Archived: Transsecure NW Ltd

Updated 1 April 2021

Transsecure NW Ltd opened in August 2019. It is an independent ambulance service based in Blackburn. The service provides patient transport services for local, regional, and national acute NHS hospital trusts, local authorities and independent hospitals, 24 hours a day, 365 days a year.

The service provides patient transport services for adults; the service does not transport children. The service transports patients with mental health needs and those detained under the Mental Health Act 1983. Most of the work undertaken by the service is inter hospital transfers; however, the service also transports patients with mental health needs to and from home addresses when required.

Transsecure NW Ltd is registered to deliver the following regulated activity:

• Transport services, triage and medical advice provided remotely

At the time of the inspection, Transsecure was in the process of identifying an individual to undertake the role of registered manager and had put in place a new nominated individual who was also the company director.

This location has been inspected three times previously since it was registered in August 2019. The previous inspections were carried out in July, October, and November 2020. We took urgent enforcement action to suspend delivery of regulated activities by the provider following these inspections.

The current focused inspection was undertaken to assess if the provider had made enough improvements. Although we saw some improvements, we identified that there were still areas that posed a potential risk to patients and we took immediate action with the provider.

Updated 1 April 2021

Transsecure NW Ltd opened in August 2019. It is an independent ambulance service based in Blackburn. The service provides patient transport services for local, regional, and national acute NHS hospital trusts, local authorities and independent hospitals, 24 hours a day, 365 days a year.

The service provides patient transport services for adults; the service does not transport children. The service transports patients with mental health needs and those detained under the Mental Health Act 1983. Most of the work undertaken by the service is inter hospital transfers; however, the service also transports patients with mental health needs to and from home addresses when required.

We carried out a short notice announced focused inspection of the service on 1 February 2020. We inspected the providers services to check on the provider’s progress towards addressing the concerns and action we took following our previous inspections in October and November 2020. Although we saw some improvements, we identified that there were still areas that posed a potential risk to patients and we took immediate action with the provider.

We did not rate the service.

We found the following areas that required improvements:

• We were not assured that there were systems or processes in place to safeguard patients from abuse and neglect. At the inspection on 27 November 2020, we noted that the adult and children’s safeguarding policies did not refer to all relevant guidance. At this inspection we found that the provider had not made any changes to adult and children’s safeguarding policies. Staff had not completed safeguarding training in line with the intercollegiate document as face-to-face training had not been provided, we also found there were no current arrangements in place to ensure access to a safeguarding level four trained member of staff.

• We were not assured there were robust systems and processes in place to ensure the safe management and prevention of the spread of infection. We did not see assurance and monitoring systems in place to ensure the cleaning of equipment and vehicles and there was no Infection Prevention and Control (IPC) lead in place.

• We were not assured that effective systems were in place to ensure the safety of the care and support provided to service users was regularly assessed and monitored to make sure it was being delivered safely. We saw a draft patient transfer record which included additional sections for staff to record primary risk assessments, dynamic risk assessment, briefing and de-briefing and space for patient’s vital signs. However, the updated form did not include details around the maximum time that restraint should be used. We did not see clear instructions on how staff should complete this form.

• We were not assured there were systems and process in place to safely manage the risks to patients being transported while sedated. For example, the guidance was based on sedation levels used in the pre-operating environment of a hospital and was not appropriate for the service.

• We were not assured that restraint would only be used as the least restrictive option or that there were sufficient policies and procedures to support staff in the application of the Mental Capacity Act. We were not assured that restraint would be used proportionately to the risk of harm and the seriousness of that harm. We were also not assured that staff were supported in seeking consent and acting in the service users’ best interest if they lacked capacity. There was no detailed instructions or guidance for staff in relation to how consent should be obtained and would be documented; how best interest decisions would be documented where patients lacked capacity; and who would be involved in making best interest decisions.

• We were not assured there were effective systems for governance and risk management to ensure patients received safe care and treatment. There was no policy and procedure to support staff in carrying out audits to improve services for patients.

• There was no registered manager in place at the time of our inspection. The provider had taken steps to advertise for a registered manager and had identified someone for this role, but this had not been formally agreed and an application had not been submitted to the CQC at the time of our inspection.

• At this inspection we found that all the requirements as set out in Schedule 3 and Schedule 4, part 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been completed such as bankruptcy and insolvency checks for the main company director. However, we were not provided with any evidence to show fit and proper person checks had been completed for the other company director and we did not see fit and proper persons requirements for directors in the recruitment and selection policy.

• Records did not show job descriptions had been created for all key staff to outline key roles and responsibilities.

However:

• The provider had taken steps to identify an external individual who would provide level 4 safeguarding support.

• Records showed that staff had completed further training including infection prevention and control training and we saw certificates for Level 2 Mental Capacity Act and Deprivation of Liberty safeguards and Level 2 Mental Health Awareness from an external training provider. We saw transport staff had completed basic life support training.

• The provider was aware it currently was not compliant with regulations and had a lot of work to do to improve the service. We were told by the nominated individual that the service was committed to accessing relevant training for staff and writing policies, procedures and patient care documents that were relevant to the service.

Updated 1 April 2021

We inspected but did not rate the service.

• We were not assured that there were systems or processes in place to safeguard patients from abuse and neglect.

• We were not assured there were systems and processes in place to ensure the safe management, prevention and control of the spread of infection.

• We were not assured that effective systems were in place to ensure the safety of the care and support provided was regularly assessed and monitored to ensure it was being delivered safely.

• We were not assured that care was provided in a way to reduce the risk of avoidable harm to patients.

• We were not assured there were systems and processes in place to safely manage the risks to patients being transported while sedated.

• We were not assured that restraint would only be used as the least restrictive option or that there were sufficient policies and procedures to support staff in the application of the Mental Capacity Act.

• We were not assured there were effective systems for governance and risk management to ensure patients received safe care and treatment.