Ambuserv Limited is operated by Ambuserv and provides an ad hoc patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 February 2017 along with an unannounced visit to the service on 2 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 areas of good practice:

• Managers documented and investigated all incidents.
• Vehicles and equipment were visibly clean, maintained and fit for purpose.
• Staff had knowledge of consent and their role in relation to patient records.
• Staff received induction training appropriate to their role.
• Based on the information from the primary contractor, staff assessed all patients prior to transport.
• All staff received annual appraisals and first aid updates.
• Communication was maintained with patients, hospitals and control centres.
• Staff were caring, considerate and respectful of both patients and family members or carers.
• Staff demonstrated a good awareness of the emotional impact of journeys on all concerned.
• Seating and ambulance entry was flexible according to patient’s needs.
• Patients transported were clinically stable prior to transfer.
• Primary contractors told us that they received positive feedback about the service from patients.
• The service had a vision to be an expanding organisation with staff on fixed contracts.
• Team members respected leaders and felt included in decisions made.
• Staff were proud to work for Ambuserv and wanted to make a difference for patients.
• Staff told us they were not afraid to raise concerns due to the small nature of the team.

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

• The service did not have an incident reporting or duty of candour procedure in place and staff were not aware of the regulation.
• At the time of inspection, the service did not perform cleaning audits to assure themselves the effectiveness of the cleaning. However, since inspection, staff told us these had been included in delivery audits.
• Staff did not receive safeguarding children training or training around the Mental Capacity Act (2005) code of practice or Deprivation of Liberty Safeguards. Following our inspection, the provider had sourced an external training organisation to deliver safeguarding training to staff. The provider also confirmed staff signed the safeguarding children and vulnerable adults policy to confirm they had read and understood it.
• Staff maintaining medical equipment had not received formal training to perform the tasks.
• The service did not have their own language aids for people who did not speak English as their first language. However, since inspection, the service provided smart phones for staff to use for translation purposes via an electronic application.
• A formal employment process was not in place. Character or employment references were not sought. However, following the announced inspection the provider told us they changed this process to include at least two references.

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 four requirement notice(s) that affected Patient transport services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals