Lifestar Medical Limited is a small, family run, independent ambulance service, based in Cornwall but providing some services out of the county. Lifestar Medical Services has one depot in Truro, Cornwall.

The service provided includes patient transport for admissions/discharges and hospital appointments, long distance repatriation, organ and surgical team support, holiday transport for clients with mobility issues, neonatal transfers, high dependency/ITU transfers, specialist bariatric transfers and event cover.

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.

Lifestar Medical Limited is registered with CQC to provide the regulated activities of:

• Patient transport services and triage and medical advice provided remotely
• Treatment of disease, disorder or injury.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 25 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?

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 saw that:

• Incidents and complaints were well managed, staff were aware of the duty of candour and the need to be ‘open and honest’ regarding incidents.
• There were reliable systems to keep patients and staff safe and safeguard them from abuse and avoidable harm. All records were stored securely to ensure patient confidentiality.
• Staff training was provided to enable staff to be competent in their roles and staff were provided with timely appraisals and learning opportunities. There was a sufficient skill mix and level of staff to meet the needs of patients. Bookings were reviewed to ensure the appropriate assessment and planning of care took place to meet patients’ needs.
• Staff records showed a high level of attendance at training; however, no overview was available to ensure any gaps in training were identified. This was planned to be put in place. Appraisals had been completed for all staff. Supervision of staff was ongoing, but as an informal process.
• Cleanliness and infection control prevention for the environment, vehicles and equipment was in place and monitored by the infection control lead.
• During the inspection we were not able to observe any patient journeys or direct care but noted staff spoke in a caring and insightful way of patients in their care. Consideration of the patient and staff needs was undertaken when planning patient journeys, both locally and nationally. Feedback from people who use the service, those who are close to them and stakeholders were consistently positive about the way staff treated people.
• Through staff interviews and observations we saw there was good leadership of the service from the managing director and the registered manager. The provider had introduced a system to obtain patient experience feedback of their journey. This development was in its infancy but was being supported with staff involvement.

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 one requirement notice that included several areas of medicine practice. Details are at the end of the report.

We found the following issues that the service provider needs to improve:

• Some aspects of medicines practice required further attention to ensure patients were not at risk. These areas included the provider not having the correct licence in place for the storage of controlled drugs. Further areas for improvement included storage of oxygen and medical gases and the lack of patient group directions (PGDs) for patient medicine administration. The recording of controlled drugs was in place but two full signatures for each controlled drug administration were not being recorded. Some first aid items such as dressings were noted to be out of date and thus no longer suitable for use.
• Following the inspection the managing director has confirmed that an application to obtain a licence from the Secretary of State for the storage of controlled drugs is underway. He has also updated CQC with his continued efforts to arrange Patient Group Directions (PGDs).
• A management overview of aspects of safety was not undertaken to ensure that all of the processes in place were being completed. These areas included cleaning of vehicles, equipment checks in vehicles, management of clinical waste and used linen and overviews of staff training.
• Not all paramedic staff dealing clinically with patients had level 3 safeguarding training. The provider confirmed this will be addressed.
• Policies were not referenced to National Institute for Health and Care Excellence (NICE) or The UK Ambulance Services Clinical Practice Guidelines 2016 to ensure they followed national guidelines.
• There were no audit outcomes of key performance indicators such as times of collection of patients and the monitoring of delays and aborted journeys. Data about the services provided was available, but the provider did not work towards any key performance indicators.
• Data and information was gathered but the provider was not using this to measure the quality of the service. Audit of aspects of service were not undertaken to identify the service’s strengths and areas for further development.
• Risk management was not recorded to identify how risks were measured and monitored. No risk registers were in place.

Professor Edward Baker

Chief Inspector of Hospitals

We visited the office of Lifestar Medical Limited and met with the registered manager, and a member of the management team. Following our inspection we spoke with three members of staff who worked for the organisation.

We did not have an opportunity to meet with people who used the service because people did not visit the office as treatment and support was provided in transit in ambulances.

Care and treatment was planned and delivered in a way to ensure people's safety and welfare.

People were protected from the risk of infection because appropriate guidance had been followed.

People were protected from unsafe or unsuitable equipment.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Due to the nature of the service we were unable to speak directly with many people who used the ambulance service. However, we spoke with one relative who had accessed the service and reviewed six ‘feedback forms’. Comments included, “the level of care is superb”, “I can’t thank them enough”, and “very courteous and helpful”.

As part of the inspection process we visited the organisations office in Truro, Cornwall, spoke with the registered manager, and spoke with three members of staff who worked for the organisation.

We spoke with the patient facilities manager for the local NHS hospital trust. We received positive feedback, and were told that “there was a positive relationship and a good rapport” with the organisation and that they had no concerns.

We found that people’s privacy, dignity and independence were respected and appropriate checks were undertaken before staff began work.

However, we found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There was not an effective complaints system available.