Personal Security Service is a patient transport service operated by Personal Security Service Ltd.

We carried out an unannounced inspection on 22 June 2017 to follow up on our previous concerns about the service. This report looks specifically at those concerns and so does not cover all of the areas of our comprehensive inspection methodology.

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 had previously carried out an unannounced inspection on 20 February 2017, along with an announced visit to the service on 21 February and 2 March 2017.

During the earlier inspection we identified the following concerns where the provider was in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

• We found there was no incident reporting system.
• Safeguarding training was not to the recommended level as per national guidance.
• The provider did not operate a safe recruitment process and there were no assurances staff were safe to work with vulnerable patients.
• We were not assured that the mandatory training was sufficient to ensure staff competence.
• There was no auditing of infection prevention and control practice and hand hygiene amongst staff when transporting patients.
• Records of patients and staff were not secured properly.
• There were no records to show vehicles were maintained on a regular basis.
• There was no dedicated training offered around supporting those with dementia or learning difficulties and there was no support for patients with communication difficulties or who did not speak English.

Following the inspection, we urgently suspended the service from carrying out any regulated activities. We told the provider that it must take actions to comply with the regulations. We returned to the service on 19 April 2017 to review what actions had been taken by the provider to respond to CQC’s concerns about the governance of the service. As a result of improvements made the suspension of the service ended at midnight on 21 April 2017.

We carried out this unannounced inspection of the service on 22 June 2017 to review progress made in accordance with the action plan which the provider submitted to CQC following the last inspection.

We found that the provider had made significant improvement on the concerns listed above. We also found the following concerns that the service provider needs to improve:

• Incidents were not logged on the electronic incident recording system.
• The auditing process was inconsistent.
• Not all managers had access to the IT system

As a result of which we issued a warning notice under Regulation 17, (1) (2) (a) (b) (f), Good governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We told the provider that they must be compliant with this regulation by 31 July 2017.

Professor Ted Baker

Chief Inspector of Hospitals

At the last inspection of the service in September 2013 we found that the provider did not have a system for regularly seeking the views of patients which meant the provider could not be assured about the standard of care provided during patient journeys. Systems in place to check the accuracy of patient journey records had failed to identify discrepancies and gaps.

Following the inspection the provider wrote to us explaining the changes they were making to ensure the quality assurance system included the views of patients and staff using the service. We undertook this inspection to check whether the necessary improvements had been made.

At the current inspection we found that a system for obtaining the views of patients and staff accompanying them on patient journeys had been introduced. Feedback from patients showed they were positive about their levels of comfort on the ambulance journey and they were satisfied with the way they were cared for by ambulance drivers and escorts.

We visited the service on 9 October and 24 October 2013. We were not able to speak with any patients who had used the service as there were none available at the time of our visits. We spoke with the manager and three drivers and were shown a vehicle used to transport patients.

We found that most records maintained by the service were accurate, although there were a few gaps in recording, and they were securely stored. Assessments of risks were made for each patient’s journey and most of these were recorded. The means of transporting the patient and number of staff accompanying them were based on the risk assessment. Arrangements were in place to provide meals and drinks to patients as well as comfort stops during longer journeys, although the offer of meals was not always recorded.

Drivers were provided with cleaning materials and knew how to dispose of waste safely. Appropriate standards of cleanliness and hygiene for patient transport vehicles were specified and vehicles were checked regularly. Staff received training that enabled them to transport patients safely.

However, although there was a system in place to assess and monitor the quality of service provided this was not always effective. The service did not regularly seek the views of patients in order to be sure the standard of care provided was safe and appropriate.

Personal Security Service is operated by Personal Security Service Limited. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 20 February 2017, along with an announced visit to the service on 21 February and 2 March 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 issues that the service provider needs to improve:

• We found there was no incident reporting system and no records maintained of any incidents.
• Safeguarding training was not to the recommended level as per national guidance. All staff should be trained to level two safeguarding training and the safeguarding lead to level three.
• We were not assured that the mandatory training was sufficient to ensure staff competence.
• There were no records to show vehicles were maintained on a regular basis.
• There was a general lack of understanding of Duty of Candour amongst all staff.
• There was no auditing of infection prevention and control practice and hand hygiene amongst staff when transporting patients.
• Records of patients and staff were not secured properly.
• The provider did not operate a safe recruitment process.
• There was no supervision or appraisal system in place.
• Staff understanding of the Mental Capacity Act and consent was varied.
• There was no system in place to monitor complaints and any recurring themes. There was no log kept of complaints.
• No support was available during journeys for patients with communication difficulties or who did not speak English.
• There was no dedicated training offered around supporting those with dementia or learning difficulties.
• There was no written vison or strategy for the service.
• There was no risk register in place.
• Disclosure and Barring Services (DBS) checks were not being completed appropriately and there were no assurances staff were safe to work with vulnerable patients.
• There was a lack of clarity about the role of the safeguarding lead and safeguarding training was not to the required levels.

Following this inspection, we urgently suspended the service from carrying out any regulated activities. We told the provider that it must take actions to comply with the regulations. Details are at the end of the report.

We returned to the service on 19 April 2017 to review what actions had been taken by the provider to respond to CQC’s concerns about the governance of the service. As a result of improvements made the suspension of the service ended at midnight on 21 April 2017.

Professor Sir Mike Richards

Chief Inspector of Hospitals