Reliance Secure Transportation Services

On this page

• 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

As we did not assess all quality statements and evidence categories in safe and therefore, we did not rate this key question. We assessed five quality statements and found that the provider did not always keep patients safe. We found the service had used an employee of another company, associated with the providers director, as an ambulance driver. They did not have the relevant background checks carried out or training in order to undertake the role. There was a lack of documentation around the cleaning and maintenance of vehicles and staff were not always aware vehicle logs should be completed.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Safe systems, pathways and transitions during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

The registered manager was the safeguarding lead and had received training as part of their role in the NHS and at this provider. The provider’s Safeguarding Adults Policy and Procedures 2023 state it is the responsibility of the safeguarding lead to ensure all staff were fully trained. Staff told us they had received safeguarding training. However, the training matrix we reviewed did not reflect this. It showed one of the three members of staff had not completed their safeguarding training at the time of the assessment. The registered manager told us staff were given 20 hours to complete training, but staff did not comply and complete the necessary training. At the time of the assessment the contract with the training provider used to deliver training including safeguarding training, had expired. The registered manager stated they were in the process of sourcing a new provider in order to compete outstanding training. There was no evidence when a new training provider would be appointed. Staff we spoke with understood their responsibilities around the Mental Capacity Act and safeguarding and knew the procedures to follow and how to access support. Following our assessment the registered manager told us all staff were compliant with their safeguarding training, however we did not see documented evidence of this training.

The provider had a safeguarding policy for adults and children. Both were in date and had a date review. They referenced national guidance and outlined a clear process for staff to follow. The policy did not outline what level training was expected for each role and it was not clear from training records what level of training had been completed. The registered manager told us the level of training was in line with requirements, but it was not clear what these requirements were and the registered manager could not clarify this.

The policy states, staff will not be allowed to provide any service in the form of a regulated activity before an enhanced disclosure baring service (DBS) check had been completed. However, staff and leaders told us an employee of the sister company had on occasion worked as a driver. They had not received safeguarding training and had not completed an enhanced DBS check. This meant the provider did not comply with their Safeguarding Adult Policy and Procedures 2023.

The registered manager told us safeguarding referrals would be discussed and learning shared with staff at supervision meetings and the quarterly board meeting. However, at the time of the assessment the provider had not made a safeguarding referral therefore there was no evidence these discussions and learning took place.

The service had an exclusion criterion which clearly showed patients they would not be able to transport, for example patients requiring a wheelchair, as they did not have vehicles suitable. Providers requesting transport from the service had to complete a conveyance form before a booking was confirmed by the service. This detailed the crew and type of vehicle required and included a risk matrix to assess the patient. It clearly stated the service could only accommodate fully mobile patients on their vehicles. However, not all staff were aware of this. A staff member told us they would carry a patient to the vehicle if they were unable to walk. This placed the patient at risk and was outside the level of service the provider stated they would provide. The conveyance form did not ask what other needs a patient might have, for example, whether a translator was required. Not all staff we spoke with knew how to access an interpreter if needed.

As part of our assessment, we looked at two vehicles, a secure and non-secure ambulance. The secure ambulance, used to transport mental health patients, did not have a ligature cutter onboard. Following our assessment the registered manager advised us the ligature cutter in the secure ambulance had been moved to where the fire extinguisher was stored. The service introduced a secure box in the vehicle where the ligature cutter is stored and is checked as part of a weekly audit.

There was a defibrillator for staff to use in an emergency, however it did not have pads to attach to a patient and no battery to charge the unit. This meant if the defibrillator was needed, it would not work putting patients’ safety at risk. Following our assessment the registered manager told us that staff had completed the daily check list confirming all equipment had been checked. This meant that the service could not be assured that all checklists had been completed correctly or equipment was safe to use.

Both vehicles had a basic first aid kit which included sick bowls, personal protective equipment and a body fluid clean up kit and a box to safely store any medications being transported with the patient.

The registered manager told us the vehicle fleet was leased and had 6 monthly maintenance checks by the lease holder. The maintenance records were requested but they were not available to review at the time of our assessment.

Staff did not complete a cleaning or equipment checklist of the vehicle before each shift. There was no record of any daily checks being carried out. These checks are important to ensure the vehicle and environment is safe to transport patients.

The registered manager told us they carried out audits of the expiry dates of equipment, however they were not able to provide a record of this.

At the time of our assessment the service employed two permanent members of staff and were in the process of recruiting more staff. The provider did not use agency staff. The registered manager told us they would not accept a booking if they did not have a crew available. Staff and leaders told us on occasions an untrained employee of a sister company, in the hospitality industry, worked as a driver as part of a two-person crew. The provider had not carried out the relevant background checks on this individual, the individual had not received relevant training and did not have experience working in the sector. The registered manager told us they would not use unvetted staff again. Following our onsite assessment, the registered manager provided evidence a DBS check had been carried out for this individual. Staff told us they received a full induction which included training and they felt confident in their knowledge and ability to transport service users safely. However, not all staff had completed their mandatory training. One employee had not completed 5 of 19 training modules. The contract with one of the training providers had expired and it was not clear when the member of staff would be able to complete this module of their mandatory training. The registered manager told us feedback from service users and other providers was used in supervision and team meetings to give staff the opportunity to learn. However, we did not see evidence of this as team meeting minutes were not provided when requested. Following our assessment, we received meeting minutes which showed that feedback from the providers stakeholders was discussed.

The provider’s Recruitment and Selection Policy was in date and referenced relevant legislation. It outlined what pre-employment checks were required.

We reviewed staff files as part of our assessment. We found the employee files for the two permanent members of staff contained DBS checks, references and records of training staff had undertaken. However, the provider did not have a staff file for the individual employed by the sister company who on occasion worked as a driver. This was in breach of their own policy.

We looked at two vehicles and both were visibly dirty. The non-secure ambulance had dirt across the dashboard and dust over the seat where a patient would sit. The passenger footwell at the front of the vehicle where the crew sat was covered in debris. The secure ambulance had mud on the floor and dirty footmarks on the seat.

The head office did not have a cleaning station in the vehicle parking area and staff did not have access to cleaning equipment. The Reliance Secure Transportation Service Vehicles Policy 2023 stated a poster should be displayed with the cleaning equipment to show colour coding for cleaning. The registered manager told us they were in the process off organising a cupboard for colour coded mops and controlled substances hazardous to health (COSHH). The provider did not have an area for clinical waste disposal, the registered manager told us they would use a sister company’s facilities who were a provider registered with the Care Quality Commission.

The Reliance Secure Transportation Service Vehicles Policy 2023 says each vehicle had its own deep cleaning passport stored in the vehicle as a log of the deep cleaning taking place monthly. At the time of the assessment, there was no record of the passport and staff we spoke with did not know what this was.

The registered manager told us staff were responsible for cleaning the vehicle after each use with cleaning equipment provided and this should be logged on the Vehicle’s Daily Inspection sheets. There were no records of these checks being carried out at the time of our assessment. However, staff told us they cleaned the vehicle after use using cleaning supplies provided.

Staff and leaders told us there was a contract in place for the vehicles to be deep cleaned weekly or as needed. The contractor would come to head office where the vehicles were parked. However, staff were not able to show us a formal contract in place for this arrangement or any audits.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.