We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. NSL South West Region Unit 16-17, Kestrel Business Park, Kestrel Way, Sowton Industrial Estate, Exeter, EX2 7JS Date of Inspections: 12 February February 2015 Tel: Date of Publication: April 2015 We inspected the following standards to check that action had been taken to meet them. This is what we found: Care and welfare of people who use services Safety, availability and suitability of equipment Requirements relating to workers Supporting workers Assessing and monitoring the quality of service provision Complaints Action needed Action needed Met this standard Action needed Action needed Met this standard Inspection Report NSL South West Region April

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity NSL Limited Mr Steven Clifford Roe NSL South West Region is a private ambulance service providing non urgent transport between peoples home and healthcare establishments. NSL South West Region provides transport for NHS services in Devon, Cornwall and Somerset. Ambulance service Transport services, triage and medical advice provided remotely Inspection Report NSL South West Region April

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 5 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Safety, availability and suitability of equipment 8 Requirements relating to workers 10 Supporting workers 12 Assessing and monitoring the quality of service provision 13 Complaints 15 Information primarily for the provider: Action we have told the provider to take 16 About CQC Inspections 18 How we define our judgements 19 Glossary of terms we use in this report 21 Contact us 23 Inspection Report NSL South West Region April

4 Summary of this inspection Why we carried out this inspection We carried out this inspection to check whether NSL South West Region had taken action to meet the following essential standards: Care and welfare of people who use services Safety, availability and suitability of equipment Requirements relating to workers Supporting workers Assessing and monitoring the quality of service provision Complaints This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 9 February 2015 and 12 February 2015, talked with people who use the service and talked with staff. We reviewed information given to us by the provider and reviewed information sent to us by commissioners of services. What people told us and what we found NSL South West Region is a private ambulance service providing non urgent transport between people's homes and healthcare establishments. NSL South West Region provides transport for NHS services in Somerset, Devon and Cornwall. A hospital / ambulance inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report. Below is a summary of what we found. At our last inspection on the 17 June 2014 the provider did not have evidence of previous training for staff members that had been transferred over under TUPE arrangements. We saw evidence that the majority of staff had not completed the necessary training. We saw arrangements in place for reporting and resolving vehicle defects in Exeter, but this was not consistent at the Redruth ambulance station. At our last inspection on the 17 June 2014, concerns had been raised with the overall performance of the provider. These were particularly around timeliness of picking up and collecting people from home or hospital. We noted that the provider had made significant improvements in this performance but needed to maintain this to ensure they were consistently providing an effective service to patients. At our last inspection on the 17 June 2014, we noted the provider did not have systems in place to learn from complaints. Staff told us that not all concerns were acted upon when raised. We noted improvements during our most recent inspection. Inspection Report NSL South West Region April

5 There were concerns that the provider did not have robust processes in place for the monitoring of the service to provide assurance that people's needs were met and that the risks to staff and people were identified and addressed. You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 23 April 2015, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report NSL South West Region April

6 Our judgements for each standard inspected Care and welfare of people who use services Action needed People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was not meeting this standard. Care and treatment was planned but not always delivered in a way that was intended to ensure people's safety and welfare. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement Following our inspections in November 2013 and June 2014 we issued a compliance action as we found people did not always experience care, treatment or support that met their needs or protected their rights because people experienced long delays waiting for transport to arrive or to pick them up from home and hospital. We received an action plan from the provider detailing how they intended to address this issue. During this inspection we spent time at the office of NSL South West in Exeter and also at one of their ambulance stations in Redruth in Cornwall. We spoke to staff and managers and reviewed documentation relating to the performance of the provider. We looked at documents supplied by the provider; these showed that since our previous inspections the provider had been working closely with its three commissioners on improving services to patients. New initiatives had been brought in by the provider to improve the timeliness of transport and reduce the waiting times for patients. These initiatives included a patient liaison officer to improve transport booking for renal patients, establishing a patient's charter and a new booking process for renal patients from Devon. We were unable to confirm compliance or impact of these new initiatives because of their recent introduction prior to our inspection. We saw evidence that showed the number of overall concerns regarding patient transport had reduced significantly from the summer of For example in Devon 356 issues were raised from May to September 2014, the majority of these related to timeliness. From October 2014 to January 2015 this number had reduced to 136. A reduction in concerns about timeliness was also seen across Somerset and Cornwall. We acknowledge that the provider has worked in conjunction with its commissioners to improve the timeliness of transport for patients and reduce delays. These improvements Inspection Report NSL South West Region April

7 were being applied more consistently across Somerset, Devon and Cornwall. However, we were unable to confirm sustained compliance during this inspection. As a result of which, care and treatment was planned, but not delivered in a way that was intended to ensure people's safety and welfare. Inspection Report NSL South West Region April

8 Safety, availability and suitability of equipment Action needed People should be safe from harm from unsafe or unsuitable equipment Our judgement The provider was not meeting this standard. People were not always protected from unsafe or unsuitable equipment. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People were not always protected from unsafe or unsuitable equipment. Prior to this inspection concerns had been raised with us about vehicle maintenance, out of date equipment and lack of oxygen. These concerns primarily focused on the Redruth branch in Cornwall. Staff had reported that they had been running low on oxygen cylinders for a number of months. We raised this with the manager who informed us that they were aware of the issue which had been due to a delayed delivery and that cylinders could have been brought from another branch if necessary. During our inspection, we found no monitoring or auditing in place for oxygen cylinders and how they were managed. We saw that eight out of the nine ambulances carried a small portable oxygen cylinder and a larger piped oxygen cylinder. We looked at the stock levels available which showed only four small cylinders were in stock and no larger cylinders were available. The small cylinders were replaced when they reached a quarter full and therefore should four out of the nine ambulances use their cylinders, no further portable cylinder stacks were available and should a large cylinder be used then no stock was available at the time of our inspection. We looked at the ordering records and could only identify that cylinders were replaced in August 2014, despite staff assuring us they received stock in January We did not see that there was a system in place for monitoring to ensure sufficient stocks were available. We were unable to check first aid boxes at ambulances based at Exeter because they were all engaged with patient transport. However, we looked at first aid boxes and how they were managed at Redruth in Cornwall. Recently stock had been identified as missing and so the team leader had asked the night duty staff to restock the boxes and attach labels to identify they were full and checked. On checking boxes we noted the labels on the outer box did not reflect the contents and their expiry dates. No system was in pace to enable staff to know when that stock was planned to be out of date or when checks were planned. One ambulance was seen to not have a first aid kit in place but had not been checked that day. Records showed that the absence of a first aid kit in the same ambulance was recorded two days previously with no action recorded as being taken. Inspection Report NSL South West Region April

9 During our visit, concerns were also raised about an ambulance for bariatric patient's and its comfort for patients. A wheelchair was available but was only able to take a patient up to 25 stone in weight. Staff told us that the noise from the ambulance ramp and the window blinds created a noisy and poor patient experience. Inspection Report NSL South West Region April

10 Requirements relating to workers Met this standard People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Reasons for our judgement At our inspection in November 2013 we issued a compliance action because the provider's recruitment and selection process were not sufficiently robust to protect people from the risk of being supported by inappropriate people. We received an action plan from the provider detailing how they intended to address this issue. At our inspection in June 2014 we reviewed the action plan the provider had taken and found the compliance action had not been met which meant people who used the service were still at risk as appropriate checks had not been carried out before the staff member commenced duties. A warning notice was issued and the provider was required to be compliant with this by 30 November We visited again in December 2014 and we found the recruitment systems and processes the provider had in place were more robust. However, there were still some elements of regulation 21 that the provider had not complied with. We issued a further compliance action. During this inspection we were told that the provider had centralised all personnel files in their main Exeter office since our last inspection. An administrator had been employed to review all the staff personnel files and to implement a work plan to make sure any gaps in those records were resolved. We saw risk assessments were in place where gaps could not been resolved. As an example, where a member of staff had been working for the provider and a further reference could not be obtained from a previous employer, a risk assessment was completed to assess the suitability of that person to remain in employment. The provider had reviewed their recruitment and selection procedures. As part of this review, we were informed that interviews were only carried out by staff that had received appropriate training. We saw evidence to support this. During this inspection we looked at the personnel files of nine staff that had started employment since December For one member of staff we noted that a gap in their employment record had not been noted or discussed. We raised this with the manager who informed us that another manager had discussed it with the member of staff but had not documented those discussions. We found one member of staff did not have references present and another member of staff that did not have a record of undergoing a check with the Disclosure and Barring Inspection Report NSL South West Region April

11 Service (DBS). When we raised this with the manager, it was confirmed that the staff concerned had not and would not start their employment until the checks were completed. This confirmed the provider was following its revised recruitment procedures and the systems the provider had put in place ensured that appropriate checks were undertaken before staff began work and that there was an effective recruitment and selection process in place. Inspection Report NSL South West Region April

12 Supporting workers Action needed Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was not meeting this standard. People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement At our last inspection in June 2014 we issued a compliance action because not all staff received appropriate professional development to undertake their role. We did not see evidence that probationary reviews took place at specific times stipulated by the provider. We received an action plan from the provider detailing how they intended to address this issue. During this inspection the manager confirmed that formal probationary reviews that should take place at four, eight and twelve weeks following a person's appointment. Whilst we saw evidence that this had taken place for some staff, it was not consistent. When we raised this with the manager, we were told that the review documentation was often kept by team leaders at the various ambulance stations rather than being sent to the Exeter branch for inclusion in staff personnel files. The nine staff personnel files which we looked at during this inspection, four staff did not have their probationary reviews filed and we were not provided with evidence that these staff had received reviews. Staff told us that did not have regular supervision or appraisals and had not always received feedback on their performance. Staff told us they had been asked to complete a performance development type document but had received no feedback from it. We looked at the training records for staff which confirmed that the majority of staff had received appropriate training for the role they were undertaking. Staff that had been transferred from their previous organisation under the Transfer of Undertakings (Protection of Employment) regulations (TUPE) all received their mandatory training which included infection control and manual handling. Probationary reviews that were being undertaken were not being forwarded in a timely way to the Exeter branch for inclusion in staff's personnel files. Inspection Report NSL South West Region April

13 Assessing and monitoring the quality of service provision Action needed The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was not meeting this standard. The provider did not have an effective system to regularly assess and monitor the quality of service that people receive. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement At our inspections in November 2013 and June 2014 we issued a compliance action because we evidenced that whilst the provider monitored the quality of the service delivered, they did not take into account action to reduce identified risks to people. We received an action plan from the provider detailing how they intended to address this issue. During this inspection, concerns had been raised with us about the planning of patient transport given the geographical locations within Cornwall. An example of this was one patient who was due to be collected by ambulance at 2pm. The staff that were due to pick the patient up were allocated another job whilst they were waiting. Whilst on a map, the new journey looked relatively easy; it resulted in nearly a two hour delay for the patient waiting to be picked up. In another example, another patient had to wait an additional two hours in hospital because the crew had been dispatched to another job in between dropping the patient off at their appointment and picking them to take them home. This lack of insight into the planning of patient transport particularly in and around Cornwall could put additional pressure on staff and impact on the safety of patients. The provider had implemented new initiatives to improve the timeliness of transport and reduce waiting times for patients. However, there remained evidence of poor and adhoc planning of journeys which meant delays for patients were not kept to the minimum. Before staff start their shift, they were required to completed basic checklists to show they had checked the vehicle for any defects and that the necessary equipment was on board. Additional checks were also completed for cleaning of the vehicles at the end of each shift. These checks were not always completed and therefore any defects of omissions were not always noted or acted upon. There was a lack of a robust system in place to monitor the checks were being carried out. This could have led to injury or harm to patients or staff. Inspection Report NSL South West Region April

14 The provider did not have a robust system in place to monitor the maintenance of its vehicles across Somerset, Devon and Cornwall. We saw a recent provider fleet audit that had identified that the system for reporting defects was not fully completed and that a record of defects that had been remedied was not evidenced. The system involved a daily check by staff and a report of any defect or concern would be recorded and made available for the team leader to action. A secondary record was made on a white board. Within the Exeter station, this was more robust than the system operated at the Redruth branch in Cornwall. Staff told us that sometimes concerns were raised about vehicle safety and no action was taken. These included concerns over brakes making unusual noises, faulty ramps and ambulances not being able to be locked. One record noted an ambulance brakes making a grinding noise. Staff told us they had written this on the white board and that the next day the white board was cleared without staff being given feedback or reasons why remedial action was not taken. The team leaders within the Exeter branch were aware of the conditions and status of the vehicles based at Exeter. However, there was no co-ordinated approach across the three counties and different ambulance bases to ensure provision of assurance that all vehicles identified with a defect were repaired in a timely way to protect patients and staff from risk of harm or injury. Whilst the provider had an up to date training matrix, the system in place to make sure each member of staff had the necessary probationary review or appraisals was not sufficiently robust to provide a timely overview for monitoring and assurance. Inspection Report NSL South West Region April

15 Complaints Met this standard People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement At our last inspection in June 2014, we issued a compliance action because people who used the service were not made aware of the complaints procedure in a format that met their needs. We received an action plan from the provider detailing how they intended to address this issue. During this inspection the provider told us that details of the complaints process and patient feedback forms were now available in all NSL South West vehicles. Staff also told us that they invited patients to complete a feedback form and informed them about the complaints process if necessary. We saw evidence that the provider logged all the comments received in the monthly quality log. Where the comment was negative, we saw that corresponding actions had been recorded. The provider had reviewed the way it handles complaints and implemented a new system, however we were not able to judge its ongoing effectiveness. Inspection Report NSL South West Region April

16 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Transport services, triage and medical advice provided remotely Regulation Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services How the regulation was not being met: People did not always experience care, treatment and support that met their needs or protected their rights because people experienced delays in waiting for transport which resulted in delayed or missed appointments or treatments. Regulated activity Transport services, triage and medical advice provided remotely Regulation Regulation 16 HSCA 2008 (Regulated Activities) Regulations 2010 Safety, availability and suitability of equipment How the regulation was not being met: The provider did not have robust systems in place to effectively monitor equipment levels and suitability. Regulated activity Transport services, triage and medical advice provided remotely Regulation Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting workers How the regulation was not being met: The provider did not have consistent robust systems in place to identify, staff who required or who had received probationary Inspection Report NSL South West Region April

17 This section is primarily information for the provider reviews and appraisals. Regulated activity Transport services, triage and medical advice provided remotely Regulation Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision How the regulation was not being met: The provider did not have robust systems in place to monitor services consistently across Somerset, Devon and Cornwall. This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 23 April CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report NSL South West Region April

18 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report NSL South West Region April

19 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report NSL South West Region April

20 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report NSL South West Region April

21 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report NSL South West Region April

22 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report NSL South West Region April

23 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report NSL South West Region April