Archived: Plymouth Central Ambulance Service

During this inspection we spoke with seven members of staff including the registered provider. We spoke with family members of two people who used the service, both of whom expressed their satisfaction of the service. We looked at care plans for children using the service and reviewed the organisation's records. We looked at six sets of recruitment and training records for members of staff.

We found that since the inspection on 2 September 2014 the provider had taken action to comply with concerns raised regarding care and welfare, cleanliness and infection control, management of medicines, safety and suitability of premises, safety, availability and suitability of equipment.

We found areas of concern around the recruitment and the support offered to staff. The recruitment of staff was not sufficiently robust to protect people who used the service. Staff were not provided with appropriate supervision or training to ensure they were trained and competent to carry out their roles.

A quality monitoring system had been introduced to seek the views of people who used the service.

We evidenced the provider had implemented systems to demonstrate the service was safe and vehicles and equipment were fit for purpose at all times.

Staff appraisals had been commenced for all members of staff, although these did not always reflect information contained within their personnel files.

During this inspection we spoke with four members of staff including the registered provider. On this occasion we did not speak directly to any people using the service, but we read letters from people who had written to the provider to express their thanks and appreciation for the service they had received. We looked at the two care plans for children using the service and reviewed the organisation's records. We looked at three sets of recruitment and training records for members of staff. We reviewed how the organisation monitored the quality of its service including infection control records and incident reporting.

We found areas of concern around care planning, infection control, management of equipment and the environment, medicines' management, recruitment and management of staff, and how the service was monitored to ensure a good quality service was being provided.

For this visit we spoke to three of the 12 ambulance crew, looked at records and the provider showed us the arrangements in place at the service to protect patient safety. We did not contact any people who use the service on this occasion due to the reason for the inspection and the type of service provided.

We found that there were very thorough systems in place to protect patients, and ambulance crew, from cross contamination. Infection control had been researched, staff trained and policies and procedures were in place.

We found that there were robust arrangements for the recruitment of suitable staff and ambulance crew said they were happy with their induction training.

We found that there were systems in place to decide what level of ambulance crew was required for patient transfers. There were arrangements for the replacement of ambulance crew should unforeseen circumstance make a journey longer than expected. Ambulance crew told us that they were happy with the staffing arrangements. Their comments included: "There is overtime there if you want it but you do not have to". "You would have a double crew if there was to be a long drive and you could tell the supervisor and swop over if it became too long". And, "It's all fine. We swap over driver if necessary. I have no concerns."

The premises were clean and there were measures in place to prevent cross contamination. However, there were no risk assessment or policies in place toward infection control. The premises (which includes vehicles) was fit for purpose and there were continuing upgrades toward improvement.

Staff recruitment arrangements had improved in that this was better organised but the provider, for a second time, had not ensured that checks were completed so that a decision could be made as to whether potential staff were safe to work with vulnerable groups of people. However, those who it was felt were unsuitable following interview had been rejected. A new staff member told us how supportive the provider and other staff had been.

We did not have an opportunity to meet with people who used the service because people did not visit the office and treatment was provided in transit in the ambulances. We viewed a questionnaire that a person had completed and we read a letter sent to the service. Comments included "I am writing to say what a wonderful, caring, professional crew you have ... I was so grateful for such careful driving and exceptional care."

We spoke with a representative of an organisation that contracted work on a regular basis with the service. This person spoke positively about the service provided and said that the service was well organised and responsive to requests. They told us that the staff team always behaved in a courteous and professional manner.

We found that the premises and vehicles were suitable and safe and that equipment was maintained to ensure its safety. The records we saw were up to date and well ordered. However the provider did not have a Statement of Purpose to provide to any interested parties.

We found that the staff recruitment procedures were not effective as they did not ensure that staff were of good character and had the skills and experience for the work.