The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: Fastrack Scan

Overall: Inadequate read more about inspection ratings

27 Brunswick Street, Hornton street, Luton, LU2 0HF 07885 238688

Provided and run by:
Ecospirito Ltd

All Inspections

06 November 2020

During an inspection looking at part of the service

We inspected Fastrack Scan because at our last inspection, we rated the location as inadequate and placed the provider in special measures to help it improve.

Our rating of this service went down. We rated it as inadequate overall as we rated safe, responsive and well-led as inadequate. We do not rate the effectiveness of diagnostic imaging services and we did not inspect caring as part of this inspection.

During our inspection we found:

  • The service did not have staff with the necessary skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Not all staff had completed mandatory training, which included basic life support. Not all staff had undertaken safeguarding training appropriate to their role.
  • The design, maintenance and use of facilities did not always keep people safe, as not all equipment had been serviced and staff did not manage clinical waste well. The service did not always use effective control measures to protect patients, staff and others from infection.
  • The service did not manage patient safety incidents well. There was no clear process for reporting, managing or investigating incidents, or for the sharing of lessons learnt with the team. Managers did not ensure that actions from patient safety alerts were implemented or monitored.
  • The service did not always provide care and treatment that was based on national guidance or evidence-based practice. There were no processes in place to ensure staff followed up-to-date guidance. Staff did not monitor the effectiveness of care and treatment, and therefore could not use the findings to make improvements and achieve good outcomes for patients.
  • The service did not make sure all staff were competent for their roles. Managers did not appraise staff’s work performance and did not hold supervision meetings with them to provide support and development.
  • It was not easy for people to give feedback and raise concerns about the care received. There were no robust processes in place for investigating complaints and sharing lessons learnt.
  • Leaders did not have the skills and abilities to run the service. They did not understand or manage the priorities and issues the service faced. Leaders did not operate effective governance processes, either throughout the service or with partner organisations. Staff were not clear about their roles and accountabilities, due to a lack of robust governance and oversight procedures. Staff did not have regular opportunities to meet, discuss and learn from the performance of the service.
  • The service did not have a vision or strategy for what it wanted to achieve.
  • Leaders and teams did not use systems to identify and manage risks to patients and the service. They did not identify or escalate relevant risks and issues, nor identify actions to reduce their impact.
  • The service did not collect reliable data and analyse it to understand performance, make decisions and drive improvements. Personal information was not processed in line with data protection guidelines.
  • Leaders and staff did not engage with patients, staff, equality groups or the public to plan and manage services.
  • Staff were not always committed to continually learning and improving services. They did not have a good understanding of quality improvement methods and the skills to use them.

However:

  • Key services were available seven days a week to support timely patient care. The service planned care to meet the needs of local people and the communities served, and people could access the service when they needed it.
  • Staff followed guidance to gain patients’ consent prior to undertaking any scan. Staff ensured patients understood the radiation risks associated with the scan.

Following our inspection, we took enforcement action against the provider due to continued non-compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which included Regulations 12, 13, 17 and 18. This enforcement action included the cancellation of the provider's registration and the registered manager's registration with CQC, which resulted in the provider no longer being registered to undertake their regulated activities, diagnostic and screening procedures.

29 May 2019

During an inspection looking at part of the service

Fastrack Scan is operated by Ecospirito Ltd. The service is mobile and provides dual energy x-ray absorptiometry (DEXA) scans from a 7.5 tonne mobile unit.

We inspected diagnostic imaging services, which is the only service provided.

We previously inspected this service following the outcome of our short-notice announced comprehensive inspection on 2 April 2019, where we made the decision to suspend the service. We formally notified the provider that their registration in respect of carrying out a regulated activity was suspended for eight weeks, under Section 31 of the Health and Social Care Act 2008. The notice of urgent suspension was given because we believed that a person or persons will or may be exposed to the risk of harm if we did not take this action. We inspected the service again on 29 May 2019 so that we could be assured that a person or persons will not be exposed to the risk of harm.

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. During this inspection, we did not collect sufficient evidence to rate caring and responsive. We do not currently rate the effectiveness of diagnostic imaging services.

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 rate

We previously inspected this service on 2 April 2019 and rated the service as inadequate overall. During the focussed inspection on 29 May 2019, we found improvements had been made. However, we still had some significant concerns and therefore rated the service as inadequate. During this inspection, we did not collect sufficient evidence to rate caring and responsive. We do not currently rate the effectiveness of diagnostic imaging services.

We found areas of practice that were inadequate:

  • Whilst there were plans in place for staff to complete mandatory training, staff had not completed mandatory training in key skills at the time of our inspection.
  • There was no formal certification of training undertaken.
  • There was no clear process for managing incidents. Incidents were not investigated and details of discussions about incidents were not recorded. There was no evidence that lessons were learned and discussed with the team. The incident policy did not include the process for recording, investigating and learning from incidents.
  • There was no process in place to ensure staff were following up to date guidance. No audits were carried out by the provider and no peer reviews had been undertaken.
  • The service did not monitor the effectiveness of care and treatment and was therefore unable to identify and act upon areas that required improvement.
  • There was no documented evidence that staff were competent for their roles. Staff’s work performance was not appraised. This meant that staff were not supported to be competent in their roles and the effectiveness of the service and the quality of scans were not monitored.
  • We could not be assured that staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They had not received any training at the time of our inspection. The mental capacity policy was not in line with Mental Capacity Act 2005. However, risks associated with radiation was explained. This was an improvement since our previous inspection.
  • Whilst the registered manager had the skills, knowledge, and experience to perform DEXA scans, they had not fully established suitable and effective policies and procedures to fulfil all of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service did not have managers with the right skills and abilities to run a service providing high-quality care.
  • There was no vision for what the service wanted to achieve and workable plans to turn it into action.
  • Whilst staff were friendly and welcoming, the culture was not focussed on safety and quality.
  • There was a lack of governance arrangements in place. The limited arrangements that were in place were not adequate to ensure high standards of care and oversight could be maintained. Systems and processes had not been established or operated effectively to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
  • The provider was failing to comply with Regulation 17, (1) (2), Good governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

However, we also found the following areas of improvement since our previous inspection in April 2019:

  • Whilst staff had not completed training on how to recognise and report abuse at the time of our inspection, this had been planned. Staff demonstrated an understanding of how to protect patients from abuse. This was an improvement since our previous inspection.
  • The service had some processes to control infection risk. Staff had an improved knowledge of how they could be compliant with best practice for hand hygiene, in accordance with national guidelines. There was now an infection prevention and control policy in place and plans to complete cleaning schedules that had been developed.
  • The provider had suitable premises. There were handwashing facilities. Environmental risk assessments had been completed. Equipment had been serviced within the last 12 months.
  • There were some arrangements in place to assess and manage risks to patients. Risks associated with radiation were displayed. Local rules were dated, displayed, and had been signed by all staff. They were reflective of current guidance. Staff had the appropriate training to manage deteriorating patients.
  • DEXA scans and local rules were based on national guidelines and standards.
  • Staff undertook scans for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Risks associated, whilst low, were communicated clearly to patients. This was an improvement since our last inspection.
  • Leaders had a better awareness of the employment checks and training that were required, which was an improvement since our previous inspection.
  • Systems had been developed to identify, reduce and eliminate risks, and to cope with both the expected and unexpected.
  • We saw some evidence of learning from previous inspection findings, plans to ensure staff completed training and improvements in infection prevention and control.

Following this inspection, we issued the provider with a warning notice under Section 29 of the Health and Social Care Act 2008. The warning notice was issued because regulation 17 (Good governance) had been breached, and not all concerns identified at the previous inspection had been addressed. The warning notice letter sent to the provider included the concerns we identified during this inspection and how the provider was failing to comply with this regulation. The provider must be compliant with this regulation by 21 July 2019. The Chief Inspector of Hospitals has recommended that the provider remain in special measures.

02 April 2019

During a routine inspection

Fastrack Scan is operated by Ecospirito Ltd. The service is mobile and provides dual energy x-ray absorptiometry (DEXA) scans from a 7.5 tonne mobile unit.

We inspected diagnostic imaging services, which is the only service provided.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 2 April 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.

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 rate

We have not previously inspected this service. At the inspection on 2 April 2019, we rated this service as Inadequate overall.

We found areas of practice that were inadequate:

  • Staff did not have the skills and training to keep people safe from avoidable harm and to provide the right care and treatment. The service did not provide mandatory training in key skills to all staff. Staff had not completed mandatory training, with the exception of the registered manager. However, there was enough staff to meet the demands of the service.

  • Staff did not demonstrate an understanding of how to protect patients from abuse. Staff had not completed safeguarding training on how to recognise and report abuse.

  • The service did not have processes to control infection risk well. Staff were not compliant with best practice for hand hygiene, in accordance with national guidelines. There was no infection prevention and control policy in place. Audits were not carried out and there were no cleaning schedules in place.

  • The provider did not have suitable premises. There were no handwashing facilities in working order. Environmental risk assessments had not been completed. Out of date consumables were stored in the first aid kit. However, we saw evidence that scanning equipment had been serviced within the last 12 months.

  • Arrangements were not in place to assess and manage risks to patients. Risks associated with radiation were not displayed. Local rules were not dated, displayed, or signed by all staff and they were not reflective of current guidance. Staff did not have the appropriate training to manage deteriorating patients.

  • There was no clear process for managing incidents. Incidents were not investigated and details of discussions about incidents were not recorded. There was no evidence that lessons were learned and discussed with the team.

  • Care and treatment provided was based on out of date national guidelines and standards. There was no process in place to ensure staff were following guidance. There were limited policies in place, no audits were carried out by the provider and no peer reviews had been undertaken.

  • The service did not monitor the effectiveness of care and treatment and was therefore unable to identify and act upon areas that required improvement.

  • There was no evidence that staff were competent for their roles. Staff’s work performance was not appraised and supervision meetings were not held with them. This meant that staff were not supported to be competent in their roles and the effectiveness of the service was not monitored.

  • Staff did not understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They had not received any training and written consent was taken without risks associated with radiation being explained.

  • Staff did not always communicate information about the scan and what it entailed with patients and those close to them. Risks associated with undertaking scans, whilst low, were not always communicated to patients.

  • The service did not always take account of patients’ individual needs. Staff described some exclusion criteria, but this was not formally documented.

  • The service did not have a complaints policy or process in place and patients did not know how to raise a complaint. Therefore, we could not be assured that the service treated concerns and complaints seriously, investigated them and learned lessons were shared with all staff.

  • While the registered manager had the skills, knowledge, and experience to perform DEXA scans, they had not establishedsuitable and effective policies and procedures to fulfil all of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service did not have managers at all levels with the right skills and abilities to run a service providing high-quality care. Leaders had no awareness of the employment checks and training that were required to keep patients safe.

  • There was no vision for what the service wanted to achieve and workable plans to turn it into action.

  • The culture was not focussed on safety and quality. There were no mechanisms in place for providing staff with the appropriate training or sharing of information.

  • There was a lack of governance arrangements in place. The limited arrangements that were in place were not adequate to ensure high standards of care could be maintained.

  • We were not assured that effective systems were in place to identify, reduce and eliminate risks, and to cope with both the expected and unexpected.

  • While the provider used electronic systems with security safeguards, it did not always collect, manage and use information well to support its activities.

  • There was no evidence of engagement with patients outside of the scan appointment. Views and experiences of patients were not collected, and therefore the service was unable to shape and improve the service based on feedback.

We found a limited number of areas of good practice:

  • Staff kept accurate records of patients’ demographics and scans, and transferred them appropriately to referring clinicians.

  • Staff undertook scans for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • Staff had the ability to minimise patients’ anxieties about the scan, if required.

  • People could access the service when they needed it.

Following this inspection, we formally notified the provider that their registration in respect of carrying out a regulated activity was suspended for eight weeks, under Section 31 of the Health and Social Care Act 2008. The notice of urgent suspension was given because we believed that a person or persons will or may be exposed to the risk of harm if we did not take this action. The letter included the concerns we identified during this inspection. In order for the suspension to be lifted, we must be assured that a person or persons will not be exposed to the risk of harm when we inspect the service again. On the basis of this inspection, the Chief Inspector of Hospitals has recommended that the provider be placed into special measures.

We also 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 two requirement notice(s) that affected Fastrack Scan. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central region)