Archived: W & N Training Limited t/a Want Medical Services

Want Medical Services (WMS) is operated by W & N Training Limited.

CQC inspected the service in 2014 and found non-compliance in relation to infection control practices. An inspection later in the year found the provider was meeting all the regulations and required standards.

We completed a comprehensive inspection of WMS on 14 February 2017 and found the following issues:

• There was insufficient focus on infection prevention and control.

• The management of waste did not meet current guidance.

• Segregated medical gasses were not stored in line with guidance.

• Staff did not manage medicines appropriately, for example the registered manager did not understand their responsibility to hold a Home Office License as controlled drugs were stored on site.

• Equipment used to provide services to patients was not regularly serviced.

• We found numerous consumables that had passed their expiry date.

• There were fire safety and health and safety risks identified.

• There was a lack of systems and processes to assess, monitor and improve the quality and safety of services. There was no formalised system of governance.

• There were unclear audit arrangements and there was no auditing of patient transport services.

• The registered manager had difficulty locating key documents and information when requested and was unable to provide us with documents and records.

• There were limited systems to collect feedback from patients.

• There was a lack of processes to assess, monitor and mitigate risks relating to the health and safety and welfare of patients and others.

• Staff records did not take into account the information required in ‘Schedule 3’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As a result of the above, CQC urgently suspended registration of the following regulated activities until 22 April 2017 to allow the provider to address the issues identified at the inspection:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder or injury

This meant the provider could not carry out these regulated activities.

The purpose of the 11 April 2017 inspection was to review the provider’s progress against the issues identified in February 2017 and assess whether the provider had met standards in order to lift the suspension on 22 April 2017.

This was an announced inspection that was focused on issues seen in the February report. At our 11 April 2017 inspection, we were not assured that people would be safe from avoidable harm and high quality care was not assured by the current governance arrangements. There was also insufficient assurance to demonstrate patients received effective care as the provider was advertising services that staff did not have the skill or knowledge to provide.

We found the following issues:

• The premises and the vehicles still did not meet standards set out in the ‘Health and Social Care Act 2008 Code of Practice of the prevention and control of infections and related guidance (2015)’.

• Medical gasses were still not stored in line with British Compressed Gases Association ‘The Storage of Gas Cylinders (2016)’.

• Equipment had not been serviced or maintained since our previous inspection although there was evidence of some planning to commence this.

• We found some out of date medicines although the provider told us these had all been checked. However, all stocks of controlled drugs had been surrendered to the local police.

• We found items of equipment that were out of date, despite being told that equipment had been checked.

• There was a lack of systems and processes to assess, monitor and improve the quality and safety of services.

• New policies had been formulated, however plans for implementing them were vague and did not include time frames or details regarding staff training. Plans did not include how policies were to be monitored and audited once they had been implemented.

• The action plan rejected by the CQC had not been updated at the time of this inspection.

• Audit activity, plans and schedules had still not been implemented. There was no evidence of how audit outcomes and details were to be reviewed or how audit formed a part of the governance structure.

• A risk register template had been set up, however this was empty. Therefore, risks had still not been identified, neither were plans to mitigate risks in place.

• Disclosure and Barring Service checks were requested by former employers or universities and not by WMS, which is not in line with recommendations set by the Disclosure and Barring Service.

However:

• The prescription only medicines were stored in a locked cupboard and were secured with digital key access. All stock inside the prescription only store was in date.

As a result, CQC extended the suspension of regulated activities until 22 July 2017.

The purpose of the 18 July 2017 inspection detailed in this report was to determine whether the provider had made sufficient improvements that suspension could be lifted on 22 July 2017. Therefore the report does not cover all areas contained within a comprehensive report. Instead it has focused on the areas of concern found at the February and April 2017 inspections.

We found the following improvements:

• The provider had redesigned the management structure to enable a greater focus on key elements of governance.

• A new electronic system was being trialled that ensured all the management team had access to key, current management concerns without meeting face to face.

• The provider had employed an independent consultancy company to support them. We reviewed the service level agreement between the two organisations and found it was current and covered those issues where WMS required specialised support.

• The provider had commenced quarterly clinical governance meetings.

• The provider had commenced collating risks and their mitigations in a formal risk register.

• The provider now has a suite of updated policies covering all essential issues. There were arrangements to ensure that staff were familiar with the policies available and their contents.

• An audit programme to cover infection prevention and control, clinical records and medicines had been developed.

However:

• Cleanliness still did not meet the standards set by ‘Health and Social Care Act 2008 Code of Practice of the prevention and control of infections and related guidance (2015)’. Items in the cleaning cupboard were still stored on the floor, which was dirty. This had been brought to the providers attention at both the February and April 2017 inspections. For example, the staff toilet was dirty, there was black particles and dust on the seat lid, rim and the main body of the toilet.

• During our inspections in February and April 2017, we noted medical equipment that was out of date. At this inspection we still found consumables that were out of date on an ambulance.

• During the period December 2016 to July 2017, engagement with the provider had been poor. CQC requests for information were repeatedly ignored. This resulted in CQC issuing a Fixed Penalty Notice under Section 64 of the Health and Social Care Act 2008.

• As a result of the improvements to governance, risk and implementation planning seen, the inspection team assessed that an appropriate and proportionate response to the above cited failures was to reimplement the providers registration when it expired on 22 July 2017, however CQC would impose conditions to the providers registration.

These conditions to registration included:

• A monthly update on the CQC action plan to be sent to the provider’s CQC relationship owner.

• Quarterly governance meeting updates to be sent to the provider’s CQC relationship owner.

• Quarterly engagement meetings with the CQC relationship owner.

• Evidence of DBS checks for all staff in line with CQC requirements to be sent to the CQC relationship owner within 6 months.

CQC placed these conditions in order to test the providers ability to make all necessary improvements and to test progress and sustain engagement.

Ted Baker

Chief Inspector of Hospitals

Want Medical Services (WMS) is operated by W & N Training Limited. WMS is an independent ambulance company, based in Portslade (Brighton) offering event medical cover, medical repatriation, ambulance transport, first aid training and medical supplies across the South of England.

In England, the law makes event organisers responsible for ensuring safety at the event is maintained, which means that event medical cover comes under the remit of the Health & Safety Executive. The activities at WMS regulated by the CQC are transport services, triage and medical advice provided remotely and the treatment of disease, disorder or injury.

The non-event service at WMS is small and has declined with changes in the way patient transport services have been provided in the region. WMS undertakes occasional transport work for private patients, health insurance providers (repatriation) and local NHS trusts. We were told that training and supplies of first aid products had ceased. We requested information from the provider regarding the scale of the service, but this was not provided.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 February 2017.

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 how the provider understood and complied with the Mental Capacity Act 2005.

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.

At this inspection, we found the following issues:

• There was insufficient focus on infection prevention and control. The premises, including offices, storerooms and vehicles were not visibly clean. Used linen was not managed appropriately.

• The storeroom was chaotic with equipment stored on the floor and equipment stored was not visibly clean.

• The management of waste did not meet current guidance. The clinical waste storage facility was unsecured and we found that waste was not always properly disposed of.

• Segregated medical gasses were not stored in line with guidance. Staff stored the cylinders in the main storeroom rather than a separate area and there was no separation. We found oxygen cylinders that had past their expiry date in use.

• Medicines were not managed appropriately. Prescription only medicines were not securely stored. We found numerous medicines that were past their expiry dates. The provider did not have the required Home Office Licence to hold stocks of controlled drugs, which they used.

• Equipment used to provide services to patients was not regularly serviced. We found patient carry chairs, a patient trolley and extrication boards with labels that had no record of when they were serviced.

• We found numerous consumables that had passed their expiry date, sometimes by years.

• There were fire safety and health and safety risks identified. Old lead-acid type vehicle batteries were stacked by the front entrance, close to an open and unlocked clinical waste bin and two loose oxygen bottles. This constituted a serious fire hazard in addition to the risk of unauthorised access to the clinical waste. Staff had cluttered the storerooms on both floors and stacked a number of items too high for safety.

• There was a lack of systems and processes to assess, monitor and improve the quality and safety of services. There was no formalised system of governance.

• There were unclear audit arrangements. The registered manager told us the operations manager performed spot checks but was unable to provide evidence of these or explain findings or resulting actions. There was no auditing of patient transport services.

• Systems for checking the cleanliness and readiness of vehicles at the start and end of each assignment were not accurately completed or checked.

• The registered manager had difficulty locating and providing key documents and information when requested and was unable to provide us with documents and records. Prior to our inspection, the registered manager did not provide any data or other information requested by the CQC.

• There were limited systems to collect feedback from patients.

• There was a lack of processes to assess, monitor and mitigate risks relating to the health and safety and welfare of patients and others as the provider did not maintain a risk register and could not provide an explanation of how risks to staff, patients and others were identified, assessed and how mitigating actions were put in place.

• Staff records did not take into account the information required in ‘Schedule 3’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As a result of the above, CQC urgently suspended registration of the following regulated activities until 22 April 2017 to allow the provider to address the issues identified at the inspection.

Transport services, triage and medical advice provided remotely

Treatment of disease, disorder or injury

This means the provider cannot carry out these regulated activities. We will re-inspect the service before this date to gain assurance that sufficient progress has been made to ensure the service meet standards of quality and safety, before lifting the suspension of registration.

Alan Thorne

Head of Hospital Inspections