Archived: Miracle in Progress

Miracle in Progress is operated by Miracle in Progress Ltd. The service is a fixed location private clinic providing obstetric ultrasound, screening blood tests and gynaecological services for women aged over 17 years across Leicestershire.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced visit to the service on 11 October 2019.

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.

Services we rate

Our rating of this service improved. We rated it as Good overall.

We found the following areas of good practice:

• The service now provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff now understood how to protect people from abuse and had completed safeguarding training on how to recognise and report abuse. Staff knew how to apply this training.

• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

• The provider mostly had appropriate arrangements in place to assess and manage risks to women.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance.

• Staff worked together as a team to care for the women and those who accompanied them.

• Services were available six days a week.

• Staff cared for women and their families with compassion. Feedback from women confirmed that staff treated them well and with kindness.

• The service planned and provided services in a way that met the range of needs of people accessing the service.

• Women could access the service when required.

• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

• Managers in the service had the right skills and abilities to run a service providing high-quality sustainable care.

• Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

• The provider had a vision for what it wanted to achieve, and staff could articulate this. workable plans to turn it into action, which it developed with staff, women and local community groups.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

However:

• The service did not monitor all aspects of effectiveness of care and treatment. The service did not complete audits into the quality of the scans provided or take part in a peer review process.

• The provider had not completed all risk assessments required.

• The provider did not have standardised document controls for policies with issue and review dates identified.

• The provider did not have an up-to-date website, to reflect the service provided.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

Miracle in Progress is operated by Miracle in Progress Ltd. Miracle in Progress offers a range of ultrasound scans to women throughout their pregnancy. These include early pregnancy scans, gender scans, and souvenir scans. The provider is run by a registered manager.

We carried out an unannounced focused inspection of Miracle in Progress on 16 April 2019, in response to concerning information we had received in relation to the management of the regulated activities at this provider. We carried out a further visit on 29 April 2019, to check on improvements the provider told us about following our initial inspection.

During this inspection we inspected using our focussed inspection methodology. We inspected the key questions of safe and well-led only. We did not provide an overall or key question rating at this inspection, as we did not carry out a comprehensive inspection.

Our findings were:

• The provider did not provide mandatory training in key skills to staff and did not ensure everyone completed it. Improvements were made by the time of our follow up inspection.

• Staff did not understand how to protect women and people attending the clinic from abuse. Staff had not had training on how to recognise and report abuse and therefore did not know what their responsibilities were in relation to safeguarding. We found this had improved by the time of our follow up inspection.

• The provider did not control infection risk well. Staff did not always keep themselves, equipment and the premises clean. They did not always use control measures to prevent the spread of infection. At our follow up inspection, we saw significant actions taken to address all of the concerns we found.

• There was no incident reporting process in this provider and staff did not recognise incidents. As incidents were not recorded they were not investigated incidents and therefore any lessons learned were not shared within the provider. Staff were unaware of their responsibilities in relation to duty of candour. We found at our follow up inspection this had improved and processes were in place.

• Managers in the service did not have the right skills and abilities to run a provider providing high-quality sustainable care.

• The provider had a vision for what it wanted to achieve, but this could not be articulated effectively by the registered manager, was not displayed in the location or understood by staff. There were no workable plans or strategy to turn it into action.

• The provider did not systematically improve provider quality and safeguard high standards of care as it did not have robust governance processes in place. At our follow up inspection, we found this had improved with further improvements planned.

• The provider did not have systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected. We found this had improved by the time of our follow up inspection.

• The provider did not improve services by learning from when things went well or wrong as they did not have process in place to support this.

However:

• There was a culture which wanted to deliver the best possible care to women.

• The provider mostly had appropriate arrangements in place to assess and manage risks to women.

• The provider had enough staff to provide the service.

Following this inspection, we took action under Section 31 of the Health and Social Care Act 2008, to urgently suspend the provider’s registration for a period of six weeks. The notice of urgent suspension of registration was given because we believed that a person will or may be exposed to the risk of harm if we did not take this action. On 29 April 2019 we returned to carry out another inspection and subsequently lifted the suspension.

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 provider improve. We also issued the provider with six requirement notice(s). Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)