Exora International Limited

Updated 12 May 2022

Exora International Limited is operated by Exora International Limited. The service was registered with the Care Quality Commission (CQC) on 23 August 2017. The service provides a patient transport service (PTS). The provider is registered for the regulated activities: transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury. 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. Exora International operates as an ad hoc subcontractor to main contractors (identified as commissioners in this report).

Exora International Limited does not have fixed contracts with any providers. In the last 12 months, the service carried out 3790 journeys. All jobs the service undertakes are ad-hoc and short notice bookings. 98% of the bookings are made on the same day.

The service has five ambulances equipped for patient transport only.

The service was last inspected in April 2019 and rated requires improvement overall. We carried out a short notice announced inspection on 11 April 2022. We inspected this service using our comprehensive inspection methodology and we checked to see if the provider had complied with the Requirement Notice issued in July 2019.

The provider had made improvements in relation to their management of medical gases. There were now clear policies outlining when staff were required to use oxygen. Medical gases were now stored appropriately and the relevant authorities had been notified of the presence of the medical gases at the property. Staff were now trained to the appropriate level of safeguarding for children and adult safeguarding and the service’s safeguarding policy had been updated to reflect the latest national guidance. The registered manager was also now trained to level four safeguarding. The service now carried out infection prevention and control audits, and risks to the service had been documented. Equipment servicing logs were comprehensive and no longer had gaps within the record. There was also now a formal record of incidents and incidents were now being discussed at regular governance meetings.

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.

Updated 12 May 2022

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff were now trained to the appropriate level of safeguarding for children and adult safeguarding and the service’s safeguarding policy had been updated to reflect the latest national guidance. The registered manager was also now trained to level 4 safeguarding.
• Policies we reviewed now reflected the service’s provision. There were now clear policies outlining when staff were required to use oxygen.
• Medical gases were now stored appropriately, and the relevant authorities had been notified of the presence of the medical gases at the property.
• The service now carried out infection prevention and control audits, and risks to the service had been documented.
• Equipment servicing logs were comprehensive and no longer had gaps within the record.
• There was also now a formal record of incidents and incidents were now being discussed at regular governance meetings.
• At our last inspection we found the service did not collect or monitor key information such as response times. At this inspection, the provider did collect and monitor response times as part of their key performance indicators (KPIs). Compliance was consistently above 95% for picks-ups that were on time.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Most staff understood the service’s vision, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. All staff were committed to improving services continually.

However:

• We found some consumables in the emergency grab bag such as bandages, oxygen masks, defibrillator pads, a tourniquet and nasal cannulas did not have expiry dates on them which meant the service was not monitoring how long these pieces of equipment should be kept on vehicles and did not have a stock rotation document. Crew would therefore not know how old the consumables were and if they needed replacing.
• Some staff we spoke with had variable knowledge around oxygen saturation monitoring.
• Although staff we spoke with had a good understanding of the protocol on how to manage a deteriorating patient, the protocol for managing a deteriorating patient was within the service’s incident reporting policy and was not a standalone policy. This meant that the protocol could not be easily found among the policies of the service.
• The service should ensure the disinfectant sprays on ambulances have Control of Substances Hazardous to Health (COSHH) risk assessments in place.
• We did not see any communication aids within ambulances to support patients who are non-verbal or have learning disabilities.

Updated 12 May 2022

Patient transport services (PTS) were the sole service provided by Exora International Limited. 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.