Aylburton Business Centre is operated by Outdoor Medical Solutions LTD. The service provided a non-emergency patient transport service. It also provided medical cover for events such as motor racing, festivals and film sets which we do not regulate. The service provided or intended to provide emergency and urgent care when patients were transported from events to urgent or emergency care providers. The service also carried out transfers between hospitals and between hospital and home where the patients sometimes required skills and competencies above that of basic first aid.

The main service provided was non-emergency patient transport services. Where arrangements were the same, we have reported findings in the non-emergency patient transport services section.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 29 March and 13 April 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.

The main service provided by this service was a non-emergency patient transport service. Where our findings on the emergency and urgent care service core service – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the non-emergency patient transport service. See the non-emergency patient transport service section for main findings.

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:

• Governance arrangements were not operated effectively so as to ensure that all quality, performance and risks were understood and managed. The service did not gather patient feedback, did not undertake clinical audit or audit other records such as vehicle cleaning checks or monitor and measure performance. The risk register was incomplete
• During the inspection the provider was not able to demonstrate that all staff had the skills, knowledge and experience to deliver effective care and treatment. There was not an effective process to monitor mandatory and statutory and other staff training because staff records were incomplete.
• There were no arrangements for appraising, supporting and supervising staff and managing their performance.
• Not all the systems and processes were in place to keep people safe and safeguarded from abuse. Not all staff had received safeguarding training and training for the registered manager was not comprehensive enough.
• Patients records were not always complete.
• Fabric on vehicle seats was damaged. One of the vehicles had small tears in the driver and passenger seats. Medical gas container bags were made of a material that was not easily cleaned which created an infection control risk from staff clothing.

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

• Staff understood their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally and externally.
• Other providers told us that the provider worked well with other agencies to investigate incidents and safeguarding concerns.
• Staff complied with key safety policies, for example, hand hygiene and use of personal protective equipment.
• Patients that used the service were treated with kindness, dignity, respect and compassion while they received transport, care and treatment. The provider took account of the needs of different patients and people close to them, including those in vulnerable circumstances. Patients’ and other’s concerns and complaints were listened and responded to and used to improve the quality of care.
• The maintenance of equipment kept people safe from avoidable harm and there were records kept of regular servicing.
• Patients were monitored during transport. The risks to patients who used the service were assessed and recorded on patient report forms.
• There was a comprehensive range of policies which supported practice in most key areas.

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 three requirement notice(s) that affected Outdoor Medical Solutions LTD. Details are at the end of the report.