Pulseline Ambulance Services provides patient transport services (PTS) to local NHS trusts and provides privately funded PTS on request.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 5 March 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 Events work.

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 areas of good practice:

• Staff completed mandatory training on induction day and then annually. All PTS staff (100%) had completed mandatory training.

• We saw robust recruitment processes were in place to ensure suitable staff were appointed safely.

• The provider had an effective system in place to ensure vehicles were re-stocked, faulty equipment was brought to their attention, and that staff had clear lines of responsibility for the cleaning of vehicles.

• The provider shared information with local NHS hospitals to ensure plans were in place in the event of a major incident.

• Staff knew how to recognise and respond to signs of abuse, and report a safeguarding disclosure. All staff (100%) had completed safeguarding adults and safeguarding children level 2 and level 3 training.

• The vehicles we inspected were visibly clean and fit for purpose. The provider had processes in place to manage cleanliness and there was evidence of appropriate waste segregation.

• Staff described a positive working culture and a focus on team working. Staff told us they could approach the manager or supervisor at any time to report concerns.

• The provider encouraged staff to seek feedback from patients. The feedback we reviewed was positive including comments about the professionalism of staff. The provider had not received any complaints since they had registered with the commission.

• The provider had some governance processes in place, for example staff appraisal, monitoring staff disclosure and barring service (DBS) compliance, and monitoring staff training.

However, we also found the following issues that the service provider needs to improve:

• We were not assured staff could define an incident or knew when to report them. No incidents had been reported since the provider had registered with the commission.

• The provider had some governance processes in place such as the monitoring of staff appraisals, training and competencies. Not all governance processes were in place however, such as environmental audits, infection prevention and control (IPC) audits, and patient transport record audits.

• The provider had policies and procedures in place however, they were not all service specific which meant they did not always direct staff to follow correct processes.

• The provider did not have a documented policy and procedure for staff to follow in the event of a deteriorating patient.

• The provider did not always ensure patient records were stored safely and securely at all times. The provider took immediate action to resolve the concern following our inspection.

• The provider did not have a risk register or a process to review and mitigate presenting risks to the business in a consistent way.

• The provider did not always store chemical products in line with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) requirements. The provider took immediate action to resolve this at the time of our inspection.

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. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals