The Limes Training Centre is operated by Mr Nigel Owen Singleton. The service mainly provides care and treatment within the confines of a public event site which is not a regulated activity. However, the provider does occasionally transport patients off site and as such requires registration with the Care Quality Commission. This regulated activity is reported under emergency and urgent care services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 January 2018 at the provider’s main headquarters location. We were unable to observe the delivery of the regulated activity during this inspection.

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.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service provides emergency and urgent care. It also provides first aid services at public events, which is not inspected by Care Quality Commission (CQC) because this falls outside of the scope of CQC registration.

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:

• There were no never events or serious incidents reported in this service between December 2016 and November 2017.
• Staff we spoke with had a good understanding about duty of candour.
• There was an effective system in place for staff to report safeguarding incidents, staff were knowledgeable, trained appropriately and had good access to designated professionals trained to level five in safeguarding and protection of vulnerable adults.

• Infection prevention and control processes were in place and equipment had been checked in line with the service policy.
• Staffing levels were planned, implemented and reviewed to ensure patients received safe care and treatment at all times.
• Emergency equipment was readily available, maintained and serviced.
• Staff assessed and responded appropriately to potential risks to patients. Staff had access to a ‘medical-prompt’ application on their mobile phones. This had been ‘custom built’ and provided guidance on for example, first aid, pain assessment and a rapid trauma assessment.
• There were effective processes in place for mandatory and additional training with very good opportunities for staff to access these.
• Services were planned and delivered in a way which met the needs of the events they covered.
• Staff we spoke with were positive about local leadership.
• Staff morale and culture was high and there was an obvious emphasis on staff engagement.
• Staff told us that managers were both visible and accessible and that they would have no concerns in raising any issues regarding the service.

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

• The reporting of incidents was low and the inspection team was not assured some incidents had been reported appropriately.

• Processes were not in place to manage the ongoing monitoring of a member of staff’s professional registration.

• Seven out of 25 members of self-employed staff did not have a valid Disclosure and Barring Service (DBS) check. DBS checks help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups, including children.

• In addition to the registered manager there were nine sub-contracted staff employed by the service, of these, only two had two references provided. This was not in line with the provider’s recruitment policy.
• Drivers had not been appropriately trained to drive under blue lights as reflected in the provider’s ‘Emergency Driving’ policy. The inspection team noted, however, driving under blue lights had not taken place in the year preceding this inspection.
• Information was not readily available for people who use the service to know how to make a complaint or raise concerns nor were processes in place to collect and/or monitor positive feedback.
• Practices at the service did not always follow the provider’s policies. For example, the ‘Compressed Gas’ policy stated gas cylinders should not be stored on vehicles when the vehicle was not in use. During our inspection oxygen cylinders were noted on the vehicles.

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 emergency and urgent care services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals