The Colin Sully Centre is operated by Devon Ambulance and First Aid Services CIC and provides a patient transport service. Devon Ambulance and First Aid Services is a Community Interest Company owned by Devon Essential Medical Services, a Registered Charity. They provide an event ambulance service, specifically where there is an actual or identified need to provide off-site transportation to a local hospital. In addition, Devon Ambulance and First Aid Services CIC provide a limited planned patient transport service either using a two-man ambulance crew or single person wheelchair accessible vehicle. All staff who worked for the organisation are volunteers who do this in their spare time.

We initially inspected Devon Ambulance and First Aid Services CIC on the 14 November 2017. During that inspection we had concerns about the safety of service users. Following the inspection, we took enforcement action and issued two warning notices. These included concerns about safe recruitment procedures for new staff and governance arrangements to monitor service provision. We also issued four requirement notices. These included; the lack of comprehensive assessment of patients’ needs for the planned transport service, no incident reporting system, no maintenance and servicing of equipment, infection control procedures and no on-going appraisal system for staff.

On 21 February 2018, the registered manager sent us an action plan outlining the actions they had taken, and planned to take, to improve the areas of concern we identified. On the basis of this, we carried out a focused inspection on 17 April 2018. This inspection was only focused on the areas of concern reported in the warning notices and requirement notices.

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 who required safeguarding training at level two for adults and children had or were due to attend courses provided by the local county council.
• Processes to identify and demonstrate the service was assessing the risk of infection, taking action to prevent, detect and control the spread of infections had been implemented.
• The maintenance and use of equipment kept patients safe. All equipment was up to date with their servicing and maintenance.
• A new comprehensive risk assessment document had been developed for people who were going to use the planned transport service. Risk management plans would then be developed to make sure their needs could be met during the journey (no planned patient transport had been undertaken since our last inspection).
• A new recruitment and selection policy had been introduced to make sure new staff were suitable for their role.
• Arrangements for reviewing and investigating incidents when things went wrong had been implemented.
• Structures, processes and systems of accountability to support the delivery of the strategy, good quality care and sustainable services had been developed.

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

• The new recruitment application form did not have enough room for proposed staff to fill in details about previous employment history.
• The updated recruitment policy needed to be amended to make sure the references they obtained with information about new staff is kept.
• Risks to the service provision were not documented and therefore could not be kept under review.

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 one requirement notice that affected patient transport. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief Inspector of Hospitals

The Colin Sully Centre is operated by Devon Ambulance and First Aid Services CIC. They provide a patient transport service. Devon Ambulance and First Aid Services is a Community Interest Company owned by Devon EMS, a Registered Charity, which provides an event ambulance service, specifically where there is an actual or identified need to provide off-site transportation. In addition, Devon Ambulance and First Aid Services provides a limited patient transport service either using a two-man ambulance crew or single person wheelchair accessible vehicle. All staff who work for this organisation are volunteers who do this in their spare time.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection 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 issues that the service provider needs to improve:

• An incident reporting procedure was not in place which meant they were not able to monitor, investigate and learn from any untoward incidents. Following our inspection the registered manager sent us a copy of their new incident reporting policy and procedure which included a copy of the incident reporting form to be used. This was going to be shared with staff.

• Equipment on the ambulances was not up to date with servicing and there were no records of ongoing maintenance. Immediately following the inspection the registered manager notified us they were in the process of addressing this and none of the ambulances would be used until the equipment had been serviced.

• A thorough assessment of the patients’ needs for the planned transport service was not undertaken or recorded.

• All vehicles used by the service were not clean, therefore there was a risk of cross infection. The cleaning products used on the ambulances and the wheelchair car did not meet national guidance to prevent the risks of cross infection.

• The service was not recording or asking for details about infection control risks associated with patients to prevent and control the spread of infection for the planned transport service.

• Staff had received safeguarding training for both adults and children but the registered manager was not able to tell us at what level this training was (levels one to three, with three being the highest level of training).

• There were no effective systems in place to be able to assess and monitor the service in terms of quality, safety, performance and risk.

• Not all staff had received their yearly appraisals to formally monitor their competence to carry out their role.

• A suitable recruitment procedure to safeguard patients against unsuitable staff was not in place.

Following this inspection, we told the provider 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 four requirement notices and two warning notices that affected safe and well-led. Details are at the end of the report.

We found the following areas of good practice:

• All staff including the registered manager and directors were volunteers and undertook this work around their other commitments, for example full time jobs. The work they carried out for the service was unpaid.

• The company was set up to help the local communities provide first aid cover at reduced costs, to enable smaller events so they could go ahead.

• Staff were up to date with the mandatory training needed to meet the demands and needs of the service.

• A clinical waste contract was in place with an external provider to make sure it was disposed of correctly. Clinical waste was also stored securely to prevent unauthorised access.

• All vehicles were serviced and maintained with access to a breakdown service.

• Patient records from the unplanned events transfers were very detailed and contained assessments of the patient’s condition.

• A member of staff from the planned patient transport told us they made sure all patients arrived in plenty of time for their health care appointments.

• Staff had weekly training sessions which included scenarios, for example using a spinal board.

• Staff told us that as this work was voluntary, they would not stay if it was not a supportive and enjoyable place to work.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)