Verulam Clinic is operated by Verulam Clinic Limited. The service provides diagnostic pregnancy and fertility imaging services (ultrasound scans) to self-funded women in St Albans and the surrounding areas.

The service also offers additional services, which are not included in their regulated activity. This includes complementary health treatments and small group classes to couples, mothers, and babies.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 5 December 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.

Services we rate

We have not previously rated this service. At this inspection in December 2018, we rated the service as good overall.

We found areas of good practice:

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

• Services were planned in a way that met the needs of women and the local community. Women were offered a choice of appointments.

• Managers promoted a positive culture that supported and valued staff. Staff confirmed they felt respected and valued.

• The service used current evidence-based guidance and good practice standards to inform the delivery of care and treatment. Staff demonstrated a good understanding of the national legislation that affected their practice.

• Verulam Clinic had a clear vision and strategy for what they wanted to achieve, with quality and sustainability as the top priorities.

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

• Staff did not receive mandatory training in key skills after their initial induction to the service. There was no oversight on what training the sonographers had completed at their substantive employer.

• While staff understood the need to protect people from abuse, they had not all completed safeguarding training at the required level to ensure they had the appropriate knowledge to do so. However, this was rectified after our inspection.

• Verulam Clinic did not have full oversight of the competencies, skills and capabilities of staff working for their service. There was no formal staff appraisal system in place at the time of our inspection. However, this was rectified after our inspection.

• We were not assured that the service always kept up-to-date with important national and statutory legislation.

• Informed consent was not appropriately gained from women who did not have English as their first language. However, this was rectified after our inspection.

• While the service generally had effective arrangements in place for identifying and recording risks, there was little evidence that these risks and their mitigating actions were discussed with the wider team.

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 one requirement notice that affected Verulam Clinic. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)

We conducted this inspection to follow up concerns identified during the 2013 inspection. We did not speak to people who used the service as the concerns previously identified related to the completion of relevant documentation as part of the recruitment process and the complaints procedure.

We followed up the concerns and found that the provider had made some effort to improve their process but that documentary evidence for new members of staff still needed some refining.

We found that people’s dignity and privacy had been upheld and people were given the choice of treatments and had been included in the decision making of the treatment plan.

People we spoke with were all happy with the service they had received. A person we spoke with said ‘We were able to ask questions and we got answered, and we didn’t feel rushed’. Another person we spoke with said ‘They were very good, they couldn’t have done more, and I got some nice photographs.

We found that the provider did not have a robust recruitment process in place to ensure that all staff had appropriate background checks. and suitable. We also found that although the provider had a complaints policy and procedure in place they did not have a documented audit trail showing the steps taken and the decision reached. We saw that records were stored in a secure and accessible way that allowed them to be located quickly.

People told us this was an excellent service for woman who wanted or needed to have an early pregnancy scan. We observed staff interacting with people who used this service in an easy going and friendly manner.

We noted the clinic was bright and welcoming and the reception and waiting room had lots of information leaflets about all the different types of services which were available at this clinic as well as other more general information.