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Secure Care UK Headquarters Requires improvement

Reports


Inspection carried out on 25 November 2019

During an inspection looking at part of the service

Secure Care UK Headquarters is operated by Secure Care UK Limited. The service provides a patient transport service for adults and children with mental health disorders. They also observe people in section 136 suites while they are awaiting a mental health assessment. A 136 suite is a place of safety for people who have been detained under Section 136 of the Mental Health Act 1983, due to concerns about their mental wellbeing and safety.

We carried out an unannounced inspection of Secure Care UK Headquarters on 25 November 2019. This was in response to information of concern. We considered the findings of our previous inspection on 2 April and 3 April 2019, when this information was relevant to the concerns raised, or our findings from this inspection. Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

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.

We focused our inspection on the questions of safe and well led because this is what the information of concern related to.

To see the most up-to-date rating for the questions of effective and responsive, please see the inspection report published on 26 June 2019. The question of caring has not previously been rated due to insufficient evidence to be able to rate this question.

The service is rated Requires Improvement overall.

Our rating of this service stayed the same. We rated it as Requires improvement overall.

  • The provider did not have effective pre-employment checks to assess the suitability of new staff. They did not always use reference checks to determine if new employees were suitable to employ.

  • Although the provider had implemented a coordinated programme for reviewing all polices, practice did not always reflect their policy related to recruitment checks.

  • The provider considered the duty of candour when reviewing complaints. The current process for reviewing incidents, did not routinely consider if the duty of candour applied.

  • The provider did not ensure all staff had a meaningful annual appraisal.

However:

  • The provider had strong leadership. They were visible, proactive and engaged with staff.

  • Staff spoke positively about the culture of the service. They felt valued, listened to, and able to raise concerns as well as ideas.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm, and to provide the right care and treatment.

  • The provider had improved its training compliance since the inspection in April 2019. As a group of staff, training compliance had exceeded 80% in all modules apart from the practical element of moving and handling. All staff attended annual training updates.

  • The shift patterns had been reviewed and changed to ensure all staff had a minimum break of 11 hours between consecutive shifts. This was largely in response to staff feedback.

  • The provider controlled infection prevention well. They had recently established a contract with an external cleaning company to complete deep cleans. This included all their vehicles used for regulated activity.

  • The provider had systems to ensure vehicles were maintained to keep them roadworthy. We saw evidence of up-to date tax, MOTs, insurance and servicing for all vehicles used to carry-out regulated activity.

  • The provider had introduced patient care records. We saw they were recording more detailed information of patients’ care than when we inspected in April 2019. However, records were not always stored securely.

  • The provider had introduced a process for coordinating the review of all incidents and disseminating learning to staff that were involved. While this learning had not been shared with all staff, the provider had plans to share the learning across the service.

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 one requirement notice that affected patient transport services. Details are at the end of the report.

Name of signatory

Nigel Acheson Deputy Chief Inspector of Hospitals (London and South), on behalf of the Chief Inspector of Hospitals

Inspection carried out on 2 April to 3 April 2019

During a routine inspection

Secure Care UK Headquarters is run by Secure Care UK Limited. The service provides patient transport for adults and children with mental health disorders, as well as the transport and supervision of people in section 136 suites whilst awaiting mental health assessment. A 136 suite is a place of safety for those who have been detained under Section 136 of the Mental Health Act by the police following concerns that they are suffering from a mental disorder.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 2 April 2019, along with a short-announced visit to the service on 3 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?

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 Requires improvement overall.

Although the service had improved since our last inspection in February 2018, we found two areas where the service still did not meet legal requirements, and therefore we could not rate this above requires improvement.

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

  • At the last inspection there was poor staff compliance with the completion of vehicle cleaning. The systems and processes to ensure cleanliness of vehicles were still not adequate.

  • We still had concerns about two governance processes; updating of policies and the management of incidents, which were highlighted at the last inspection. Although, the service had a stronger governance structure, this was only recently implemented and needed embedding.

  • At the last inspection, the service had not met its requirement to apply the duty of candour for incidents. At this inspection, we did not see records which showed the service had or had not discharged its responsibility to the duty of candour.

  • At the last inspection, the service had not implemented changes to improve patient assessment and record keeping. The documentation of restraint was still a serious concern at this inspection and there was no consideration for a patient’s mental capacity or their deprivation of liberty safeguards. The clinical risk assessment at booking stage was not always complete which might lead to an inappropriate management plan for the patient.

  • There was poor compliance to mandatory training with some compliance rates as low as 17%. None of the mandatory training compliance rates met the provider’s target of 80%.

  • Management and storage of equipment within vehicles was poor. There was no standardised equipment checklist which meant the equipment carried on each vehicle varied.

  • Policies did not always reflect the service provided and contained unclear information. They did not always reflect national guidance or best practice. No input from healthcare professionals was sought to develop the provider’s clinical policies.

However, we found the following areas of good practice:

  • Since the last inspection, there was improved staff compliance to completing vehicle inspection checklists which ensured the vehicle was safe to use.

  • Staff awareness of the interpretation service had improved since the last inspection.

  • The service had improved its recruitment processes and checks since the last inspection. This ensured that persons employed were fit to carry out their jobs.

  • All staff received a comprehensive three staged induction which included face to face training, online training and shadowing of shifts.

  • All staff knew how to escalate safeguarding concerns and more questions were asked at the booking stage for patients under 18 years old.

  • There was an overarching focus on communication and therapeutic intervention with patients rather than restricting them or limiting their independence.

  • Staff worked well as a team and relationships with external stakeholders showed effective multidisciplinary working.

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 two requirement notice(s) that affected its patient transport service. Details are at the end of the report.

Nigel Acheson

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