Secure Care UK Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question requires improvement. The service was in breach of legal regulation in relation to premises and equipment, and staffing. The service has made improvements and is no longer in breach of regulations. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely transport medicines. The service managed patient safety incidents well.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported all incidents that they should report. Leaders monitored and reviewed incident data in detail to learn from incidents. Between January and March 2025, there had been a total of 130 incidents reported by the service, with 115 relating to restraint monitoring. This was not a disproportionately high number of incidents as the service monitored all transport episodes where restraint was either planned or not planned to be used. This included reporting on the number of occasions where patients became agitated or aggressive, and the number of times and type of restraint used. The service demonstrated a culture of restraint avoidance, where physical restraint was undertaken only when necessary. In response to increased reporting of use of handcuffs, the service introduced an additional review process. This ensured each use was fully justified in line with agreed processes.

Staff understood the duty of candour. Staff and leaders were open and transparent and gave patients and families a full explanation if and when things went wrong. Patients were involved with the investigation process, and their experiences were taken seriously. Between January to March 2025, there were 2 incidents where leaders had undertaken duty of candour following patient complaint investigations. Following investigations, one patient reported their experience of care had improved.

However, some staff felt the learning culture was poor, where leaders did not ensure debriefs occurred following conveyances. Some staff felt when they had raised concerns, these had not been listened to. However, leaders were aware staff morale was negatively affected and were able to give examples of when and why this gap in expectations had occurred.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured all essential information about the patient was received to determine if the patient’s needs could safely be met. Staff understood how they contributed to a patient’s health and care journey. They involved other key stakeholders and escalated concerns within the service to ensure patients had a better experience of care. The service undertook monthly audits of patient records to monitor the quality of record keeping. Administrative and operational staff had a strong awareness of risks to patients and other staff. This meant care planning was detailed and considered the individual needs of patients.

External stakeholders spoke positively about the quality of shared care planning conversations. For patients with complex needs, such as bariatric patients, transport arrangements were booked in advance. This worked well to ensure the correct equipment and the right staff with the right skills were available to provide the care patients needed. The service shared information with external stakeholders to ensure teams at the transferring and receiving service were able to continuously monitor the wellbeing of the patient. External stakeholders told us they felt the behaviour monitoring handover system worked well. Quarterly performance reports showed patients usually finished their transport journey less anxious than at the start.

When the service was unable to provide the required transport, there were clear agreements to ensure an alternative local provider could do so. Service records between January and March 2025 showed 190 cancellations had occurred. Of these, 80 were cancelled once the transport crew had been deployed. The main reasons for cancellation were due to transport no longer being needed, schedule changes or patient refusal. Cancellations were investigated by the service, and leaders were assured they had occurred for appropriate reasons.

Leaders monitored driving safety by reviewing live tracking systems installed in transport vehicles. Driving safety was a key part of staff performance review. Between February and August 2025, leaders performed 81 random spot checks with staff at the service which included driving safety. This meant the service could be assured patients were being safely transported.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service ensured staff were trained to the correct level of safeguarding for children and adults. The compliance rate for training to safeguarding adults and children level 3 was 95% at the time of inspection. This meant staff recognised the signs of abuse and understood how to report safeguarding concerns.

Staff were strong advocates for their patients and passionate about ensuring they were protected from abuse and harm. Staff showed us how safeguarding concerns were reported on their electronic tablets. When safeguarding concerns were raised by staff, electronic systems immediately notified the service’s safeguarding leads. Leaders described how these safeguarding concerns were reviewed to submit safeguarding referrals to the appropriate local authorities. Leaders understood their legal obligation to contribute to counter terrorism, modern slavery and female genital mutilation mandatory reporting. There had been no incidences where they had needed to do this.

The service had undertaken limited transfers for children and young people as there was limited need for this. When these types of patients became known to the service, this was always escalated to safeguarding leads to ensure oversight. Between January and March 2025, the service had cared for 11 patients who were children and young people. Registered Mental Health Nurses supported all conveyances from the transferring to the receiving service. These staff were usually employed by the transferring organisation and provided an additional safety net to ensure patients were protected from harm. There were no safeguarding or serious incidents related to the transfer of children and young people.

External safeguarding teams gave positive feedback about the service’s learning culture, where staff and leaders took concerns seriously and were proactive in addressing these. The service engaged with external stakeholders to report safeguarding concerns when this was appropriate. There were 19 safeguarding referrals submitted by the service in 2024. Leaders noted 44% of these resulted in a local authority safeguarding referral. Although the service had not notified the Care Quality Commission of these incidents directly, these had been reported to us through their head office location. Leaders made improvements following inspection to improve the reporting process.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff avoided the use of restraint where possible. Call operators recorded individual patients’ needs to the electronic booking form when patients were referred to the service. Risk assessments were documented with information provided by the referring service and used to calculate how many mental health transport assistants and what type of vehicle was appropriate for the level of need. Risk assessment documents were highly detailed and covered areas such as escalation triggers, recommended de-escalation actions and other measures to safely manage patient care. This meant patients were more likely to have a better experience. Staff used risk assessments well to manage and prevent escalations of behaviour that might lead to unnecessary restraint.

Staff undertook dynamic risk assessments where the initial risk assessment did not reflect the changing need of patients. Incident records showed where transport journeys had been cancelled or altered due to this change. This meant patients and staff were protected from harm.

During the transport journey, staff regularly recorded care information at least once every 10 minutes to document how the patient was presenting, their behaviours and all actions taken if restraint was deemed necessary. We reviewed 6 records and found staff effectively de-escalated situations when patients were agitated. This prevented use of unnecessary restraint and enabled staff to calmly handover patient care to the receiving service.

Staff managed and prevented escalation of patient behaviours well, which reduced the number and severity of restrictive practice incidents. All staff received training which met the high standards for restraint reduction training set by the Restraint Reduction Network and demonstrated by the service’s British Institute of Learning Disabilities Association of Certified Training (Bild ACT) certification.

The service did not use chemical restraint or spit hoods on patients. Instead, staff used goggles to protect themselves and used less restrictive practices such as encouraging patients to wear face shields or face masks when needed.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Leaders ensured all transport vehicles associated with the service were safely managed. Maintenance records and audits showed the 11 transport vehicles were regularly serviced, had been checked daily at the start and end of shifts and had passed their annual vehicle inspections. This meant both staff and leaders could be assured vehicles were safe to use.

Each service location held an equipment register which tracked all transport equipment such as electronic tablets, Automated External Defibrillators (AEDs) and restraint equipment. This included details of when equipment was last serviced.

On the day of inspection, we checked the contents of 2 transport grab bags containing essential equipment. Both AEDs were labelled as requiring servicing by February 2025. Leaders said all the AEDs had recently been serviced due to a required software update, but the labelling had not been updated. We confirmed the service’s equipment register, risk register and servicing records, which showed leaders had ensured the faulty AEDs had been appropriately removed from use in February 2025 and concerns fully resolved by July 2025.

However, in one of the staff toilets, there was an unlabelled sharps box that was not safely secured despite containing sharps waste. There was no risk to patients as this was only accessed by staff. However, there was a potential safety hazard to staff accessing this area. Leaders had arranged for this to support a staff member’s needs, but it was no longer required. Following the inspection, leaders safely disposed of the sharps box.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service was challenged by several full-time staff vacancies, but leaders had reasonable strategies to resolve this. Staff reported 4 team leaders in post at the time of the inspection, instead of the expected 6. This had impacted on the service’s activity between January and March 2025 where external stakeholders had raised concerns about staffing levels impacting on availability of patient transport. Leaders were actively recruiting to fill both full time and bank positions, with new staff starting training in August 2025. Leaders were well informed about the challenges they faced with onboarding processes such as criminal records checks taking longer than expected. Performance reports showed how leaders had increased flexible working and overtime to mitigate this in the short term.

Training records showed staff had received regular training and yearly updates in line with the service’s own policy. All mandatory training modules met or exceeded the service’s minimum goal of 90% completion. All staff received an induction with between 1-5 days of training provided depending on level of experience. Leaders used a staged assessment programme to monitor whether new staff were progressing through set competencies at 7 meeting checkpoints through the 10-week induction period.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Some staff were observed with false nails or nail varnish which could impact on effectiveness of hand hygiene and was not in line with the service’s own policy. Following inspection, leaders addressed individual uniform policy non-compliance and made improvements to enforcement of uniform policy with staff in general.

In the equipment storeroom, we observed a recently serviced stretcher with tears in the material, exposing the porous padding material to air. This presented a potential infection prevention and control risk as the stretcher could not be easily cleaned. When this was raised with leaders, they arranged for the equipment to be repaired.

Leaders undertook infection prevention and control audits using a standardised workbook for ambulance sectors in line with the National Standards of Healthcare Cleanliness 2024. This included checks to make sure specified areas were clean and that daily, weekly, and deep cleans were completed. The audit record for March to June 2025 showed the overall ambulance audit compliance was 97%.

Vehicles appeared clean and well maintained. However, during the transport journey we attended on the day of inspection, we observed cleaning of high touch services was not undertaken between patients. When we raised this with leaders, they noted cleaning standards were appropriate for the level of infection risk for their service type. Additionally, there were already management plans for patients with high cross contamination risks. However, following the inspection, leaders implemented cleaning of all high touch areas between patients and enhanced processes for end of day cleaning in line with newly implemented national guidelines.

Staff were provided with a uniform, and the expectation was for staff to launder their uniforms at home. The service’s home laundering protocol was in line with Health Technical Memoranda (HTM) standards for decontamination of linen for health and social care.

On the day of inspection, staff had raised concerns with us about cleaning, following an incident where fleas were found in a transport vehicle following use. The service’s records showed the vehicle was removed from usage for 5 days, while staff and leaders undertook deep clean processes. This meant the service protected patients and staff from risk of harm.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The service had effective processes to ensure safe storage and transportation of medicines, when patients needed to carry medications. The service did not order, retain or administer medical gases and medicines. Medicines were stored in a sealed, tagged bag at the transferring service and documented in the patient care record and the service’s own transport of medications form. When the patient reached the recipient service, staff handed this over to the nurse in charge of the ward.

Patients who needed chemical restraint were always supervised by a trained registered mental health nurse provided by the transferring service. For patients who had received sedation in the 3 hours preceding transport, staff ensured patients were reviewed by the prescribing doctor as medically safe to travel and supervised by an appropriate registered nurse. When the transferring service could not support this, the service stipulated a mandatory 3 hour delay to ensure patients were safeguarded from harm.

Between April and September 2025, incident records showed 4 incidents relating to medicines. Staff followed processes to escalate and document transferring services’ use of sedative medications to control room staff, which meant patients were protected from risk of harm.