Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service as a follow-up, responsive inspection to our inspections of 14 March 2017, when the service was suspended until 16 May 2017, and an unannounced inspection on 10 May 2017. At this time improvements had been made and the suspension was lifted.

We carried out this inspection on 10 October 2017 and our specific focus was to determine if improvements had been made against the areas highlighted in the section 29 warning notice issued on 22 June 2017.

We looked at governance under the Well-led key line of enquiry, as highlighted in the warning notice.

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? We have not commented on caring in this report, as there were no concerns highlighted from the previous inspection.

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 that the service provider had made significant improvements in key areas such as staff training and monitoring of their service.

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

• The service did not have a risk register relating to the business.

• Governance meetings were being held on an informal basis and details of those meetings were not recorded.

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

Amanda Stanford

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

Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service as a follow-up, responsive inspection after our inspection of 14 March 2017 when the service was suspended until 16 May 2017.

We carried out the inspection on 10 May 2017 and our focus was to determine if improvements had been made against the areas of poor practice highlighted at the previous inspection.

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? We have not commented on caring in this report, as there were no concerns highlighted from the previous inspection.

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:

• The provider did not have processes or practices in place to assess, monitor and improve quality and safety. There was not a robust system to ensure all incidents were recorded and monitored appropriately and no learning or outcomes were shared with staff.

• There were limited policies and guidelines to support staff to provide evidence based care and treatment.

• Managers did not have an understanding of risk and its management relating to the business and they did not demonstrate the necessary knowledge to lead effectively. The registered manager appeared to have very little understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and how these related to the business, or the consequences of not complying with them.

• There were no effective governance arrangements in place to monitor or evaluate the quality of the service and improve delivery. Audits were not undertaken and therefore learning did not take place from review of procedures and practice.

• There was no formal risk register in place at the service and therefore we had no assurances that risks were being tracked and managed to mitigate risks.

• There was limited provision on ambulance vehicles to support people who were unable to communicate verbally or for whom English was not their first language.

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 two requirement notices that affected the patient transport service. Details are at the end of the report.

Despite improvements that still needed to be made, as highlighted above and in this report, we determined that the significant concerns we previously had regarding the immediate risk to patients had been sufficiently mitigated. We were therefore satisfied that the registration of the service could resume on 16 May 2017 and we informed the provider of this on 12 May 2017.

Professor Edward Baker

Chief Inspector of Hospitals

Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 March 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.

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 provider did not have processes or practices in place to assess, monitor and improve quality and safety. There was not a robust system to ensure all incidents were recorded and monitored appropriately and no learning or outcomes were shared with staff.

• Systems and processes were not in place to implement the statutory obligations of Duty of Candour (DoC).

• The staff did not have current mandatory training and were not supported appropriately, either by the provider’s induction or through ongoing training. Staff delivering training were not up-to-date themselves.

• Arrangements for safeguarding vulnerable adults and children were not adequate. There was a lack of safeguarding training to ensure staff were aware of their responsibilities. There was a risk that staff would not be able to recognise and report potential safeguarding concerns.

• Medicines were not always managed safely or securely. The service had a medicine management policy. However, they did not have any medicine protocols to support staff to administer medicines safely. A regular patient carried their own midazolam, which would need to be administered by a member of the crew if the patient deteriorated. Midazolam is a Schedule 3 Controlled Drug as defined by the Misuse of Drugs Act 1971 and has strict rules in place for its use.

• We found the service did not have recruitment procedures in place to ensure all staff were appointed following a robust check of their suitability and experience for the role. Neither was there evidence of robust pre-employment checks were carried out.

• There were no systems in place to ensure staff received regular appraisal on their performance or development needs or received clinical supervision. There was no evidence of an induction policy or process within the service.

• There were limited policies and guidelines to support staff to provide evidence based care and treatment.

• Managers did not have an understanding of risk and its management relating to the business and they did not demonstrate the necessary knowledge to lead effectively. The registered manager appeared to have very little understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and how these related to the business, or the consequences of not complying with them.

• There were no effective governance arrangements in place to monitor or evaluate the quality of the service and improve delivery. Audits were not undertaken and therefore learning did not take place from review of procedures and practice.

• There was no formal risk register in place at the service and therefore we had no assurances that risks were being tracked and managed to mitigate risks.

• There was limited provision on ambulance vehicles to support people who were unable to communicate verbally or for whom English was not their first language.

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

• The service had a system for handling, managing and monitoring complaints and concerns.

There were areas of poor practice where the service needed to make improvements.

Following the inspection, we used our urgent powers to suspend registration of the service until 16 May 2017. This action was taken in response to our significant concerns of the immediate risk to patients. We found that care and treatment was not provided in a safe way and there were no effective governance systems in place within the organisation. Staff providing care or treatment did not have the skills, competence and training to do so safely. For example, in medicines management, risk assessments, risks of infection control and equipment. We also found that there was a lack of systems and processes in place to protect patients from abuse and improper treatment.

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. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We spoke with a relative of a young person who used the service and a matron who used the service for school events. Both spoke highly of the service. The relative said "I am more than happy with the service provided for my son. We use them on a daily basis and the service is excellent. We get regular crews who know my son well and understand his needs. They are punctual, flexible and nothing is too much trouble". The matron said "I have used them for five years and they provide an excellent and appropriate service. We often change our match schedule at short notice and they always accommodate us and rise to the mark".

People we spoke with told us they felt involved in the service and care provided and that communication was excellent. We looked at assessments for people who used the service and saw that people had been involved in the process.

The provider had taken steps to ensure people's safety. All ambulance staff had been trained in safeguarding vulnerable children and adults. The ambulance staff we spoke with demonstrated a good knowledge of abuse and what to do if they suspected abuse was happening.

The provider had appropriate recruitment and selection procedures in place. References were sought and backgrounds were checked to ensure people were of good character.

The provider monitored the quality of service it provided. Service user surveys were conducted every six months, audits were conducted and complaints were dealt with appropriately.

We spoke with three people who use Alpha Care for patient transport or event cover. They told us that the staff were “fantastic” and “very professional”. One person said they were “100% involved” in the transport of their family member and that their family member was “relaxed and confident” with Alpha Care staff.

People who used the service and staff members told us that the office staff made sure that all the information about patient and event requirements was correct. This meant that correctly qualified staff and the right equipment were allocated to each job.

There was a clear infection control policy which we saw was followed. Vehicles were clean and precautions were taken to minimise the risk of cross contamination.

There was an effective assessing and monitoring tool in place.