SNP Medical Ltd is operated by Mr Nicholas Stefan Pridden. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 October 2017 and 1 November 2017 along with an unannounced visit on 14 November 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 areas of good practice:

• Staff knew about the duty of candour and their roles and responsibilities of being open and transparent when things went wrong.

• Staff demonstrated infection control practices in line with organisational policies. Staff used personal protective equipment, and we saw vehicles and equipment were visibly clean.

• We inspected three vehicles. All vehicles had appropriate equipment and all equipment on the ambulances had been electrically tested, checked and maintained.

• The provider stored records securely and we observed staff comprehensively completed patient report forms.

• Staff knew their responsibilities regarding safeguarding children and vulnerable adults.

• The provider used evidence-based guidance to inform staff practice and procedures. For example, staff procedures around needle stick injuries, using personal protective equipment and cleaning chemicals.

• Staff assessed any care requirements prior to patient journeys by communicating with staff from other providers. Staff asked about pain management prior to transporting the patient.

• We saw good communication and working with other patient transport providers and NHS hospital staff.

• The provider checked staff driving licenses and ensured all staff had a valid disclosure and barring service (DBS) check and therefore legally able to undertake their role.

• Staff received training on the mental capacity act (MCA) and dementia. Staff understood their roles and responsibilities concerning patient consent.

• Staff described and demonstrated their passion for providing good patient care.

• We observed positive interactions and relationships with patients. Staff displayed a supportive attitude and used encouragement and praise when supporting patients to move.

• Staff communicated with patients in a way that enabled patients to understand what was happening.

• Staff involved patients in what was happening, explaining and providing opportunities for questions.

• We observed staff reassuring patients and communicating in a meaningful manner to alleviate fears patients may have had.

• The service was flexible and was designed and delivered to meet patients and other provider’s needs.

• Staff identified individual needs of patients. Staff treated patients on a case-by-case basis and said they would ensure patients were comfortable and meet any of their particular needs.

• Staff used a communication book to communicate with patients living with dementia, learning disabilities and patients with speech impairments.

• We saw a positive patient-centred culture. Staff were happy working for the provider and said they felt supported.

• The provider had a customer charter, which demonstrated a commitment to values centred on treating people with respect and recognising their needs.

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

• Staff did not always report incidents in accordance with the incident reporting policy.

• The provider did not record, investigate or retain incidents meaning there was insufficient oversight to assess and monitor risks.

• The provider did not assure us that staff had received appropriate training in manual handling and paediatric basic life support.

• Staff did not demonstrate knowledge of storing medical gases in ambulances..

• Staff did not receive regular meetings or support during their induction period.

• The provider did not have any materials available in other languages.

• There was not an effective system for the managing and handling of complaints with the provider had not documenting a complaint investigation in detail.

• The provider did not have a vision or strategy for the service and staff we spoke with did not know in what direction the organisation was heading.

• The provider did not audit or collect information regarding staff or organisational performance.

• The provider did not effectively monitor or manage risk. The provider had not reviewed risk assessments since 2015 and some were not relevant to current service provision.

• The provider had not tailored all policies to the organisation and some did not explain clearly what staff should do, how they should do it, and when they should do it.

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 two requirement notices that affected patient transport services. Details are at the end of the report.

Importantly, the provider must take action to ensure compliance with regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Heidi Smoult

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