We carried out a focused unannounced inspection on 24 May 2016 to follow up on the service’s actions to address concerns found on the last inspection in December 2015. As this was a focused inspection, we did not inspect every key line of enquiry under the three key questions we inspected (safe, effective and well led). We have not rated the three key questions inspected. Whilst improvements had been made in a number of areas, further work was required to demonstrate full compliance with some of the breaches of regulations identified at the last inspection. The regulations that were breached during the last inspection were regulations 12, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014).

On this inspection, we found that the service demonstrated compliance with regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Are services safe at this service

During the last inspection, there were serious concerns that care and treatment were not being provided in a safe way for patients. During this inspection, we found:

• Generally, some improvements had been made to address some of the safety concerns that had been identified at the last inspection.
• Policies and procedures within the service generally had improved and were relevant for the staff groups employed.
• The service generally had an appropriate understanding of safeguarding vulnerable adults and children, and had a policy and procedure surrounding this.
• Medicines management had improved and all medicines were kept securely.
• Equipment storage and suitability had been reviewed and all items of single use equipment were in date and stored correctly on vehicles.
• Environmental risk assessments, including fire safety, had now been completed by the service.
• Oxygen storage facilities had improved since our previous inspection, and that all cylinders were appropriately stored.

Some concerns raised during our previous inspection had not been fully resolved including:

• Not all vehicles were secure meaning there was a risk of tampering to equipment contained within them. The premises where vehicles were stored was secure.
• Infection control concerns were still apparent within some vehicles, including dirty surfaces and open clinical waste storage. Deep clean procedures were not always timely.
• Regular audits were not undertaken and therefore learning did not take place from review of procedures and practice.
• There was no assurance that vehicle repairs and maintenance were carried out by suitably qualified staff.
• Whilst staff within the service had attended some appropriate mandatory training for their role, not all staff had had the required level of mandatory training.
• Not all patients using the service had had a robust risk assessment completed.

Are services effective at this service

During the last inspection, there were concerns that there were not systems in place to ensure staff were suitable, experienced and competent for their role. During this inspection we found:

• Recruitment procedures had improved to ensure that competent and experienced clinical staff were employed by the service to care for patients. However, there were not effective processes in place for ensuring non-clinical staff were suitable for their role.

However, some concerns raised during our last inspection had not been fully resolved including:

• There were no systems in place to ensure staff were suitably appraised or received clinical supervision.
• There were not effective processes in place for ensuring non-clinical staff were suitable for their role.

Are services caring at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services responsive at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services well led at this service

During our last inspection, we had significant concerns regarding the governance and risk management processes within the service. During this inspection, we found that:

• Several new policies and procedures had been put into place to support staff in their role.

However, some concerns raised during our previous inspection had not been fully resolved including:

• There were not effective, robust systems in place to assess, review and monitor risks

within the service. An audit process was not in place to allow oversight of quality and safety within the service.

• There was still no registered manager or nominated individual in place to ensure regulatory oversight of the service.
• The policy for safeguarding adults and children did not provide staff with clear guidance on how to make a referral and to whom.

The service must take action to ensure that:

• Robust governance and risk management systems are in place and understood by all staff.
• Staff are supported in their roles by effective supervision and appraisal systems and ongoing training.
• Effective processes are in place for ensuring non-clinical staff are suitable for their role.
• Vehicles servicing and security must be maintained.
• Appropriate infection control procedures are in place to minimise the risk of acquired infections.
• Ensure that a registered manager is in place to provide regulatory oversight of the service.
• All staff receive appropriate mandatory training for their role.
• All patients’ using the service have a risk assessment completed to identify any potential risks to their health and safety.

Importantly, the provider must take action to ensure compliance with regulations 7, 12, 15, 18, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We carried out a focused unannounced inspection on 22 December 2015 to review the service’s arrangements for the safe transport and treatment of patients as we received information of concern about this service. As this was a focused inspection, we did not inspect every key line of enquiry under the three key questions we inspected (safe, effective and well led).

Are services safe at this service

There were serious concerns that care and treatment was not being provided in a safe way for patients.

We found numerous items of equipment throughout the service that had not been serviced or calibrated to ensure its safe and accurate use. Disposable equipment items in both the store room and on vehicles were past their expiration dates.

Not all vehicles had had regular servicing to ensure they were safe for use.

Vehicles and the equipment inside these were not secure. We found that 11 vehicles were open and unlocked, in the parking area of the premises, and that equipment, including defibrillators, oxygen cylinders, airways equipment and first aid and dressing packs were all accessible and at risk of being tampered with.

Medication was not stored properly and there was no medication policy to outline arrangements for its storage, administration or disposal.

Arrangements for safeguarding vulnerable adults and children were not adequate. There was a lack of safeguarding training to ensure staff were aware of their responsibilities. There was a risk therefore that staff would not be able to recognise and report potential safeguarding concerns.

There were no environmental and infection control audits to ensure the safety of patients and staff. Internal areas of all vehicles were not visibly clean.

Staff had not had the required mandatory training including moving and handling, infection control, health and safety, and administration of medicines.

Oxygen cylinders and chemicals hazardous to health were not being stored safely. We asked staff to take immediate action regarding this.

There was a lack of appropriate environmental and fire safety risks assessments in place.

Are services effective at this service

There were no systems in place to ensure staff were suitably appraised or received clinical supervision.

There was no evidence of an induction policy or process within the service.

Are services caring at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services responsive at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services well led at this service

We found serious concerns regarding the governance and risk management processes of the service. There were no effective governance arrangements in place to evaluate the quality of the service and improve delivery.

There were minimal documented guidelines or policies for staff to follow. The management team had not taken sufficient measures to identify, assess and manage risks throughout all aspects of the service.

We found that the service did not have recruitment procedures in place to ensure that all staff were appointed following a robust check of their suitability and experience for the role, together with robust pre-employment checks having been carried out.

The service had not informed us that the nominated individual and registered manager no longer worked for the service. This meant there was no one in place to take regulatory responsibility for the health services being provided.

We identified poor practice where the provider needs to make improvements. We also informed other agencies, including the local fire safety officer, the Health and safety Executive and the police regarding some of the concerns that we found during this inspection.

The service must take action to ensure that:

• Robust governance and risk management systems are in place and understood by all staff.
• The service has effective and current policies in place that are understood by all staff.
• Recruitment processes are in place so all staff employed have the experience and competence required for their role, together with robust pre-employment checks having been carried out.
• Staff are supported in their roles by effective supervision and appraisal systems and ongoing training.
• Medicines are stored and administered to ensure there are no risks to patients.
• All equipment is fit for use and required checks and maintenance is carried out.
• Vehicles and premises security must be maintained.
• Appropriate infection control procedures are in place to minimise the risk of acquired infections.
• Robust safeguarding adults and children procedures are in place and understood by all staff.
• Ensure any changes to the individuals registered for the service are notified to CQC.

Importantly, the provider must take action to ensure compliance with regulations 12, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014). On this basis, the registered provider had conditions placed on their registration to ensure safe working practices and that patients were protected.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We spoke with a member of the public who had used the service to transport their relative; they told us that “our request was very last minute but all the staff communicated with me well and kept me informed about everything”. The service was brilliant; the staff were all very helpful and did exactly what was needed”.

We saw two complimentary emails that had been sent to the service from patients who had used the service; one patient stated “An ambulance was sent out to me when I became unwell, two lovely men came out to me and made me feel a lot better, I wanted to say thank you to them as they made me smile and cheered me up”.

We also spoke with an event management provider who told us that the staff provide a very good service and they are always very helpful”.

We also spoke with a manager from a private hospital and a representative from a private air ambulance service, they told us that they were satisfied with the service provided and that they had not received any complaints. They also told us that they would know who to contact if they had any concerns.

We spoke with two people who had used this service; they told us they were very pleased with the service that they received. On person said “the staff were very professional in the way that they explained everything”. Another person said “because we organise sporting events participants often have accidents and can sustain injuries. We find that the staff always respond appropriately, they talk to people, reassure them and explain what they need to do to help them”.

We also spoke with two hospital managers; they told us that they were satisfied with the service provided. One manager told us “they are very, very good with our patients they communicate well so that people understand what they are being asked to do and are able to co-operate and provide their consent to be supported”.

Both of the hospital managers told us that they thought that the ambulance staff had the right skills to care for people during their transportation. One of the managers said “the ambulance staff are excellent; they always accommodate our needs and keep us informed”.

However we found that the provider was not meeting the government standard in relation to Outcome 12, Requirements relating to workers.