Archived: Homelands House

Homelands House is operated by Thames Ambulance Service Limited. The service provides patient transport services (PTS).

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 February 2017 along with an unannounced visit on 03 March 2107.

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.

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.

We found the following issues that the service provider needs to improve:

• Incident reporting systems and processes were not robust and did not operate effectively. There was a lack of incidents being reported, and investigating and learning from incidents needed to be better.
• Staff could not demonstrate they understood the term Duty of Candour and their role in regard to the legislation.
• Staff were not trained appropriately in vehicle deep cleaning and they did not always use personal protective equipment (PPE) during deep cleaning processes; the management of healthcare waste had not been risk assessed and the service was not disposing of mopheads used for cleaning areas where a patient had an infection via an orange-bag system. This meant that the service was not following national waste management standards and guidance.; staff did not have access to a change of uniform at work in the event their uniform became contaminated; patient’s risk of infection was not routinely assessed at each patient booking; and staff were unaware whether there was an infection control lead for the organisation.
• Managers did not have oversight of the MoT and servicing status of any of the vehicles used for PTS. They told us that a local car garage took responsibility for this.
• Whilst daily vehicle checklist forms were completed by staff, we saw that where items or equipment were recorded missing or faulty, the subsequent action taken was not recorded.
• We requested a copy of the policy for the management of medical gases; however, this was not provided so we were not assured that the management of medical gases was safe.
• Only 79% of staff were up-to-date with adult safeguarding training, and staff were unaware whether there was a lead for safeguarding within the organisation.
• Safeguarding policy and procedures did not reflect necessary national best practice guidance, nor the relevant local authority contact details and referral forms.

• We were unable to determine whether the service had suitable systems and processes in place for the investigation of safeguarding incidents because the service could not evidence that a thorough investigation had taken place by way of a report.
• 79% of staff were compliant with mandatory training requirements. This was below the services target compliance rate of 85%.
• Staff had not received training on, nor was there a policy and procedure in place for the management of violence and aggression.
• Patient booking records did not contain sufficient patient identifiable information, nor sufficient information regarding the patient’s medical condition.
• There was a lack of risk assessments undertaken for those considered high risk, such as those patient’s transported who were detained under the Mental Health Act. In addition, there was no policy and procedure in place in relation to the management of such detained patients.
• Staff had not received training on mental health, learning disability, dementia, and older people with complex needs, despite people living with these conditions who regularly used the service.
• The majority of policies and procedures we looked at were under review and, or, were missing necessary evidence-based practice and accurate information.
• The service did not assess and monitor their performance in terms of response times, waiting times, number of patients spending more than (locally defined) standard time on vehicles and rate of same day bookings. There was also no benchmarking of service performance against other similar providers.
• We requested staff appraisal rates from the service however these were not provided; therefore we could not be assured that staff appraisals were conducted.
• Staff said that additional training opportunities need to get better.
• Whilst staff confirmed that managers regularly assessed their driving ability, there was no record kept to show this.
• 79% of staff had received training on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS), and staff had insufficient understanding of the related legislation and unlawful and lawful restraint. However staff demonstrated to us that they would not restrain a patient in anyway, and if they were asked to they would seek immediate support and advice from a manager within the service.
• There was a lack of patient feedback systems in place and the service could not show that it improved the quality of its care as a result of feedback.
• Information about how to make a complaint was not made available to patients in PTS vehicles, and there was a lack of guidance available to staff as to how to manage a complaint.
• There were no formal and agreed eligibility criteria in place for people who used the service.
• Staff were not provided with learning aids to assist effective communication for those living with dementia or a learning disability, nor were there translation service available.
• There was no governance framework in place to outline governance arrangements within the organisation.
• The service risk register did not make reference to the person accountable for each risk and there was no specific date that each risk was to be, or had been reviewed.
• Team meetings with a manager did not happen, and meetings between the two managers were neither formal nor minuted.
• Staff did not receive one to one meetings with their line manager.
• Monthly staff newsletters had not been distributed since October 2016.
• We saw that building work had commenced for the development of a new ambulance parking area and dedicated cleaning bay. However there was no strategic plan or record to support this.
• We had concern about one manager’s lack of understanding in relation to: audit, the service’s strategy, plan and core values, known service risk, certain policy and procedures, number of complaints and incidents reported, and they did not demonstrate they were able to ensure good governance of the service.
• The services Statement of Purpose (SoP) as required by the Care Quality Commissions (Registration) Requirements 2009 did not meet Regulation 12 of those regulations.

However, we also found areas of good practice:

• Staffing levels and skill mix was appropriate to meet patient need, and staff received adequate time off between shifts.
• Other providers who worked with the service gave us positive feedback, and told us that the service was very responsive and performed well.
• Staff demonstrated they were caring people, who strived to provide high quality and individualised care to people who used the service. They also told us that they enjoyed working for Thames Ambulance Service Limited.

• 100% of patient driving staff that had completed their First Person on Scene Intermediate (FPOS-I) or Enhanced (FPOS-E) training.
• There had only been one complaint made about the service between January 2016 and January 2017.
• Staff had monthly peer meetings called “Speak Out” which provided an opportunity for staff to give feedback and ask questions as a group to management.
• There were provider-wide “Monthly Performance, Quality and Audit reports” which were well formatted, and provided good oversight of the issues covered, allowing different locations to be compared in terms of performance.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with three requirement notices. Details are at the end of the report.

Ted Baker

Deputy Chief Inspector of Hospitals (Central Region)