Mealing Taxis Limited

Mealing Taxis Limited is operated by a provider of the same name, Mealing Taxis Limited. The service provides patient transport services as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from Mealing Taxis Limited liaise directly with National Health Service (NHS) providers. The service is based in Northwood, London and makes journeys to various locations within the United Kingdom. This service does not undertake any urgent or emergency transfers such as responding to 999 calls. The majority of the work carried out by Mealing Taxis Limited involves the transportation of renal dialysis patients. Dialysis is a procedure to remove waste products  and excess fluid from the blood when the kidneys stop working properly. It often includes diverting blood to a machine to be cleaned.

We inspected Mealing Taxis Limited in July 2016 and again in December 2016 as part of our comprehensive programme of inspections. We found Mealing Taxis Limited to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and commenced enforcement action against them. This was in the form of a notice of proposal to suspend their registration. 

In May 2017, we carried out an unannounced focused inspection. This was to follow up on concerns identified in the 2016 inspections and to determine whether Mealing Taxis Limited had made the necessary improvements. As this was a focused inspection, we did not conduct an in depth review of evidence against each of our five key questions (safe, effective, caring, responsive and well led). The inspection focused on whether the service was safe, effective, and well led.

Following this inspection, the Care Quality Commission (CQC) made a decision not to proceed with the suspension of the provider’s registration.

The initial concerns giving rise to enforcement action were as follows:

• Systems and processes had not been established and operated effectively to prevent abuse of service users. For example, the provider had not provided staff with training in safeguarding vulnerable adults or children and staff had no or little understanding of safeguarding processes.

• The service had not carried out independent Disclosure and Barring Service (DBS) checks on staff as part of the recruitment process and relied on third parties (taxi and private hire licensing authorities) to undertake the DBS checks. The service had not seen or kept copies of DBS checks carried out by third parties and had no assurance staff were of good character as required by the regulations.

• Control staff at Mealing Taxis Limited sent patient journey information including patient identifiable information to drivers’ personal mobile phones. We were concerned that there was a risk patient data could be accessed by unauthorised persons.

• There were no systems and processes for the effective reporting of incidents within the organisation and there was a lack of incident reporting by staff overall.

• The provider did not carry out appraisals or supervision of staff and this was not in line with the regulations.

• Staff had not had refresher courses following the initial training as part of induction.

• We found poor infection control practices in the service. For example, staff had no personal protective equipment in vehicles and vehicles were visibly dirty inside.

• There was insufficient governance in the service in relation to risk management, incident reporting, and the secure maintenance of patient records.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

On 26 May 2017, we found the provider had made improvements to address our concerns. We found the following areas of good practice:

• The provider had established systems and processes to protect service users from abuse and improper treatment. The service had an updated safeguarding policy, which had been implemented.

• Staff had been trained in safeguarding vulnerable adults and children at level two and staff were knowledgeable about safeguarding processes and were able to give examples of what might constitute a safeguarding concern.

• The service had carried out DBS checks for staff and obtained copies of DBS checks carried out by the taxi licencing authorities for drivers whose checks were pending.

• The provider established systems and processes to enable them to assess, identify, monitor and mitigate risks.

• There were clear processes for the reporting of incidents and staff were aware of the service’s incident reporting policy. We saw examples of incidents that had been reported in the service and how they had been investigated.

• Mealing Taxis Limited had responded to our concerns around the security of patient data by providing drivers with company mobile phones to be used to communicate patient journey details to drivers by control staff.

• We found that staff had infection prevention and control training in February 2017 and the provider updated its infection prevention and control policy which set out the infection control processes for the organisation. Drivers showed an understanding of the service’s infection control processes.

• We inspected three vehicles and found all three to be visually clean and free from dust. All three vehicles had gloves, hand gel, spill kits, and sanitising wipes.

• The compliance manager for the service kept an electronic log with dates for when refresher training was due for each of the courses staff had undertaken.

• The compliance manager and the managing director regularly appraised and supervised staff.

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

• The provider did not consistently keep minutes of management review meetings.

• The provider did not keep minutes of staff supervision and appraisals.

• One of the two control staff had not been trained in safeguarding.

• The safeguarding lead for the service was not trained to level four children safeguarding which is the minimum requirement.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

The provider should :

• The provider should keep records of staff appraisals and supervision.

• The provider should keep minutes of management review meetings.

• The provider should ensure the safeguarding lead is trained to level four in children safeguarding in line with the intercollegiate document.

• The provider should ensure all staff are safeguarding trained.

• The provider should ensure that changes made following the notice of proposal are maintained and sustained.

Professor Edward Baker

Chief Inspector of Hospitals

Mealing Taxis Limited provides Patient Transport Services as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from Mealing Taxis Limited liaise directly with NHS providers. The service is based in North West London and makes journeys to various locations within the United Kingdom. This service does not undertake any urgent and emergency transfers such as high dependency transfers. The majority of the work carried out by Mealing Taxis Limited involves the transportation of renal dialysis patients.

We inspected Mealing Taxis Limited on 27 and 28 July 2016 as part of our comprehensive programme of inspections. Following the first inspection we decided that there should be a follow up inspection of the service in order to obtain further information and follow up on some concerns arising from the July inspection. This second inspection took place on 16 December 2016. The findings of both inspections are set out in this report. We do not have the statutory authority to formally rate independent ambulance services and as a result we have not formally rated this service.

On our initial inspection on 27 and 28 July 2016,and following a consideration of evidence submitted to us prior to the inspection, we found the following areas of poor practice:

• Staff were not trained in adult or children safeguarding and staff had no or little understanding of safeguarding processes.

• The service did not carry out independent Disclosure and Barring Service (DBS) checks on staff as part of the recruitment process and relied on third parties (taxi/private hire licensing authorities) to undertake the DBS checks.Copies of the DBS checks carried out by third parties had not been seen by them or kept on employee files.

• Patient identifiable information was sent to drivers’ mobile phones by control staff.This raised data protection concerns.

• There were no systems and processes in place for the reporting of incidents within the organisation and there was a lack of incident reporting by staff overall.

• There was no formal appraisal or supervision of staff.

• There were no refresher courses following the initial training of staff as part of induction.

• We found poor infection control practices by staff at the service.

• The service did not get feedback from commissioners on the outcome of complaints or incidents.

• The service had recorded risks within the service in a “Health and Safety and Risk Assessment” document. The document did not state dates when a risk had first been identified or when it had been reviewed. Risks identified included motor vehicle accidents and staff lone working. We found that risks we identified during the inspection had not been recorded as risks, for example, the lack of safeguarding training for staff.

However:

The positives and areas of good practice were:

• All staff we spoke with were happy to work for the Mealing Taxis Limited .They felt supported, respected and valued.

• Staff spoke highly of the leadership of the organisation. Staff told us the managing director was supportive, visible and approachable.

• We observed positive, compassionate and caring interactions between staff and patients.

• Hospital staff were positive about the service and described staff as professional and caring.

• The patient feedback forms we viewed were positive about the service.

• Vehicles were well maintained and had up to date Ministry of Transport (MOT) checks.

Findings of the follow up inspection on 16 December 2016 were as follows:

• Staff had not been trained in adult or children safeguarding.

• Patient identifiable data was still being sent to drivers’ personal mobile phones by control staff.

• The service still did not carry out its own DBS checks on staff and relied on checks by third parties. These third parties were taxi and private hire licensing authorities. Copies of the DBS checks carried out by third parties had not been seen by the service or kept on employee files.

• There was evidence of poor infection control practices. The two cars we inspected did not have any gloves, alcohol gel or wipes in them.

• Staff had not had refresher training following the initial induction.

• No incidents had been reported by staff in the period between the inspection in July and the time of the follow up inspection in December 2016.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals