E-Zec Medical- Dorset provides a patient transport service to patients who are registered with a GP in Dorset, Bournemouth and Poole and who meet the eligibility criteria agreed with the commissioners.

We carried out an announced inspection of E-Zec Medical- Dorset on 18 October 2016. This was a routine comprehensive inspection. We inspected against the following key questions: are services safe, effective, caring, responsive and well-led?

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

Our key findings were as follows:

We saw areas of good practice including:

• Openness and transparency about safety was encouraged. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• There were reliable systems, processes and practices in place to protect adults, children and young people from avoidable harm. The patients we spoke with during this inspection told us they felt safe with the staff and in the vehicles.

• Staff adhered to good infection prevention and control practice.

• Vehicles were maintained to a high level of cleanliness.

• There were safe systems for medicines to be appropriately stored and managed.

• Staff were qualified and had the appropriate skills to carry out their roles effectively, and in line with best practice.

• Staff were supported to deliver effective care and treatment, through meaningful and timely supervision and appraisal.

• We saw staff treating and caring for patients with compassion, dignity and respect.

• Staff felt valued and proud to work for the service.

• The service was planned to meet the needs of its contractual arrangements with health service providers.

• Patients told us they received a reliable service as crew members came on time, and they were not left waiting for long periods.

• Staff were able to plan appropriately for patient journeys using the information provided through the booking system.

• There was good coordination with other providers.

• There was a clear vision and credible strategy to support quality care. We saw evidence that the key to good non-emergency patient transport was understood by the relevant staff.

• Senior management team and other managers encouraged openness and transparency. Leaders encouraged appreciative, supportive relationships among staff.

• Staff and patient feedback was collected and used in service development.

However, we also found the following issues that the service provider needs to improve:

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• Ensure a manager for the regulated activity is registered with the Commission.

• Ensure the person appointed to be the registered manager has the relevant qualifications, skills, competency and experience and meets the regulation requirements.

• Ensure the Commission is notified of safeguarding incidents.

• Ensure all locations from which the service operates from are registered with the Commission.

• Ensure senior managers are consistently aware of the legal principles of the Duty of Candour legislation.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

This inspection was a focused inspection, to check the service had achieved compliance with medicines management and to follow up on other concerns we had received relating to patient safety.

The inspection focused on safety and we found some areas of concern.

Systems for assuring that vehicles and equipment to a safe standard were not robust which meant there was a risk these items could be used when it was not safe to do so. Records were not consistently accurate.

The service had an incident reporting procedure and there was some evidence of learning from incidents resulting in changes in practices. Incidents were not consistently reviewed however, and systems for sharing learning were not robust. The detail of the Duty of Candour legislation was not well understood by staff, but staff recognised the need to be honest and open about incidents.

Although the vehicles were visibly clean and there were cleaning rotas in place, the mop heads were not clean and some items of patient equipment were not stored correctly to keep them clean. Staff recognised the importance of maintaining a clean environment.

Staff training was monitored and staff were up to date with essential safety training. They understood their role in reporting situations of suspected or actual abuse and the service had built links with local safeguarding teams. There were safe systems for medicines management and for assessing patients for transport. Staffing levels met the needs of the service and were flexed to support times of high demand.

Action the ambulance service MUST take to improve

The provider must ensure:

• Equipment used by the service is safe for use and maintain records locally to demonstrate this.
• Staff must receive regular supervision and appraisal to support the delivery of a safe service.

Action the ambulance service SHOULD take to improve

The provider should ensure:

• Cleaning equipment, such as mops and buckets, is available and stored in a clean condition.
• Equipment is always stored safely.
• Incidents are reviewed consistently, staff receive feedback and learning is shared effectively and the Duty of Candour is applied and monitored safely.
• Accurate records are maintained to demonstrate the safe management of the service.
• Medicines for disposal are removed from site

Professor Sir Mike Richards

Chief Inspector of Hospitals

We carried out this inspection to check whether E-Zec Medical - Dorset had taken action to meet the essential standards for care and welfare of people who use service, requirements relating to workers, staffing and complaints that they had not been meeting in January 2014. We also assessed their compliance against the essential standards about the management of medicines and supporting workers. This was because we had received concerns from members of the public and health professionals about these areas.

During this inspection we spoke with the managing director, two E-Zec Directors, the registered manager, the fleet manager, Patient Transport Liaison Officers, call centre operators, ambulance crew, dispatchers and the member of staff responsible for responding to complaints. We also spoke with four people who had used the patient transport service E-Zec provided.

Since the inspection in January 2014 the service has moved premises. We were told this was in response to their previous premises being too small to effectively manage the contracted work load. The service had commenced functioning from their new premises the day prior to our inspection.

We found that action had been taken to achieve compliance with the shortfalls identified in the inspection of January 2014. Processes and structures had been put in place and were being followed to plan and deliver a service that met the needs of people. These processes needed to be fully embedded in to practice in order to ensure the service continued to improve the service for people and further reduce incidents of delayed transport.

Action had been taken to ensure people were supported by staff who had completed DBS checks and had the appropriate skills and qualifications to provide the service.