The Fetal Medicine Centre was located in the basement at 137 Harley Street, London. The service had a reception on area. There were six scan rooms in the premises as well as a small laboratory for blood collection and blood processing. The laboratory was located at the back of the reception area. The service had five toilets three of these being in scan rooms. The service also had offices for the doctors/management and a telephone switchboard room with backrooms used for storage and for record keeping.

The service has had a registered manager in post since 2012.

The Fetal Medicine Centre was registered to provide the following regulated activities:

• Diagnostic and screening procedures

During the inspection we spoke with four staff including; the deputy manager, consultant and two sonographers. We also spoke with four patients.

There were no special reviews or investigations of the unit ongoing by the CQC at any time during the 12 months before this inspection.

The service conducted 700 scans per month. Staff in the service consisted of one whole time equivalent (WTE) registered manager, 1 WTE deputy manager, 1 WTE team leader, 1 WTE laboratory technician and 6 WTE receptionists. There were six consultants that currently provide services to the Fetal Medicine Centre as well as several doctors undergoing postgraduate training in Fetal Medicine at an NHS trust in London. The Nominated Individual also worked one day each week.

Every year The Fetal Medicine Foundation awards a two-year training fellowship in fetal medicine. The practical training is undertaken at the Fetal Medicine units at an NHS trust.. Some fellows will be selected to provide services at the Fetal Medicine Centre and as part of their development they provide their services free of charge at the service.

The aim of the Fetal Medicine Foundation is to assess the risk for pregnancy complications at such an early time in pregnancy that this may give doctors the chance to reassure patients, and to prevent pre-eclampsia and premature birth, which are major contributors to maternal and neonatal morbidity and mortality.

Track record on safety

• No Never events.

• No serious injuries.

• No incidences of healthcare acquired Meticillin-resistant Staphylococcus aureus (MRSA).

• No incidences of healthcare acquired Meticillin-sensitive staphylococcus aureus (MSSA).

• No incidences of healthcare acquired Clostridium difficile (c. diff).

• No incidences of healthcare acquired Escherichia coli (E-Coli).

• No deaths.

Services provided under service level agreement:

• Clinical and or non-clinical waste removal

• Building Maintenance

• Laundry

On our inspection of 17 December 2013 we found that the recruitment processes the provider had in place were inadequate. Pre-employment reference requests and Disclosure and Baring Service (DBS) checks had not been made for some non-medical staff employed. In addition there was no evidence to support that the skills and experience of staff had been assessed prior to their employment. The provider was not meeting the standard for requirements relating to workers.

The provider wrote to us on 21 January 2014 to inform us of the action they had taken to make improvements to the recruitment process and to advise that DBS checks had been completed for all administration staff.

On our inspection of 15 August 2014 we reviewed the progress the provider had made to improve the recruitment process and checked the reference records maintained in non-clinical staff files. We saw that DBS checks had been completed for all administration staff however, retrospective reference checks had not been sought. Despite the improvements made, the provider was still not meeting the standard.

We spoke with five people who were using the service and one family member. We spoke with the registered manager, two doctors and one receptionist who were working in the clinic.

One person told us that “staff take time” and they did not feel rushed and could ask questions. Another person told us “staff are very friendly” and they “feel very comfortable.” Three people told us that “staff are very professional.” Others told us that the care they had received was “perfect.”

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found that staff assessed people's needs and planned treatment for each individual. Equipment used for scanning was safely maintained and suitable for its use. We found that the recruitment process was inadequate for clerical staff at the clinic as there were insufficient checks on staff’s suitability to work at the unit before offering a contract of employment. We saw that people who attended had individual records which were stored safely.

The centre had information available to people on its website and on-site leaflets. People told us that the information provided about the services was made "clear up front" and was "well explained". Scanning procedures took place in private and a chaperone was available if a woman requested one. People described staff as "friendly, efficient and welcoming".

People were assessed by a doctor, who carried out the scanning procedure. The scanning process included the taking of blood samples for analysis and this was verbally explained to people. One person said that they had a "brilliant experience" at the centre.

The centre had a policy on safeguarding vulnerable adults in place. This policy described how to recognise the signs and symptoms of abuse and stated the details of who to contact at the local authority should staff have concerns for a person's welfare.

The sonographers were all medical doctors from outside the UK who were also employed within the NHS. One doctor told us that they had completed online courses relevant to foetal scanning.

People gave feedback on the experiences at the centre via thank you cards. Comments we saw included "baby is a big boy now, thanks to you" and "thank you so much for the support you provided during my pregnancy". There were mechanisms in place to monitor the quality of the service and we saw an example of an audit of a doctor’s scans that had been carried out.