The Care Quality Commission
  • Ambulance service

R & K Healthcare Limited

Overall: Good read more about inspection ratings

8 The Street, Charlwood, Horley, Surrey, RH6 0BY

Provided and run by:
R & K Healthcare Limited

All Inspections

8 October 2019

During a routine inspection

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.

20 February 2018

During a routine inspection

R & K Healthcare Limited provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 20 February 2018.

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:

  • There were no incidents recorded during the reporting period but we were verbally told of at least two incidents that should have been formally documented.

  • The provider could not evidence that all members of staff had up to date mandatory training in first aid at work.

  • There were no business continuity or major incident plans in place.

  • Some of the policies and guidance were not specific to the roles, responsibilities and type of service provided, and were created less than a month before our inspection.

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

  • There was no evidence of how audit outcomes and details were to be reviewed or how audit formed a part of the governance structure.

  • Recruitment checks were minimal, including criminal checks on staff prior to their commencing employment with the provider. Staff references or checks regarding the validity and endorsements of driving licences were incomplete or inconsistent. Following our inspection the provider sent us a revised recruitment policy and procedure.

  • Staff had received no appraisals and there was no evidence of a structured induction. Following the inspection, the provider sent us an example staff induction checklist and advised us that staff appraisals had commenced.

  • The service did not monitor its performance, including number of patient transport journey or time on scene.

  • 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.

The provider also acted quickly to resolve the following issues:

  • Following our inspection, we issued the provider with a letter of intent to impose conditions to the registration regarding the improper use of blue lights when completing patient transport journeys. We received confirmation from the registered manager that no staff would use blue lights in the future, and he sent us a policy setting out the rationale and consequences for this.

  • During our inspection, we saw that none of the staff had received any safeguarding training. Following the inspection, the registered manager contacted us to advise that safeguarding training had been booked for all members of staff and we saw training certificates that indicated this had occurred

However, we also found the following areas of good practice:

  • We saw positive feedback received by the provider from service users.

  • The registered manager recognised the service shortcomings and was passionate and dedicated to make these right.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Amanda Stanford (Deputy Chief Inspector), on behalf of the Chief Inspector of Hospitals