The Care Quality Commission
  • Ambulance service

Primary Ambulance Services Limited - Operations Centre Also known as Primary Ambulance Services

Overall: Inadequate read more about inspection ratings

Little Mollands Farm, Mollands Lane, South Ockendon, Essex, RM15 6RX

Provided and run by:
Primary Ambulance Services Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

21 June 2022

During an inspection looking at part of the service

Primary Ambulance Services Limited - Operations Centre is operated by Primary Ambulance Services Ltd. The service opened in 2009. It is an independent ambulance service based in South Ockenden, Essex providing patient transport services to the public and private sector. The service primarily serves the communities of the London and Essex area.

The service is registered to provide the following regulated activity:

  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder or injury

We inspected the service using our focused inspection methodology.

The service was previously inspected in May 2022. As a result of this inspection we took urgent action to suspend the registration of the provider, scheduled to end on 22 June 2022. This inspection was a focused follow up inspection to review if all areas of concern had been resolved and the risk of harm to patients had been removed. We did not rate the service at this inspection.

As a result of this inspection, concerns had been rectified and a decision was made not to extend the notice of decision, under Section 31 of the Health and Social Care Act 2008, to suspend the service. Therefore, the provider was able to continue regulated activities following this inspection.

10/05/2022

During an inspection looking at part of the service

Our rating of this location stayed the same. We rated it as inadequate because:

  • Managers did not monitor mandatory training and did not alert staff when they needed to update their training. The service could not provide assurance it controlled infection risk consistently well. There were limited systems and processes in place to ensure regular cleaning of ambulance vehicles and equipment. The service still had limited processes in place to manage patient safety incidents. We could not gain assurances that staff and managers effectively recognised incidents, reported and investigated them appropriately.
  • Managers did not monitor agreed response times or the effectiveness of the service. Managers did not appraise staff’s work performance or hold supervision meetings with them to provide support and development.
  • Leaders did not have the skills and abilities to run the service consistently. Leaders did not understand and manage the priorities and issues the service faced, there were gaps in safety management. The service had no written vision or strategy. Leaders still did not operate an effective governance process. Systems in place to manage performance effectively were not in place or not fully embedded. Managers did not identify and escalate all relevant risks and issues, nor identify actions to reduce their impact. The service did not collect reliable data or perform analysis to help improve the service.

However:

  • The service had now introduced a mandatory training programme for all staff which was an improvement from our last inspection.

25/01/2022

During a routine inspection

Our rating of this location went down. We rated it as inadequate because:

  • Staff did not receive and keep up to date with their mandatory training. Managers did not monitor mandatory training and did not alert staff when they needed to update their training. Staff did not receive training specific for their role on how to recognise and report abuse. The service could not provide assurance it controlled infection risk consistently well. There were limited systems and processes in place to ensure regular maintenance of ambulance vehicles and equipment. The service still had limited processes in place to manage patient safety incidents. We could not gain assurances that staff and managers effectively recognised incidents, reported and investigated them appropriately.
  • There was no evidence that the service provided care and treatment based on national guidance and evidence-based practice. Managers did not check to make sure staff followed guidance. Managers did not monitor agreed response times or the effectiveness of the service. Managers did not make sure staff were competent for their roles nor appraise staff’s work performance or hold supervision meetings with them to provide support and development.
  • Leaders did not have the skills and abilities to run the service consistently. While they understood and managed the priorities and issues the service faced, there were gaps in safety management. The service had no written vision or strategy. Leaders did not operate effective governance processes. Systems were not in place to manage performance effectively. Managers did not identify and escalate relevant risks and issues, nor identify actions to reduce their impact. The service did not collect reliable data or perform analysis.

However:

  • Staff told us they treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
  • The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it.

11 and 26 April 2019

During a routine inspection

Primary Ambulance Services is operated by Primary Ambulance Services Limited. The service provides a patient transport service. This service registered with the Care Quality Commission (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 types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC regulates the patient transport service and treatment of disease, disorder and injury service provided by Primary Ambulance Services. The other services provided are not regulated by CQC as they do not fall into the CQC scope of regulation. The areas of Primary Ambulance service that we do not regulate are events cover.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of the inspection on 11 April 2019 and an unannounced visit to the service on the 26 April 2019.

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.

We rated the service as Requires improvement overall because;

  • The provider was failing to effectively assess and prevent the risk of an injury. The non-slip mat on the ramp of one ambulance was ripped and ruched, which presented as a slip/trip hazard for both patients and staff members.

  • The provider was failing to effectively assess and prevent the risk of the spread of infection. There were small tears in two ambulance seats. They were not able to be cleaned effectively and presented an infection control risk. There was a liquid stain on one of the stretcher straps, which was a potential infection control risk.

  • There was a lack of understanding of what constituted as an incident. Managers and staff told us they had not had any incidents within the reporting period April 2018 to March 2019. On the day of the inspection we were told of an incident that they had not reported, as the provider did not think this had constituted as an incident. We were not assured that the incident reporting process was embedded, although staff we spoke with told us that they had received incident reporting training.

  • Safeguarding concerns were raised by staff with the appropriate authorities but were not reported to CQC. Therefore, we were not assured that the provider understood the process for submitting a safeguarding statutory notification to CQC. Registered providers must notify CQC about certain changes, events and incidents that affect their service or the people who use it. This was not taking place at the time of our inspection.

  • There were some systems in place to monitor vehicle servicing and maintenance. This had been identified as a concern at the service’s previous inspection in March 2017 and a warning notice had been issued.

  • There were limited systems and processes in place to ensure the monitoring and oversight of consumables and equipment as we found a number of consumables were out of expiry date.

  • The provider did not undertake staff appraisals. We were told that informal meetings took place, but these were not documented. Therefore, we were not assured that the provider had the systems and processes in place to effectively assess staff competencies.

  • The provider had limited governance systems and processes in place. They had little oversight of risk or how to identify risks and manage them. The risk register had several identified risks; however, they were not reviewed regularly, did not contain descriptions of the risk, harm ratings or the person responsible for managing the risk.

However:

  • Both ambulance vehicles had a current MOT and were taxed.

  • Feedback from patients and relatives was consistently positive.

  • The service had an inclusion and exclusion policy.

  • The service provided a personalised service.

  • Staffing was sufficient to meet the patients’ needs and was planned in advance.

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 three requirement notices that affected Patient Transport Services. Details are at the end of the report.

Nigel Achieson

Deputy Chief Inspector of Hospitals

29 March and 6 April 2017

During a routine inspection

Primary Ambulance Services Ltd is operated by Primary Ambulance Services Ltd. 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 29 March 2017, along with an unannounced visit to the provider on 6 April 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:

  • The service did not have any systems or processes in place for the reporting, investigating and sharing of learning around incidents. Incidents were not recognised. Staff had not received training in incident reporting.

  • There was no process in place for the deep cleaning of vehicles to prevent the spread of infection.

  • There was no system in place to monitor vehicle servicing and maintenance. There was no audit to ensure that vehicle daily checks were being completed accurately. We found faulty equipment in vehicles, which posed a risk to staff and patients.

  • We were unable to gain assurances that staff had received the necessary mandatory training to carry out their roles safely and effectively.

  • There was no contemporaneous record of decisions taken in relation to the care and treatment provided to patients by the service.

  • Processes to assess patient eligibility were lacking. There were no inclusion or exclusion criteria in place.

  • There was a lack of oversight of staff compliance with mandatory training. There was no appraisal process to assess staff competencies. There was a lack of regular and documented staff engagement.

  • The service had weak governance systems and poor oversight of risk.

    However, we found the following areas of good practice:

  • Vehicles contained personal protective equipment for staff.

  • All vehicles had an up to date MOT and tax.

  • Staffing was sufficient to meet patient need and was planned in advance.

  • Patient feedback was consistently positive.

  • The service was planned and delivered to meet the individual needs of local people.

  • Staff described management as approachable and supportive. They reported feeling valued in their role and felt that the service was a positive place to work.

    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 section 29 Warning Notice that affected patient transport service. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

25 November 2013

During an inspection looking at part of the service

We previously inspected Primary Care Ambulance service in July 2013. At that inspection we raised minor concerns regarding the robustness of recruitment checking practices to ensure that appropriately qualified competent staff were employed. We also had minor concerns regarding the lack of quality monitoring systems in place to ensure the service provided to people was of a good standard.

We went back to the headquarters for Primary Ambulance Care services on the 25 November 2013 and found that appropriate actions had been taken to ensure all recruitment checks were actioned before anybody started work at the service. We found that additional quality monitoring systems had been put in place to monitor the levels of service provided including a patient survey. We saw positive quotes from recent customers in the last three months such as, 'outstanding service' 'extremely helpful, polite professional staff.' All the completed surveys seen noted that they would recommend the service to family and friends.

15 July 2013

During a routine inspection

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. They were provided with appropriate information about Primary Ambulance Services to show that people's privacy, dignity and independence were respected.

We saw that people experienced care and support that met their needs and protected their rights. Systems were in place so people were protected against the identifiable risk of acquiring infections.

Developments were needed regarding recruitment checks to ensure that staff were screened appropriately prior to employment.

We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.