The Care Quality Commission
  • Ambulance service

Hatzola Trust

Overall: Good read more about inspection ratings

Rookwood Road, London, N16 6SD

Provided and run by:
Hatzola Trust

All Inspections

25 May 2022

During a routine inspection

Our rating of this service improved. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. The service had improved awareness of safeguarding concerns in relation to child accidents since the last inspection, and had improved processes to identify addresses which may require police assistance or addresses the service received frequent calls from.
  • Staff provided good care and treatment, and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. The service had improved access to guidelines for responders, who now had the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines on their tablet devices. The service had also improved its monitoring of the number of calls where callers were advised to call 999.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually. The service had improved staff training in risk identification and management, which was now part of the online mandatory training program.

However:

  • We found that a sharps bin did not have a date on.
  • The service did not always follow their policy on storing medicines.
  • There were no details of source references, authors or review dates on the call handling protocol.

11 Feb & 12 March 2020

During a routine inspection

Hatzola is a charity operated by The Hatzola Trust. The service provides an emergency and urgent care ambulance service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11th February 2020, along with another visit to the provider on the 12th March 2020.

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.

The main service provided by this service was emergency and urgent care.

The service had been inspected previously but not rated. We rated it as Requires improvement overall.

  • Access to medicines were not always restricted to qualified members of staff.
  • Policies were not always written by appropriate people working within the service or signed off at an appropriate level.
  • The provider did not always use evidence based best practice to inform policies, improve treatments and keep staff updated.
  • The provider did not have processes in place to identify addresses where police assistance may be required or locations from which the service received frequent calls from.
  • Staff were not always appraised by managers who had full knowledge of the staff members performance.
  • Not all staff were trained in risk identification and management.
  • The provider had an over-reliance on external management consultants, therefore, had limited continuity built into the workforce.
  • The provider did not always complete full pre-employment checks including gaining references, qualifications and employment history.

However, we found the following areas of good practice:

  • The provider ensured everybody had completed mandatory training.
  • Ambulance vehicles were supplied with antibacterial hand gel and cleaning equipment, and personal protective equipment (PPE) was available.
  • The provider had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

Summary of findings

  • The provider gained feedback from patients and relatives who praised staff for their compassion and support.
  • The provider had strong links to the community served.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. 

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

17-19 January 2017, and 31 January 2017

During a routine inspection

Hatzola is operated by The Hatzola Trust. The service provides emergency and urgent care ambulance services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17-19 January 2017, along with an unannounced visit to the provider on the 31 January 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 what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this service was emergency and urgent care ambulance services.

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:

  • The service did not have suitable systems in place to monitor safety over time, which included learning from incidents. Staff were not aware of actions they should take when a ‘reportable patient safety incident' occurred. We found six examples that would have met the provider’s policy categorisation as a serious incident but had not been reported. Near misses and serious incidents were not identified and there were no systems in place to review safety outcomes for patients.

  • Staff demonstrated some understanding of their responsibility to report safeguarding concerns, however there had been no safeguarding referrals made by the service in 2016.

  • There was a delay in the escalation of patients with critical conditions. The service had no escalation policy for patients requiring immediate emergency care for critical conditions. The call handlers always put calls through to members, or called one of the two coordinators. They did not immediately call 999 for any situation and there was no policy for doing so.

  • We were not assured that patients were assessed and treated in line with best practice and current national guidance. For example, the service did not have clear pathways for common emergency conditions. Ambulance technicians were sometimes working above their competency level. They were responding to calls that were of a more critical nature and more suited for ambulance paramedics.

  • Standard operating procedures for call handling were not clear in defining the prioritising of different calls. For example the policy required call operators to wait a set period of time for code one, two and three calls after requesting an ambulance technician attend. Code one calls were for “immediately life threatening situations”. For these, the protocol required the operator to wait three minutes and then contact the coordinator if no units had responded. The coordinator would then decide whether to call the London Ambulance Service for further advice. It was unclear how long this process took in practice and delays can cause serious consequences for patients. For example, cardiac arrest patients have 10% less chance of survival for every minute they don't receive CPR (JRCALC guidance).

  • Systems to check clinical outcomes for patients were not in place to enable co-ordinators to be assured that staff were making the right decisions on patients’ care. This meant there was no way to monitor and learn from good or poor outcomes.

  • Quality checks on patient care records (PCRs) were not effective to check staff had responded appropriately with the correct treatment. We viewed several PCRs where the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) protocols for treatment had not been followed. Staff told us they followed these protocols.

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

  • Equipment and ambulances were clean and kept in good repair.

  • There were systems in place for the segregation and correct disposal of waste materials such as sharp items. Staff had access to personal protective equipment when needed.

  • Ambulance technicians were administering medication appropriately and medical gases were safely stored.

  • Staff understood how to raise concerns and record health and safety incidents, such as equipment damage or failure, or injury to staff.

  • Patients were treated with compassion and respect and their privacy was maintained.

  • Patient feedback was overwhelmingly positive about the service. Patients commented they could ring the provider at anytime and ask for help or advice.

  • The service was planned to meet the immediate urgent and emergency care needs of local people. There was flexibility, choice and continuity of care which was reflected in the types of services we saw.

  • There were very few complaints and those we viewed had been handled sensitively and promptly. Learning and improvements were made when people complained about the service they received.

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 a warning notice that affected urgent and emergency services. Details are at the end of this report. We conducted a follow up visit on 20 April 2017 and found that the provider had taken steps to begin to address these issues.

Professor Edward Baker

Deputy Chief Inspector of Hospitals