In-Pulse Ambulance Service Limited is an independent ambulance company, based in Lewes offering event medical cover and patient transport services across the South East of England.

In England, the law makes event organisers responsible for ensuring safety at the event is maintained, which means that event medical cover comes under the remit of the Health & Safety Executive. The activities at In-Pulse Medical Services regulated by the CQC are; transport services, diagnostic and screening procedures and the treatment of disease, disorder or injury.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 8 August 2017 and did not carry out an unannounced 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?

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:

• Aside from checklists there was no evidence that the provider monitored safety.

• There was no evidence that staff had received an appropriate level of safeguarding training.

• We did not see evidence of up to date mandatory training.

• Not all staff had a disclosure and barring service (DBS) certificate in place.

• The provider did not keep records of patient journeys and was therefore unable to accurately evidence the volume of work undertaken or the timeliness of the service.

• There was little or no governance of the service, with limited knowledge of what constitutes an incident or near miss, no formal risk register and no version control on service policies.

• The provider had not reported any incidents or near misses in the past 12 months indicating that staff may not be aware of their role and responsibilities around this.

• Policies did not reference national guidance and therefore there was a risk these did not reflect current best practice.

• Feedback forms were only given to patients on one day of the week, therefore the service may not be getting a full picture of the patient experience of the service.

• We saw minutes from team meetings, however these occurred sporadically and there was no set schedule for when these occurred.

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

• The ambulances were clean, serviceable and well maintained.

• Patient comments about the service were positive about the care they had received.

• Staff we spoke with described that they felt supported, both inside and outside of work.

• The service had received no complaints in the last 12 months and no complaints came directly to the CQC regarding ths service.

• The service utilised online engagement with the public by having social media and web pages displaying information and opportunities to contact the service.

In addition, the provider also reacted promptly in response to the following issues raised:

• The fire extinguishers on the vehicles had not been serviced, however following the inspection we saw evidence that new fire extinguishers had been purchased.

• Several pieces of equipment had not been calibrated or serviced, and following the inspection we saw that the provider had promptly booked these items in for servicing and calibration.

Following this inspection, we told the provider that it must take action to comply with the regulations and that it should make other recommended improvements. We issued the provider with a requirement notice. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

People experienced safe and appropriate care that met their needs and protected their rights.

We found there were process and procedures in place to protect people from receiving ineffective or unsafe care. We contacted the service commissioners who gave us positive feedback about the service In Pulse provided. An example of the comments provided was “I’ve never had any problems” and “They are very good at communication”. Staff told us that they were happy in their jobs and “enjoyed going that extra mile for people”. One staff member told us “We deliver quality care that we would like our own parents to receive” and “We all enjoy patient contact and doing a good job”. The people who used the service were also very complimentary about the standard of care and staff team at In Pulse. Comments included "Really professional" and "friendly and caring staff".

There were effective systems in place to reduce the risk and spread of infection. The provider had systems in place to monitor the cleanliness of vehicles.

The service ensured that medicines were handled safely and securely and appropriately stored.

People who used the service were protected from harm and unsafe or unsuitable equipment because there was a system in place to monitor and provide regular maintenance.

The service had adequate recruitment processes in place to ensure that people were safe and their health and welfare needs were met by staff that were fit and adequately qualified. We found that staff had the relevant pre-employment checks in place before commencing employment.

The provider ensured that people benefited from safe quality care, because there were systems in place to monitor the quality of the service that people received. There were also systems in place to manage the risks to people and staff that worked at or visited the service.

People who used the service received care that took account of their mobility, age, religious persuasions, racial and cultural backgrounds and acknowledged and accommodated any disabilities.

We spoke with seven members of staff, organisations that commissioned services on behalf of people and reviewed feedback mechanisms that the provider had in place to gain the views of people that used the service. When we analysed the results of these we found that people reported that they had received care in clean, well maintained vehicles by professional, trained and caring staff. Among the comments we received were “The staff were wonderful and it was good to be going home with such a caring crew”. When we spoke to commissioners of this service they told us “This is an extremely professional service offering specialist bariatric transport and they are always reliable and professional”.

We found that the provider employed well trained staff who were supervised, supported and undertook an annual appraisal. People were transported in vehicles and supported with equipment that was maintained in a safe and clean condition. Medications were managed and stored safely and in accordance with the provider’s policy

There were systems in place to manage and respond to incidents, accidents and complaints. Staff were knowledgeable about how to deal with complaints and incidents and referred to the policy and the reporting process to be adopted.