Hardcore Medical & Ambulance Service is operated by Hardcore Medical & Ambulance Services Limited. The service provides an emergency and urgent care transport service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 21 August 2018.

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.

Hardcore Medical & Ambulance Service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service provides emergency and urgent care. It also provides first aid services at public events, which is not inspected by Care Quality Commission (CQC) because this falls outside of the scope of CQC registration.

Hardcore Medical & Ambulance Service registered with the Care Quality Commission in March 2017 and has not previously been inspected.

We rated this service as good overall. Our ratings were good for safe, effective, caring, responsive and well led.

We found the following areas of good practice:

• The service had a positive safety culture. Incidents were reported appropriately and lessons learned shared throughout the team.
• Staff received effective training in safety systems, processes and practices. Mandatory training compliance was at 95% and staff had good access to additional training relevant to their role.
• Infection prevention and control (IPC) was given sufficient priority. Audit results demonstrated areas were clean and staff adhered to IPC practices.
• Staff used recognised tools when monitoring patients for signs of deteriorating health and assessed patients against Joint Royal Colleges Ambulance Liaison Committee (JRCALC) protocols.
• Nurses, a pharmacist and doctors were available as part of the service to act as clinical experts and were a source of support and information for all staff.
• Individual care records were written and managed in a way that kept patient’s safe. Records were clear and complete, dated, timed and signed and followed Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.
• The service had patient group directions (PGDs) in place to enable qualified nurses to administer medications in a timely manner.
• Policies, procedures and clinical guidelines were based on evidence-based best practice, national guidance and relevant legislation.
• Ambulance response times were consistently better than times stated in the Ambulance Response Programme (ARP) approved by the Secretary of State for Health in 2017.
• Without exception, online patient feedback was positive about the way they were treated by staff. Staff were described as "caring and non-judgemental". A relative, we spoke with, described the care as, "exceptional".
• The service had received no complaints, either formal or informal, since registration in March 2017.
• The operations and clinical director(s) had the skills, knowledge, experience and integrity that they needed to run the service.
• The culture of the service encouraged candour, openness and honesty, staff told us they felt supported, respected and valued and directors described their staff as their "greatest asset".
• The operations director had recently designed and introduced an online management application (App). The App, which was in the operational testing stage, provided the directors with an ‘all in one’ performance monitoring system that was accessible by any member of the team.

However, we also found:

• The service did not monitor the room temperature where medicines were stored.

Following this inspection, we told the provider that it should ensure action is taken to comply with the regulations. Details are at the end of the report.

Heidi Smoult

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