The Care Quality Commission
  • Ambulance service

Zot Limited

Overall: Requires improvement read more about inspection ratings

112 Stanford House, Station Approach, Oldfield Lane North, Greenford, UB6 0AL (020) 3971 1001

Provided and run by:
Zot Limited

All Inspections

06 November 2020

During a routine inspection

We conducted a short notice unannounced comprehensive inspection of Zot Limited, which is a Patient Transport Service (PTS) to see if improvements had been made since our inspection in January 2020. We inspected Zot Limited as part of our continual checks on safety and quality of healthcare services and to look at all parts of the service that did not previously meet legal requirements in the January inspection. At that time, we rated the provider as inadequate and the provider was suspended due to concerns we had about the quality of the services. The provider was also placed in special measures. Following the January inspection, Zot Limited regularly engaged with CQC around the improvement action plan.

Overall, we found the provider had made significant improvements since our last inspection. Our rating of Zot Limited improved. We rated it as requires improvement because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. We reviewed records from all five staff files and saw staff members had been re-trained in all areas of mandatory training since the last inspection. Staff knowledge on mandatory training topics such as safeguarding and consent had improved.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The safeguarding policy was up to date with relevant national guidance and the safeguarding lead was now trained to the recommended level.
  • The service controlled infection risks. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. There was a good understanding of national guidance for COVID-19 and good access to personal protective equipment (PPE).
  • All staff had been re-trained in the use of equipment by a qualified trainer. Staff were able to demonstrate how to use pieces of equipment such as the patient carry chair. The provider had also purchased a children’s harness for the second vehicle to keep children safe during transport. All equipment was well maintained and serviced as per manufacturer’s guidance.
  • The provider had updated their Deteriorating Patient Policy so that it was in line with the scope of practice of a Patient Transport Service (PTS). Staff had a good understanding of the signs of a deteriorating patient and knew to call 999 or attend the nearest emergency department if this happened.
  • The provider had introduced an exclusion criteria as part of their booking process. This ensured patients were risk assessed for suitability to a PTS service before accepting the transfer. The booking form also contained an assessment designed to exclude patients displaying COVID-19 symptoms, as the provider was currently not transporting these patients.
  • The provider had enough staff with the right skills and competencies for a PTS. This ensured patients were kept safe from avoidable harm.
  • Patient booking forms were now completed for each patient and contained all relevant details and information about the person being transferred. The registered manager was now auditing all booking forms staff fully completed them.
  • The provider had improved the way they managed patient safety incidents. An incident reporting log was now in place and all incidents were investigated and any learning identified and shared as per the incident reporting policy. Staff awareness of incidents and what they should be reporting had improved.
  • The provider was monitoring performance against Key Performance Indicators (KPIs) for arrival and departure times and had good compliance.
  • The consent policy had been updated and patient consent was documented on the booking forms. Staff knowledge of the mental capacity act and deprivation of liberty safeguards had improved.

However;

  • The provider had updated a number of their policies so they were up to date with relevant national guidance. Whilst all policies had been reviewed and were up to date we noted no policies had version control. Therefore, there was no record of what had been added or removed from policies following changes. Therefore, we could not be assured staff knew about the changes.
  • The provider took into account peoples individual needs at the time of booking. However, there were limited facilities available to ensure these needs were met. For example, there were no communication aids available to support those who could not communicate verbally. Following the inspection, the provider informed us they had ordered communication aids for both vehicles.
  • The provider had a complaints procedure in place, however we were not assured it was easy for patients and relatives to give feedback.
  • The provider had improved risk management and a risk register was now in place, which listed each risk to the service and what actions the provider was taking. However, risk management was not fully robust. The risk register did not provide detail as to why each item was a risk to the service or dates when risks were last reviewed. The process for removing risks from the risk register was also not established.
  • The provider had improved clinical governance within the service. However, the clinical governance meeting had no terms of reference and meetings did not state quoracy. Whilst the same items were discussed, there was no documented agenda.
  • Whilst there was a document called the quality and strategy document 2020 to 2022, knowledge about the aims of this amongst staff was poor. The leadership team stated compliance with CQC was the overall focus at the moment.

21 January 2020

During a routine inspection

Zot Limited is operated by Zot Limited. The service provides a patient transport service (PTS). The service was registered with the Care Quality Commission (CQC) on 9 September 2018. The provider is registered for the regulated activity: transport services, triage and medical advice provided remotely.

The service transports non-emergency patients to and from community care locations, airports, hospitals and patients’ home addresses. The service transports both adults and children. Zot Limited had one contract with a county council but no other contracts with providers. The service began transporting patients in February 2019 and had carried out 535 journeys between February 2019 and January 2020. The jobs the service undertakes are ad-hoc and short notice bookings all obtained via an electronic-procurement platform or requested directly from patients who are self-funding. This framework is an e-procurement system who providers apply to be an accredited provider with. Once accredited providers can bid for contracts via the portal.

The service had two vehicles equipped for patient transport.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 21 January 2020.

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 because:

  • While staff were up to date with mandatory training, this training was completed on the same seven hour day and we were not assured this provided staff with the right skills and knowledge for the role they were employed for.

  • Staff did not demonstrate they had an understanding of safeguarding adults and children and were protecting vulnerable patients. The safeguarding lead was not trained to the recommended level and the safeguarding policy was not up to date and did not reflect current relevant national guidance.

  • There was no evidence staff were suitably trained to use equipment such as carry chairs to keep people safe. The registered manager told us the management team had read the equipment handbook and self-trained prior to training staff. The clinical director told us they had someone in to train staff on the use of equipment but there was no evidence of this.

  • The service was transporting children without a children’s harness available in one of the vehicles. This placed children at risk. There was also no formal training on the use of children’s harnesses for staff.

  • Staff were not suitably trained to recognise a deteriorating patient and we had concerns patients were not appropriately risk assessed prior to transport. There was no exclusion criteria in place in order to ensure patients were suitable for patient transport services.

  • 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 booking form did not always record or store information about patients the service transported.

  • The service did not manage patient safety incidents well. Staff were not trained to recognise incidents and near misses. There was no incident log and no learning from incidents within the service.

  • The service did not provide care based on up to date national guidance. We found policies in place which staff were not aware of and did not follow.

  • The provider did not have a policy or training on the rights of patients who were 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.

  • Staff did not support patients to make informed decisions about their care or have the knowledge to support patients who lacked capacity. The consent policy was not reflective of what the service did.

  • Leaders did not have the skills and abilities to run the service. The service did not operate an effective governance process throughout the service.

  • 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 collect data on any of their activity and therefore could not analyse it to improve the service.

  • The service’s data protection policy did not reflect what the service did. The registered manager told us booking forms with patient identifiable information were photographed and sent out using a social media messaging application to staff. They told us this was later deleted but there was no evidence this was audited.

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. These can be found 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.’

Nigel Acheson

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