Archived: LCT Ambulance Ltd

LCT Ambulance Ltd is operated by LCT Ambulance Ltd and they provide patient transport services. The provider was not commissioned by any NHS provider and did not hold any contracts to provide patient transport services. They only provided services to patients who had directly contacted them and self-funded these services. At the time of our inspection most of the provider’s work was not regulated activity and therefore was not inspected as part of this inspection.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of the inspection on 16, 18 and 20 December 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?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated it as Inadequate overall.

• The service did not provide mandatory training in key skills to staff.
• The service did not provide training in how to recognise and report abuse. There were no effective safeguarding systems and processes in place for staff to follow.
• The service did not control infection risk well. Staff did not always have access to equipment and control measures to protect patients, themselves and others from infection.
• The maintenance of vehicles and equipment did not keep people safe and staff did not receive training in how to use them.
• Staff did not complete risk assessments for each patient and did not receive training to help them identify patients at risk of deterioration.
• The service had enough staff but not all staff had the right skills, training and experience to keep patients safe from avoidable harm.
• Staff did not keep detailed records of patients’ care and treatment. The provider did not record or store information about patients they transported.
• The service did not manage patient safety incidents well. Staff were not trained to recognise incidents and near misses. The manager and staff had no knowledge or understanding of duty of candour.
• The service did not provide care based on national guidance. The provider did not have a policy or training on the rights of patients subject to the Mental Health Act 1983.
• The service did not collate data around response times and did not monitor the effectiveness of care and treatment.
• The service did not make sure staff were competent for their roles. The manager did not appraise staff and staff were not supported in their development.
• The service did not work or communicate with other agencies to provide care for patients.
• Staff did not support patients to make informed decisions about their care or have the knowledge to support patients who lacked capacity.
• The service did not take into account patients’ individual needs and preferences or make reasonable adjustments to help patients access services.
• There was no evidence the service treated concerns and complaints seriously. It had limited knowledge of how to investigate them.
• Leaders did not have the skills and abilities to run the service. They did not support staff to develop their skills.
• The provider did not have a written vision or strategy for the service.
• The service did not have processes and procedures in place to ensure there was an open and honest culture.
• The service did not operate an effective governance process throughout the service. Staff were not clear about accountabilities and did not have regular opportunities to meet, discuss and learn from the performance of the service.
• The service did not use systems to manage performance effectively. They did not identify and escalate relevant risks and issues and identify actions to reduce their impact. Staff did not contribute to decision-making to help avoid financial pressures compromising the quality of care.
• The service did not collect data on any of their activity and therefore could not analyse it to improve the service.
• The service did not engage with staff or the public and did not collect patient feedback.

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 issued the provider with six requirement notice(s) that affected patient transport services. Details are at the end of the report.

I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Name of signatory

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals