they supported.

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents and investigations took place and appropriate changes implemented.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Termination of pregnancy services caring, effective, responsive and well led; however, there were some areas for improvement in the safe domain.

There was a culture of reporting and learning from incidents, across the organisation and within the Doncaster service. Staff could demonstrate their understanding of safeguarding adults and children and knew what actions they needed to take in cases of suspected abuse. All patients received a private initial consultation without anyone else present to safeguard against possible coercion or abuse and to give them the opportunity to disclose such information in a safe environment. Staffing levels, medicine management and record keeping were good.

However, we found that the theatre environment was not properly clean during our first visit; but this had been resolved when we carried out our unannounced inspection Staff did not always wear aprons when delivering personal care in clinic areas. There were trip and injury hazards in the theatre and recovery area due to lack of space. Surgical safety checklists / briefings were not always effective. It was not clear from records if all appropriate water outlets were flushed following closure of the unit on non-working days. There was a lack of assurance whether the ventilation in theatre and the pack room met the required standard

Staff followed evidence-based guidelines, patient assessments were thorough and staff followed clear pathways of care. The service managers used a clinical dashboard, which measured and facilitated improvement in the quality and safety of clinical standards. Staff were competent and observation and assessment of staff competence was an integral part of pathway audit.

Staff treated patients with compassion, dignity, and respect. They focused on the needs of each patient and responded quickly to their needs. Staff were very aware of the additional needs and risks associated with the care of young people and made every effort to ensure young people were supported through their treatment. Patients gave very positive feedback in the BPAS Patient Satisfaction reports.

Waiting times were consistently within the guidelines set by the Department of Health, unless patients chose appointment times outside the recommended timescale. Information and advice were available from staff, leaflets and on-line to women at all stages of their care. Interpreting and counselling services were available to all patients and staff made every effort to meet individual patients’ needs. Staff had access to a specialist placement team who would arrange referral to appropriate providers for patients with complex or additional medical needs, who did not meet usual acceptance criteria. There were systems in place to ensure sensitive disposal of foetal remains.

The organisation had a clear mission to provide for safe and effective care. Senior managers had a clear vision and strategy for this service and there was strong local leadership of the service with quality care and patient experience seen as the responsibility of all staff. Staff felt supported by their managers and were confident they could raise concerns and have them dealt with appropriately. There were effective governance systems in place and staff received feedback from governance and quality committees. There were corporate risk registers and business continuity plans in place. Local risks were identified separately in general risk assessments. Some of the local risk assessments were due or overdue for review. Department of Health requirements were met. The organisation had a proactive approach to staff and public engagement. Innovation, learning, and development were encouraged.