R & K Healthcare Limited

Updated 19 December 2019

R&K Healthcare Limited opened in 2014. It is an independent ambulance service which transports patients throughout the UK and parts of Europe. The service transfers patients to and from hospital appointments and returns patients to their homes after a stay in hospital, or on to a care home, nursing home and hospices. The service covers the county of Surrey, East Sussex and the borders of Kent.

The provider did not have any formal contracts. Instead the service had an informal arrangement and worked on an ad hoc basis supporting transportation of patients to and from a local NHS trust. The service did not provide clinical care, but they transported patients who were vulnerable or had complex needs. If patients had extra needs, they were accompanied by a nurse or support worker organised via the hospital who were responsible for deciding the eligibility of patient’s suitability for the journey.

The service has had a registered manager in post since 29th September 2014, who is the company director.

The service is registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely

• Treatment of disease and disorder.

The provider had one senior manager, four full-time patient transport drivers working for the service, and a bank of three temporary staff that it could use to cover any surges in demand. The service had four vehicles.

Activity (April 2019 to September 2019)

In the reporting period there were 677 patient transport journeys undertaken.

Track record on safety

- No never events or clinical incidents

- No complaints

The local NHS trust that uses the service told us that no negative concerns had been raised regarding the service R&K provided during the reporting period (August 2018 to August 2019).

There were no special reviews or investigations of the service ongoing by the CQC at any time during the 12 months before this inspection.

The service has been inspected once before in May 2018 but we did not rate the service.

Updated 19 December 2019

When we inspected the service in 2018 we did not rate the service. However, we did make recommendations to the provider, which can be viewed in the previous report found on the CQC website. During this inspection we found that the registered manager had made changes based on our recommendations and requirement notifications.

We found the following areas of good practice:

• Since our last inspection, the service had made positive changes based on our previous recommendations. At this inspection, the registered manager responded to our concerns and acted immediately to implement changes and update staff.

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• 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 service-controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

• Patients and hospital staff told us that the service provided outstanding kind and compassionate patient centred care. Crews went extra mile to ensure vulnerable people were looked after with dignity, and respect.

• The team were responsive to the needs of their local NHS hospital. Hospital staff told us how they could rely on the service to support access and flow for patients and their families.

• The service had invested in new digital systems that were designed to improve staff performance and patient safety and provided accurate data which would drive services forward in the future.

However, we found areas for improvement

• Although the service transported vulnerable and frail people, the provider did not offer staff training in dementia awareness or Mental Capacity Act (2005). This training is essential for workers involved in the care and treatment of people who may lack mental capacity.

• The service did not have a robust system to monitor or mitigate risk. We found that the providers risk register was blank, and the registered manager had a lack of awareness on what risks should be recognised in the risk register.

• We found that although there was a safeguarding policy which included safeguarding forms. Staff reported safeguarding concerns to the local NHS trust, they did not formally document or raise safeguarding incidents within the provider service.

• The registered manager failed to complete statutory notifications under Regulation 17 1,2 (f) of the Care Quality Commission (registration) Regulations 2009 (Part 4). We found the provider lacked awareness on the contents of the services safeguarding policy and the procedures’ contained within this.

• The provider did not meet with staff formally on a regular basis, nor keep minutes of the meetings and keep records of actions to make sure changes were safely implemented and concerns were followed up.

Following this inspection, we told the provider that it must take one action to comply with the regulations and that it should make other minor improvements, to help the service improve. We also issued the provider with one requirement notice.

Updated 19 December 2019

R & K Healthcare Limited provide patient transport services via an informal contract with a local NHS trust and private transportation services when required. The service transports people throughout the UK and Europe.

We found the following areas of good practice

• Since our last inspection, the service had made positive changes based on our previous recommendations. At this inspection, the registered manager responded to our concerns and acted immediately to implement changes and update staff.

• 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. However the service failed to provide the CQC with statutory notifications

• Patients and hospital staff told us that the service provided outstanding kind and compassionate patient centred care. Crews went the extra mile to ensure vulnerable people were looked after with dignity and respect.

• The team were responsive to the needs of their local NHS hospital. Hospital staff told us how they could rely on the service to support access and flow for patients and their families.

• There was a positive culture within the organisation the registered manager was approachable and honest, and staff felt respected, because good performance was recognised.

• The service had invested in new digital systems that were designed to improve staff performance and patient safety.

However:

• Although the provider transported vulnerable people who may lack capacity, the service did not provide training in dementia awareness or Mental Capacity Act (2005).

• Although staff reported safeguarding concerns to the local NHS trust, they lacked understanding about reporting safeguarding concerns within the service. The policy laid out guidelines and contained a safeguarding reporting form, but staff did not use these. There were no completed safeguarding referral forms at the location.

• The service did not provide us with a policy or procedure that ensured no discrimination of people with protected characteristics under the Equality Act (2010).

• We found that the provider had no clear method for using data to make improvements to the service.

• The registered manager failed to complete CQC statutory notifications and lacked awareness of the full contents of the services safeguarding policy and procedures.