MR Emergency Medical Services Ltd is operated by MR Emergency Medical Services Ltd. The small service provides emergency and urgent care to patients requiring care and treatment from an event to a hospital setting. The nominated individual for the company and the registered manager were the same person. They were also the only director of the company.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 31 July 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 how the provider understood and complied with the Mental Capacity Act 2005.

The service provided by this provider was emergency and urgent care.

We regulate independent ambulance services and have a legal duty to rate them. However, we did not rate ‘effective’ and caring’ because of the lack of evidence. 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:

• The safeguarding policy did not reflect elements relating to female genital mutilation (FGM), modern slavery or the risk of being drawn into terrorist activity.
• Equipment checks did not relate to what we found on inspection.

• No contracts were in place for disposal of clinical waste or sharps and a review of the organisation’s policy relating to the management of health records was required.

• There was no contract in place with a reputable medical gas provider.
• Annual checks on oxygen piping and servicing of some items of equipment were not in evidence.
• A child harness for secure transportation of children was not available.
• The acquisition, management and audit of medicines were not robust.
• Staff had not received dementia awareness training.
• The risk register did not reflect the risks we observed during the inspection.
• Policies did not always reflect processes within the organisation. They were not easy to read for staff and did not have a review date in place.
• Minutes were not available of staff meetings.

However, we found the following areas of good practice:

• All staff were trained to level three in safeguarding adults and children.
• Staff assessed patients, and used clinical protocols to inform clinical decisions and safe administration of medicines as laid down in the Joint Royal Colleges Ambulance Liaison Committee guidance for pre-hospital care.
• All equipment appeared visibly clean with cleaning equipment available to use during an event.
• Equipment was available for both adults and children with medicines and medical gases stored safely.
• An incident reporting policy was in place and the manager understood the duty of candour regulation.
• The registered manager, a registered nurse with experience in emergency care provided guidance on the most effective care for patients,
• An effective staff recruitment and induction was in place.
• The service had a clear vision underpinned by patient-centred values with a registered manager who was approachable and available.
• A whistle-blowing policy was in place to support staff to raise concerns without retribution.

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. The registered manager had begun to address the concerns outlined in the report and provided dates for completion. However, further work was still required to address the outstanding concerns which the provider was still working towards. We issued the provider with one requirement notice that affected urgent and emergency care. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central), on behalf of the Chief Inspector of Hospitals