The Care Quality Commission
  • Ambulance service

Archived: EMC Medical Services - Blewbury

Overall: Requires improvement read more about inspection ratings

Downside Farm, Woodway Road, Blewbury, Didcot, Oxfordshire, OX11 9EX 0845 003 5663

Provided and run by:
EMC Medical Services Limited

Important: The provider of this service changed. See new profile

All Inspections

2 March 2020

During a routine inspection

EMC Medical Services Blewbury is operated by EMC Medical Services Limited. The service predominantly provides patient transport services on an when required basis for local authorities, private patients and NHS trusts. EMC Medical Services Blewbury also provides event cover. However, we do not currently regulate event medical cover. A small proportion of the service’s activity was the transfer of patients from events sites to hospital. This activity is regulated by us.  We inspected this service using our comprehensive inspection methodology. We carried out the announced (24 hours’ notice) part of the inspection on 2 March 2020.

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.

The main service provided was patient transport services. Where our findings on patient transport services – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the patient transport service level.

We rated it as Requires improvement overall.

  • There were limited governance systems to improve service quality and maintain high standards of care.

  • The provider did not have an effective system in place to identify, limit and control clinical and non-clinical risks. The managers were able to identify several risks. However, there was limited evidence to demonstrate the managers identified all service risks including some we identified during our inspection.

  • The recruitment records did not provide assurance that all staff had the required employment checks completed before they commenced work.

  • Most staff understood how to protect patients from abuse. However, the managers were unsure of who the safeguarding lead was.

  • Although medicines were stored securely, the patient group direction did not include pharmacist sign off and medicine storage temperatures were not monitored.

However:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The provider controlled infection risk well. Staff assessed risks to patients and acted on them.

  • Managers made sure staff were competent for their roles.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

  • Staff were focused on the needs of patients receiving care. The provider engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

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 four requirement notices that affected both patient transport and emergency and urgent care services. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South) on behalf of the Chief Inspector of Hospitals

6 November - 16 November 2018

During a routine inspection

EMC Medical Services-Blewbury is operated by EMC Medical Services Limited and was registered with the Care Quality Commission (CQC) on 15 May 2011. It is an independent ambulance service provider based in Blewbury, Oxfordshire. The service provides patient transport services (PTS), first aid, medical training, event medical cover, fire, and health and safety training. The provider is registered to provide the regulated activities: transport services, triage and medical advice provided remotely; treatment of disease, disorder and injury; and diagnostic and screening procedures. The patient transport service was staffed by ambulance care assistants and operates twenty-three hours a day, five days a week and on Saturdays 10am to 8pm.

We inspected the patient transport service using our comprehensive inspection methodology. We carried out an unannounced inspection on 6 November 2018 and a further announced visit on 16 November 2018.

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.

The provider had made significant steps towards improvement since the inspection in 2016, to address the areas of poor practice identified in the CQC report (9 January 2017). A registered manager had been in post since 18 August 2017 and was introducing systems and improvements to governance.

Our rating of this ambulance service as Good overall.

We found the following areas of good practice:

  • The staff had a clear ethos of putting the patient first and caring for them in a professional and compassionate manner.
  • EMC Medical Services had a multidisciplinary approach and worked well with the acute NHS hospitals and the acute ambulance service.
  • The staff were responsive and applied their knowledge, experience and common sense to find practical solutions to the day to day challenges they faced.
  • The service provided mandatory training in key skills to all staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well. Ambulances and equipment were visibly clean. They consistently followed good infection control practice.
  • The service had enough staff, with the right qualifications and skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  •  The service took account of patients’ individual needs.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

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

  • There was no clear audit program to monitor the quality and effectiveness of the service. We were unable to interrogate the risk register to gain assurance all identified risks were captured, mitigated and reviewed.
  • Staff informed us while they saw and knew the registered manager, they did not often see the directors.
  • Some staff did not have a form of personal identification such as a name badge.
  • Not all staff were happy with the induction they had received and felt that it had been kept to a minimum.
  • While staff talked about being open and honest they did not all demonstrate an understanding of the term and requirement of duty of candour. Significant improvement had been made in duty of candour training in the last year, however there had been inconsistent delivery of the material.
  • Although EMC Medical Services had a number of contingencies including spare devices and WIFI access in areas of poor signal. Staff were using their own phones as a back up to personal digital assistants (PDAs) as they were unaware of this contingency.
  • The wall-mounted glove storage system on the new ambulances, was not secure and there was no evidence of any remedial action although staff had reported this as a safety concern.
  • There was no system for the safe storage of waste on the vehicles.
  • There was no system for the management of information with out of date paper copies of policies in the office and risk assessment on the internet.

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 been breached, to help the service improve.

Nigel Acheson

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

15 September 2016 and unannounced on 27 September 2016

During a routine inspection

EMC Medical Services Limited - Blewbury is part of EMC Medical Services Limited. It is an independent ambulance service provider based in Blewbury, Oxfordshire. The service provides patient transport, event medical services, first aid training and ambulance aid training. We inspected patient transport and event medical services. Services are staffed by trained paramedics, ambulance technicians and ambulance care assistants. The service has a contract with a local NHS hospital trust and provides services on request from a local NHS ambulance trust.

We carried out a scheduled comprehensive inspection on 15 September 2016 and an unannounced inspection on 27 September 2016. .

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and areas that service providers need to improve.

Our key findings were as follows:

  • The service had a system in place for reporting and recording incidents. Staff knew how to keep patients safe through incident reporting, incidents were reported, investigated and learnt from.
  • Services were planned and delivered in a way that met the needs of the local population. The service took into account the needs of different people, such as bariatric patients or people whose first language was not English, and journeys were planned based upon their requirements.
  • The service had a system for handling, managing and monitoring complaints and concerns. Public engagement mechanisms were in place in the form of patient experience feedback forms. The service had a duty of candour policy. However, there was no duty of candour training for staff.
  • Staff had a strong focus on providing a caring and compassionate service. We observed staff acting in professional and respectful ways when engaging with patients and their families.
  • Staff felt valued by their peers and managers and reported high levels of support. The managers organised social events for the staff which helped with team bonding and cohesiveness. However, we found there were no structured meetings to share learning from incidents or changes to practices
  • We observed good hand hygiene, clean and well maintained vehicles. However, we were not assured that the vehicles were being deep cleaned to a satisfactory standard.
  • We found concerns regarding the governance and strategic risk management processes of the service.There were no effective governance arrangements in place to evaluate the quality of the service or to improve delivery.
  • There was no formal risk register in place at the time of the inspection and therefore we had no assurance that risks were being tracked, managed or mitigated. However, since the inspection we have been provided with a risk register.
  • A vision and strategy for the service had not been developed.
  • The service had not had a CQC registered manager in post for over six months. They had submitted an application but remained unregistered.

However, there were also areas of poor practice where the location needs to make improvements.

Importantly, the location must:

  • Implement robust systems to assess, monitor and improve the quality and safety of the services provided.
  • Develop a vision and strategy for the service and ensure this is embedded across the organisation.
  • Ensure systems and processes are in place to implement the statutory obligations of duty of candour.
  • Ensure a manager for the regulated activity is registered with the Care Quality Commission.
  • Store oxygen and medicines safely and securely, preventing a risk to others.
  • Notify the Care Quality Commission of both safeguarding incidents and incidents if they occur which affects the running of the service as required by Health and Social Care Act.

In addition the location should:

  • Ensure hand held communication systems for staff are in a useable condition and available for use.
  • Review its process for operational issues within a strategic overview or central risk register.
  • Ensure all staff are trained and understand the duty of candour.

Professor Sir Mike Richards

Chief Inspector of Hospitals

5 December 2013

During a routine inspection

On the day of our visit the service had nine vehicles and 30 ambulance staff on call to deliver services. The service mainly provided emergency medical cover at events.

We spoke with two people who used the service. Both spoke very highly of EMC Medical. One said 'I let them know what we need and they accommodate every time. I tell them what we plan to do and we discuss the appropriate medical cover". Another said "I have used them for events for some years now. They are very good". Both people we spoke with told us they felt involved in the service EMC Medical provided.

We spoke with two ambulance staff who told us they liked working for the service and felt well trained to do their job. We asked them about safeguarding children and vulnerable adults. Both staff demonstrated a good knowledge of abuse and what to do if they suspected abuse was happening. Training records confirmed all ambulance staff had been appropriately trained. This meant people were safe from the risk of abuse.

The provider had appropriate recruitment and selection procedures in place. Background checks were conducted and references were sought. Ambulance staff also received an induction programme of training. Ambulance staff also declared they were fit to carry out their job.

The provider monitored the quality of service it provided. The opinions of people who used the service were sought and complaints and comments acted upon.

28 January 2013

During a routine inspection

EMC Medical services provides a range medical cover from first aiders to paramedics at events. They are also registered to provide transport. At the time of our inspection this aspect of the service was in development.

The provider had a range of vehicles to ensure that they always had appropriate transportation for patient transport services and for manoeuvring around event sites. We looked at one of the ambulances and saw that it was fully stocked with appropriate equipment. It had also been deep cleaned and each part tagged to state what had been cleaned and when.

People were informed of the treatment suitable for their injuries and given appropriate advice. Good, clear records of both patient transport and event treatments were kept.

Correct numbers of appropriately qualified staff were available for each patient transport request or event. This was driven by a comprehensive risk assessment and communications with the event organisers.

Staff members had received a variety of training including safeguarding and Mental Capacity Act courses. They were ale to demonstrate a good understanding of abuse issues.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.