Grange Farm is operated by Ikon Ambulance Services Ltd. Grange Farm supplies paramedics, emergency technicians, first responders, and first aiders to provide first aid cover and patient transport services (PTS) at organised sporting and public events such as stock car racing, horse shows, and agricultural shows amongst others.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 July 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 PTS. Where our findings on Grange Farm for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the PTS core service.

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:

• The ambulance we inspected was visibly clean, staff completed daily records of hygiene routines and ambulance inspections. Staff maintained consumables and stock to ensure stock was in date and fit for purpose.

• The registered manager ensured that policies and procedures were up to date and reviewed in line with set review dates.

• The online electronic event management system was effective and enabled the registered manager to allocate staff and resources in line with specific event risk assessments.

• Staff stored patient report forms securely within the ambulance and the ambulance station. In the main, staff completed patient report forms to a good standard. The registered manager reviewed these for themes, trends, and took appropriate action where staff failed to complete these appropriately.

• Staff maintained the ambulance station, office, and storage areas to ensure they were visibly clean and safe from any trip or fall hazards. Within the ambulance station, clear signage was in place warning staff of the dangers in relation to COSHH (Control of Substances Hazardous to Health Regulations 2002) and other key health and safety issues.

• Medication was stored and maintained appropriately. The registered manager was in the process of implementing a new medications policy and updating existing patient group directions (PGD) at the time of our inspection.

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

• We found three small oxygen cylinders stored within the main ambulance station, secured against the wall with a metal chain and pad lock, on the floor, on a small metal tray at the side of an ambulance. Ideally these cylinders should be sited away from any sources of heat or ignition, have warning notices posted prohibiting smoking and naked lights within the vicinity of the store and be secure enough to prevent theft and misuse (British Overseas Chemical (BOC) guidance).

• The registered manager did not ensure that staff received appropriate disclosure and barring scheme (DBS) checks, in line with DBS guidance.

• The registered manager did not maintain a risk register or overarching quality assurance and governance system to measure the performance of the service or manage any risks associated with the safe operation of the service.

Following this inspection, we told the provider that it should take some actions to comply with the regulations. Details are at the end of the report.

Name of signatory

Heidi Smoult

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