Archived: Lincs House

Lincs House is operated by Lincs Medical Services Ltd providing mainly patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 14 to15 September 2017 and an unannounced visit on 29 September 2017.

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.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve;

• The service did not routinely carry out any hand hygiene or infection control audits to monitor staff adherence to policies and guidance.

• The service did not carry out formal driver assessments to determine if staff were competent to drive vehicles, including driving under emergency blue light conditions.

• The service did not have a documented risk assessment in relation to ligature risks on the patient transport vehicle used for transporting mental health patients.

• The service did not have a documented risk assessment for use of a sluice room with no dedicated hand wash sink.

• The service did not have a formal business continuity plan in place at the time of our inspection.

• The safeguarding lead had not completed training to an appropriate level for their role, in line with intercollegiate guidance.

• Staff were not aware of female genital mutilation and had not received training regarding this.

• The service did not participate in any local or national benchmarking audits and did not routinely collate information about patient outcomes.

• There were no formal systems in place to allow staff to receive regular supervision or appraisal. There were no documented staff competency assessments in the staff files we looked at.

• The service did not have access to interpreting services or communication aids for patients that were not able to communicate with staff.

• Team meetings involving all staff across the service did not take place on a routine basis. Three meetings had taken place during the last 12 months.

• These were no formal documented audit processes to identify gaps or demonstrate improvements in areas such as infection control, medicines management, patient records and staff recruitment and training.

• The service did not have systems in place to undertake appropriate recruitment checks required for directors in line with the fit and proper person’s requirement.

• The service did not have systems to monitor key performance indicators. There were no records in place to show overall performance against key indicators such as number and type of patients conveyed or patient collection and drop off times.

• The service did not have a formal documented strategy. The management team were able to verbally describe the future strategy for the service.

However, we also found the following areas of good practice;

• Staff understood how to report incidents. Incidents were investigated and lessons learned were shared with staff. Staff were aware of the basic principles of the duty of candour legislation.

• The staffing levels and skills mix was sufficient to meet patients’ needs. Most staff had completed their mandatory training.

• Patient records were completed appropriately and stored securely.

• There were suitable systems in place for the safe management of medicines, including controlled drugs.

• Ambulance vehicles and the premises were clean, tidy and well maintained. There were sufficient vehicles and equipment available and these were routinely checked and suitably maintained.

• Patients were assessed prior to referral to the service. This allowed staff to plan for their care and have the appropriate staffing, equipment and vehicles in place.

• The service could operate during out of hours and on weekends if a booking became available.

• Staff took into account individual needs and preferences when transporting patients with mobility needs, bariatric patients and patients living with dementia or mental health conditions.

• Complaints were investigated and responded to in a timely manner and shared with staff to aid learning.

• Staff were committed to providing good patient care.

• Patients and their relatives were kept fully involved in their care and the staff supported them with their emotional needs.

• Staff provided care and treatment that followed national guidelines such as the National Institute for Health and Care Excellence and the Joint Royal Colleges Ambulance Liaison Committee .

• The service had a clearly defined leadership structure that was understood by staff.

• Key risks to the service were managed through the use of an organisational risk register.

• Patients received care and treatment by competent staff that worked well as part of a multidisciplinary team.

• Staff understood the how to seek consent from patients and were aware of the Mental Capacity Act (2005) and Mental Health Act (2007).

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 also issued the provider with four requirement notices that affected patient transport services. Details of these are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals.