06 November 2020
During a routine inspection
We conducted a short notice unannounced comprehensive inspection of Zot Limited, which is a Patient Transport Service (PTS) to see if improvements had been made since our inspection in January 2020. We inspected Zot Limited as part of our continual checks on safety and quality of healthcare services and to look at all parts of the service that did not previously meet legal requirements in the January inspection. At that time, we rated the provider as inadequate and the provider was suspended due to concerns we had about the quality of the services. The provider was also placed in special measures. Following the January inspection, Zot Limited regularly engaged with CQC around the improvement action plan.
Overall, we found the provider had made significant improvements since our last inspection. Our rating of Zot Limited improved. We rated it as requires improvement because:
- The service provided mandatory training in key skills to all staff and made sure everyone completed it. We reviewed records from all five staff files and saw staff members had been re-trained in all areas of mandatory training since the last inspection. Staff knowledge on mandatory training topics such as safeguarding and consent had improved.
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The safeguarding policy was up to date with relevant national guidance and the safeguarding lead was now trained to the recommended level.
- The service controlled infection risks. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. There was a good understanding of national guidance for COVID-19 and good access to personal protective equipment (PPE).
- All staff had been re-trained in the use of equipment by a qualified trainer. Staff were able to demonstrate how to use pieces of equipment such as the patient carry chair. The provider had also purchased a children’s harness for the second vehicle to keep children safe during transport. All equipment was well maintained and serviced as per manufacturer’s guidance.
- The provider had updated their Deteriorating Patient Policy so that it was in line with the scope of practice of a Patient Transport Service (PTS). Staff had a good understanding of the signs of a deteriorating patient and knew to call 999 or attend the nearest emergency department if this happened.
- The provider had introduced an exclusion criteria as part of their booking process. This ensured patients were risk assessed for suitability to a PTS service before accepting the transfer. The booking form also contained an assessment designed to exclude patients displaying COVID-19 symptoms, as the provider was currently not transporting these patients.
- The provider had enough staff with the right skills and competencies for a PTS. This ensured patients were kept safe from avoidable harm.
- Patient booking forms were now completed for each patient and contained all relevant details and information about the person being transferred. The registered manager was now auditing all booking forms staff fully completed them.
- The provider had improved the way they managed patient safety incidents. An incident reporting log was now in place and all incidents were investigated and any learning identified and shared as per the incident reporting policy. Staff awareness of incidents and what they should be reporting had improved.
- The provider was monitoring performance against Key Performance Indicators (KPIs) for arrival and departure times and had good compliance.
- The consent policy had been updated and patient consent was documented on the booking forms. Staff knowledge of the mental capacity act and deprivation of liberty safeguards had improved.
However;
- The provider had updated a number of their policies so they were up to date with relevant national guidance. Whilst all policies had been reviewed and were up to date we noted no policies had version control. Therefore, there was no record of what had been added or removed from policies following changes. Therefore, we could not be assured staff knew about the changes.
- The provider took into account peoples individual needs at the time of booking. However, there were limited facilities available to ensure these needs were met. For example, there were no communication aids available to support those who could not communicate verbally. Following the inspection, the provider informed us they had ordered communication aids for both vehicles.
- The provider had a complaints procedure in place, however we were not assured it was easy for patients and relatives to give feedback.
- The provider had improved risk management and a risk register was now in place, which listed each risk to the service and what actions the provider was taking. However, risk management was not fully robust. The risk register did not provide detail as to why each item was a risk to the service or dates when risks were last reviewed. The process for removing risks from the risk register was also not established.
- The provider had improved clinical governance within the service. However, the clinical governance meeting had no terms of reference and meetings did not state quoracy. Whilst the same items were discussed, there was no documented agenda.
- Whilst there was a document called the quality and strategy document 2020 to 2022, knowledge about the aims of this amongst staff was poor. The leadership team stated compliance with CQC was the overall focus at the moment.