Hearts First Aid Training Limited, trading as Hearts First Ambulance Service provides repatriation services and patient transport services on an ad hoc basis.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on the 5 July 2017, along with a further unannounced visit to the service on the 17 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.

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:

• All vehicles were of a high standard and maintained regularly by a reputable company. They were designed specifically in mind for the specifications of the services work.

• The compliance manager had commenced new processes and procedures since being in post from May 2017.

• Policies that were in place gave clear instructions for staff on their roles and responsibilities. Most of these were largely based on national guidance and recommendations.

• We saw that each member of staff completed local induction training on commencing employment within the service. The compliance manager or director would supervise the induction process.

• Staff completed training appropriate to their roles, responsibilities and the needs of the service.

• Staff had completed Mental Capacity Act training and were aware of their roles and responsibilities in ensuring consent and escalating concerns.

• Staff had received safeguarding training for children, level 2 and 3. There was a lead for safeguarding, who had completed level 4. We were given an example of a safeguarding referral they were currently referring and were assured of their processes.

• Facilities were appropriate to the needs of the service. Ambulances were secure.

• There was a clear vehicle maintenance log, which included MOTs and required vehicle services.

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

• Recruitment processes need to be more robust to ensure that legal compliance and consistency is maintained for all candidates.

• There was no framework in place for the service to describe its governance arrangements. We found that reporting arrangements to ensure effective information sharing were weak.

• There were no formal arrangements for clinical staff to receive annual appraisals.

• There was no formal risk register or similar tool used.

• There was not an accompanying policy to inform staff what type of incident to report or what would be done once a report was received.

• The service had no formal policy or guidelines for the transfer of patients living with dementia or a learning disability.

• There were new policies in place, however, these were not clearly dated when created or when they were for review.

• There was no formal audit process or audit calendar in place, although we saw some evidence of audits that had commenced from June 2017.

• The service did not have a patient group direction for all necessary medicines used within the service. Staff had not all received competency checks for medicines administration.

• There was no process to monitor temperatures in the vehicles where medications were permanently stored.

• Mental Capacity Act training compliance for staff was at 66%.

• The service did not formally record any details of one to one discussions with staff or clinical supervision.

• There were no formal team meetings.

• The service did not have a formal vision or strategy.

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

Edward Baker

Chief Inspector of Hospitals (Central Region)