Archived: Health Tech Services Group Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s safe care and treatment and governance. We found people did not have the best possible outcomes because their needs were not fully assessed. Their care, support and treatment did not always reflect these needs and any protected equality characteristics. The service did not work in harmony, with people at the centre of their care.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed significant shortfalls. The service did not make sure people’s care, and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We looked at 12 patient records during this assessment.

The service had an Assessment of Care Needs policy which identified the need to complete a comprehensive assessment of patients’ needs. All 12 Patient records we saw did not follow either the service’s policy or best practice guidelines. People’s communication needs were not assessed and met to maximise the effectiveness of their care and treatment. We could not be assured peoples’ needs were appropriately assessed and were fully understood by staff. Staff were not involved in the assessment process; this was undertaken online with a follow up call. The risk assessment was not person centred and holistic to the person.

The registered manager told us there was a reassessment of patients' needs should they book further patient transport after 6 months of last using the service. We looked at people who had used the service and found no reassessments of patients’ needs had been undertaken.

The provider requested basic information about people which did not enable effective planning and deliver of care. They did not follow legislation and current evidence-based good practice and standards.

We were not assured staff worked to national guidance and evidence-based to deliver care and treatment. During the first day of our assessment most policies and procedures in the office had not been reviewed within their review dates. When we visited the second time all had been reviewed. However, it was evident that staff were not following policies for example assessing needs. It was also evident that the manager had not identified that staff and records were not compliant with policies which identified best practice.

We found there was no system in place for managers to monitor staff performance to ensure they were working in line with evidence-based practice.

There were no clinical audit systems in place, benchmarking or quality improvement initiatives.

Most staff had not worked previously in care, requiring them to undertake a recognised National Vocational Care Certificate which provided entry level accreditation as the benchmark for healthcare assistants. Managers provided all new staff with their own version of entry level training as part of their induction pathway. Although the certificates did not specifically state a formal qualification level, the registered manager said they were generally considered equivalent to Level 1 induction training standards. The lack of information included on certificates did not provide this assurance.

Effective systems were not in place for managers to identify the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Just 1 of 17 staff had had an appraisal in the last 12 months. One of the 17 staff had a record of supervision. Both the appraisal record and the 1:1 supervision meeting were used as a tool for recording staff disciplinary action. There was no ongoing record of their performance issues which identified any learning, development or improvement.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

Effective systems were not in place to enable staff to work across teams and services to support people. Information about people did not provide sufficient information to enable other services effective continuity of care.

The service did not work effectively with its staff. Staff were notified of a patient transport request via a portal which required them to check regularly. We saw in an incident report 1 employee had been asleep and had not seen the job request and then needed to collect the ambulance from another employee resulting in very late attendance. Managers did not call staff members to discuss the job or ensure they were available, although the managers had recently started to message staff to inform them to check the electronic portal regarding a new job.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. We could not determine who had completed the patient risk forms and where a representative may have acted on a person’s behalf. We saw no evidence of the patient being involved and patients’ views gained for the information shared on them.

We found the service lacked focus on identifying risks to peoples’ health and wellbeing, and on how to support people to prevent deterioration. During inspection we saw evidence of where a patient required a stretcher but then was transferred into a chair, due to the pain the person encountered they could not be supported to use the service. There was no recorded information that this change in moving and handling techniques were safe to the persons health.

There was no health promotion information available or displayed on ambulances for example smoking cessation. The service transported people to access health and social care services which could support them to live healthier lives.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was no clear approach to monitoring, auditing, or benchmarking the quality of the service and the outcomes for people receiving care and treatment.

There were no systems in place to detect and respond to clinical deterioration in patients as a key element of their safety and improving patient outcomes. Assessment of needs were not comprehensive and did not consider what to do in emergencies or in the event of a deteriorating patient. There were no tools to monitor patients, for example the use of patient observations and National Early Warning score to identify patient deterioration, or consciousness level to assess when timely escalation to hospital was required. A lack of systems to check patients’ health and wellbeing gave no assurance of patient safety and improving patients’ outcomes.

Patients’ care and treatment was not routinely monitored to ensure they received safe and effective care, or when identified improvements were not routinely made.

There were limited systems to demonstrate how the service monitored its performance with time of pick up, time to transport and drop off identified. We were unclear how data was used to improve services and where it was shared. We saw evidence that mileage and postcodes were captured but staff/managers did not record whether the patient transport had reached its target of getting a person somewhere on time.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The systems in place did not allow staff to effectively assess the patient’s capacity to consent in appropriate circumstances. Information and advice about care and treatment was not always accurate or complete. Senior staff did not understand the importance of ensuring that people fully understand what they are consenting to and the importance of obtaining consent before they provided care or treatment. Where a representative had completed the form, once contacted by the service no recorded conversations were had with the patient. We could not be assured patients or their representatives received information about care and treatment in a way they can understand and had appropriate support and time to make decisions.

Once at the patient's home, staff took practical steps to support the patient to make their own decisions within the limited information available about their needs and choices. Staff said if a patient refused to be transported, they would contact the office for further guidance and would not force anyone to do anything against their will. However, patients' records were limited and it was difficult to identify what actions staff had undertaken when patients lacked mental capacity and ensured that best interest decisions were made in accordance with legislation and guidance recognising the importance of the patient’s wishes, feelings, culture and history.

Staff had received training in consent and the requirements of legislation and guidance, including the Mental Capacity Act (MCA) 2005 and other relevant national standards and guidance.

The service had no systems in place to monitor and improve how the MCA was applied and decisions communicated with all relevant people/organisations involved in the person’s care.