Invictus Medical Services Ltd

Invictus Medical Services Ltd is operated by Invictus Medical Services Limited. The service provides an emergency and urgent care ambulance service by conveying patients from event sites to the local acute NHS trust. Invictus Medical Services Limited was not commissioned by other organisations to deliver services. Work was acquired through a tendering process with event organisers. Although the provider told us they would provide patient transport services if the opportunity arose, this activity was not being provided at the time of this inspection. We were not able to observe staff carrying out regulated activities as, at the time of the inspection, the service was not delivering any regulated activities. The service had one emergency ambulance to carry out the regulated activities.

The service did provide medical cover at events. However, the CQC does not currently have the power to regulate events work, therefore we did not review that work within this report.

We previously inspected the service on 27 November 2018, using our comprehensive inspection methodology. Due to the concerns we had about the lack of governance, the management of safety and staffing concerns, the service was rated inadequate and placed in special measures. We urgently suspended the registration of the provider because we believed that people were or might have been exposed to the risk of harm if we did not take this action.

We carried out a focused follow up inspection on 18 February 2019 to assess whether the provider had made enough changes to the service to lessen the risk to people using the service. Following this inspection, we told the provider of additional areas where it must take some action 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 Invictus Medical Services. This was not a full inspection and the rating and actions of the previous report remained active until we carried out a comprehensive inspection.

On 1 July 2019 we carried out an inspection using our comprehensive inspection methodology, following which the service remained rated as inadequate and remained in special measures.

On 17 January 2020 we carried out a focussed inspection of the service. At this inspection we assessed the provider’s progress against specific areas of concern and breaches of regulation that were identified at the inspection in July 2019. This was not a full inspection and the rating of inadequate remains until we carry out a comprehensive inspection.

We gave the service two weeks’ notice of our inspection to ensure everyone we needed to speak with was available. We spoke with two of the directors. The registered manager, who was the third director, was unavailable for this inspection. The service contracts self-employed staff when needed, they had not carried out any regulated activity since the last inspection and therefore no staff or patients were available to speak with.

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

We found the following areas of improved practice:

We found the provider had addressed the specific concerns raised at the inspection in July 2019. In particular:

• The safeguarding lead had completed level 3 training about both safeguarding children and young people and safeguarding adults.

• The provider had reviewed and revised safeguarding policies, which now included current national best practice guidance.

• The service followed processes to ensure all equipment on the ambulance was available, clean and in date.

• Equipment was serviced by professionals to ensure it was safe to use.

• The provider had purchased a child harness to enable children to be conveyed on the stretcher.

• The provider had reviewed and revised their medicines management policies to reflect the service provided and reference current legislation and best practice guidance.

• The provider had made some improvements to the governance of the service. They held monthly meetings which were recorded, there was now a planned programme for review and revision of policies and procedures.

• The provider had a risk management policy and manager meeting records detailed some of the actions the service was taking to lessen risks to the service and to people who used the service.

However, we found the following issues that the service needs to improve:

• The provider should consider changes and improvements to the governance and risk management of the service to demonstrate ongoing effective and safe leadership of the service.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

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

Invictus Medical Services Ltd is operated by Invictus Medical Services Limited. The service provides an emergency and urgent care ambulance service by conveying patients from event sites to the local acute NHS trust. Invictus Medical Services Limited was not commissioned by other organisations to deliver services. Work was acquired through a tendering process with event organisers. Although the provider told us they would provide patient transport services, if the opportunity arose. We were not able to observe staff performing regulated activities as, at the time of the inspection, the service was not delivering any regulated activities. The service had one emergency ambulance to carry out the regulated activities.

The service did provide medical cover at events. However, the CQC does not currently have the power to regulate events work therefore we do not review that work within this report.

We previously inspected the service on 27 November 2018, using our comprehensive inspection methodology. Due to the concerns we had about the lack of governance, the management of safety and staffing concerns, the service was rated inadequate and placed in special measures. We urgently suspended the registration of the provider because we believed that people were or might have been exposed to the risk of harm if we did not take this action.

We carried out a focused follow up inspection on 18 February 2019 to assess whether the provider had made enough changes to the service to lessen the risk to people using the service. Following this inspection, we told the provider of additional areas where it must take some action 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 Invictus Medical Services. This was not a full inspection and the rating and actions of the previous report remain active until we carry out a comprehensive inspection.

On the 1 July 2019 we carried out an inspection using our comprehensive inspection methodology. We gave the service two weeks’ notice of our inspection to ensure everyone we needed to speak with was available. We spoke with the three directors one of whom was also the registered manager. The service contracts self-employed staff when needed, they had not carried out any regulated activity since the last inspection and therefore no staff or patients were available.

We looked at three staff files, audits, policies and procedures, management of medicines and tools the service used to monitor its quality.

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 service understood and complied with the Mental Capacity Act 2005.

The service provides an emergency and urgent care ambulance service by conveying patients to the local acute NHS trust.

We found the following issues:

• Cleanliness still did not meet the standards set by ‘Health and Social Care Act 2012 Code of Practice of the prevention and control of infections and related guidance (2015)’. The ambulance was dirty and the harness on the seat for carrying children was visibly dirty.

• The service had not made sure all equipment required to deliver safe care and treatment was available, in working order, in date and undamaged.

• The service had not made sure items for treatment on the ambulance were in date.

• The management of medicines was unsafe.

• There was no governance process to support improvement of the service quality and safeguarded high standards of care.

• There was limited evidence of how the provider continually monitored and identified risks to the service such as the management of medicines, equipment, infection control and the safeguarding policy. The main evidence of response to risks was to risks which had been identified externally.

• The safeguarding lead did not have level 3 safeguarding training. This is a requirement set by ‘Safeguarding children and young people: roles and competences for health care staff intercollegiate document 2018.’

• The registered persons did not consider the most recent national guidance to determine what level of children’s and young people’s safeguarding training that staff working for the service needed complete.

• The service had a process to supervise staff. However, staff had not received supervision as no work had been undertaken.

• The service had not made sure all staff working for the service were of good character. They had checked the qualifications, and all three files we looked at had a DBS check, however, these had not been undertaken by the provider.

• There were no references available in the files we looked at, and the records within were retrospective submissions. The provider stated that they would seek references for new staff.

• The provider had updated policies covering all essential issues however, they had not referred to recent national guidance to ensure policies were relevant.

• The directors and leaders of the service did not demonstrate a good understanding of their legal responsibilities towards the Health and Social Care Act 2012 (Regulated Activities) Regulations 2014.

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

This service was placed in special measures in November 2018. Insufficient improvements have been made such that there remains a rating of inadequate for any core service, key question or overall. Full information about our regulatory response to the concerns we have described will be added to a final version of this report, which we will publish in due course

Nigel Acheson

Deputy Chief Inspector of Hospitals South