The Care Quality Commission
  • Ambulance service

Alpha Care Ambulance Service

Overall: Requires improvement read more about inspection ratings

Unit FT2 1-3, Greenlands Rural Business Centre, Moulsford, Oxfordshire, OX10 9JT (01491) 652444

Provided and run by:
Alpha Care Ambulance Service Limited

All Inspections

23 November 2021

During a routine inspection

Our rating of this service stayed the same. We rated it as required improvement because:

  • The governance and leadership of the service did not fully protect the safety of the patients. There was no oversight of mandatory training compliance rates. Staff did not always have or had not completed all the relevant training. Governance meetings and supervisions were not held and safety information was not collected in order to improve the service. Policies and procedures were not evidenced as being understood by staff.
  • Governance and leadership of the service did not effectively manage performance. The service did not have a system to effectively manage risks or audit the quality of the service. Data was not used to make decisions and improvements. Leadership did not use monitoring of the service to support ongoing improvements which could potentially put patients at risk of avoidable harm.

However:

  • The service had enough staff to care for patients. The service-controlled infection risk well. People could access the service when they needed it.
  • Staff provided good care and treatment. Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. They provided emotional support to patients, families and carers. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

5 December 2019

During an inspection looking at part of the service

Alpha Care Ambulance Service is operated by Alpha Care Ambulance Service Limited. The service provides patient transport services.

This was a focused inspection to follow up on the breaches to the fundamental standards found at a comprehensive inspection in March 2019 when a warning notice was served. A warning notice informs the provider they are not compliant with the regulation and gives a time frame for improvements to be made. A warning notice was issued because the service was not consistently and effectively using audit to monitor and improve the quality and safety of the services it provided. There was no assurance risks were being adequately monitored and effectively managed.

We inspected this service using our comprehensive inspection methodology in March 2019 where we rated the service as requires improvement. The issues found in March 2019 included;

  • The service provided mandatory training in key skills to all staff however, not everyone had completed it.

  • There was no assurance that the service had full oversight of its medicine service and required further advice in relation to the licence of controlled drugs.

  • The service provided care and treatment based on national guidance, however, there were no assurances that staff had read and understood policies.

  • Information about patient’s care and treatment was not routinely collected and monitored.

  • The service had poor completion and recording of appraisals and supervision.

  • The service had limited systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

  • The service did not have a schedule for auditing, audits that were scored were not used correctly or followed up. There was no infection control audit.

  • Managers had organised training for their personal development. However, at the time of inspection only the operation manager had completed three out of 10 topics.

  • Managers did not ensure staff had appropriate reference checks or mitigation if references were not provided.

As this was a focused follow up inspection we have not rated the service. At this inspection we found the provider had made improvements since we last inspected in March 2019.

  • The service provided mandatory training in key skills to all staff and ensured staff completed the training.

  • The managers had identified and completed their own personal development training.

  • All staff had signed company policies to indicate they had read and understood them.

  • Staff files contained the required information to assist the employer in assessing their character, qualification, competence, skills and experience in relation to the role they were employed to undertake.

  • All staff had received a current appraisal.

  • There was a system to monitor and manage performance. Staff identified and escalated relevant risks and issues and identified actions to reduce their impact.

However;

  • The provider had not been able to arrange current training in relation to storage of oxygen.

  • There was still no official documentation of supervision.

  • There was no date for when a risk was added to the risk register.

As this was a focused inspection, not a comprehensive one, the evidence within this report will not change the rating of the service. The rating of this service will therefore remain as requires improvement as found at the previous comprehensive inspection.

Following this inspection, we told the provider that it should make other improvements to help the service improve. Details are at the end of the report. However, the requirements of the warning notice have been met.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

28 March 2019

During a routine inspection

Alpha Care Ambulance Service is operated by Alpha care Ambulance Service Limited. The service provides patient transport service and some emergency and urgent care to the local area.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 March 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 this service as Requires improvement overall.

  • The service provided care and treatment based on national guidance, however did not always show the evidence of its effectiveness.

  • There was no assurance that the service had full oversight of its medicine service and required further advice in relation to the licence of controlled drugs.

  • The service had limited systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

  • Information about the outcomes of people's care and treatment were not routinely collected and monitored.

  • The service provided mandatory training in key skills to all staff however not everyone had completed it.

  • Staff kept equipment and their premises clean and used control measures to prevent the spread of infection, however the service did not have a full oversight of infection control audits.

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

However

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient and event.

  • Staff cared for patients with compassion.

  • Staff involved patients and those close to them in decisions about their care and treatment.

  • Staff provided emotional support to patients to minimise their distress.

  • The service planned and provided services in a way that met the needs of local people.

  • People could usually access the service when they needed it.

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 a warning notice and three requirement notices that affected Alpha Care. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals London and South.

10 October 2017

During an inspection looking at part of the service

Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service as a follow-up, responsive inspection to our inspections of 14 March 2017, when the service was suspended until 16 May 2017, and an unannounced inspection on 10 May 2017. At this time improvements had been made and the suspension was lifted.

We carried out this inspection on 10 October 2017 and our specific focus was to determine if improvements had been made against the areas highlighted in the section 29 warning notice issued on 22 June 2017.

We looked at governance under the Well-led key line of enquiry, as highlighted in the warning notice.

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? We have not commented on caring in this report, as there were no concerns highlighted from the previous inspection.

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 that the service provider had made significant improvements in key areas such as staff training and monitoring of their service.

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

  • The service did not have a risk register relating to the business.

  • Governance meetings were being held on an informal basis and details of those meetings were not recorded.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

10 May 2017

During an inspection looking at part of the service

Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service as a follow-up, responsive inspection after our inspection of 14 March 2017 when the service was suspended until 16 May 2017.

We carried out the inspection on 10 May 2017 and our focus was to determine if improvements had been made against the areas of poor practice highlighted at the previous inspection.

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? We have not commented on caring in this report, as there were no concerns highlighted from the previous inspection.

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 provider did not have processes or practices in place to assess, monitor and improve quality and safety. There was not a robust system to ensure all incidents were recorded and monitored appropriately and no learning or outcomes were shared with staff.

  • There were limited policies and guidelines to support staff to provide evidence based care and treatment.

  • Managers did not have an understanding of risk and its management relating to the business and they did not demonstrate the necessary knowledge to lead effectively. The registered manager appeared to have very little understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and how these related to the business, or the consequences of not complying with them.

  • There were no effective governance arrangements in place to monitor or evaluate the quality of the service and improve delivery. Audits were not undertaken and therefore learning did not take place from review of procedures and practice.

  • There was no formal risk register in place at the service and therefore we had no assurances that risks were being tracked and managed to mitigate risks.

  • There was limited provision on ambulance vehicles to support people who were unable to communicate verbally or for whom English was not their first language.

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 two requirement notices that affected the patient transport service. Details are at the end of the report.

Despite improvements that still needed to be made, as highlighted above and in this report, we determined that the significant concerns we previously had regarding the immediate risk to patients had been sufficiently mitigated. We were therefore satisfied that the registration of the service could resume on 16 May 2017 and we informed the provider of this on 12 May 2017.

Professor Edward Baker

Chief Inspector of Hospitals

14 March 2017

During a routine inspection

Alpha Care Ambulance Service is an independent medical transport provider based in Moulsford, Oxfordshire. The service provides a patient transport service and medical cover at events. Services are staffed by trained paramedics, emergency care technicians, ambulance care assistants and technicians.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 March 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 provider did not have processes or practices in place to assess, monitor and improve quality and safety. There was not a robust system to ensure all incidents were recorded and monitored appropriately and no learning or outcomes were shared with staff.
  • Systems and processes were not in place to implement the statutory obligations of Duty of Candour (DoC).
  • The staff did not have current mandatory training and were not supported appropriately, either by the provider’s induction or through ongoing training. Staff delivering training were not up-to-date themselves.
  • Arrangements for safeguarding vulnerable adults and children were not adequate. There was a lack of safeguarding training to ensure staff were aware of their responsibilities. There was a risk that staff would not be able to recognise and report potential safeguarding concerns.
  • Medicines were not always managed safely or securely. The service had a medicine management policy. However, they did not have any medicine protocols to support staff to administer medicines safely. A regular patient carried their own midazolam, which would need to be administered by a member of the crew if the patient deteriorated. Midazolam is a Schedule 3 Controlled Drug as defined by the Misuse of Drugs Act 1971 and has strict rules in place for its use.
  • We found the service did not have recruitment procedures in place to ensure all staff were appointed following a robust check of their suitability and experience for the role. Neither was there evidence of robust pre-employment checks were carried out.
  • There were no systems in place to ensure staff received regular appraisal on their performance or development needs or received clinical supervision. There was no evidence of an induction policy or process within the service.
  • There were limited policies and guidelines to support staff to provide evidence based care and treatment.
  • Managers did not have an understanding of risk and its management relating to the business and they did not demonstrate the necessary knowledge to lead effectively. The registered manager appeared to have very little understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and how these related to the business, or the consequences of not complying with them.
  • There were no effective governance arrangements in place to monitor or evaluate the quality of the service and improve delivery. Audits were not undertaken and therefore learning did not take place from review of procedures and practice.
  • There was no formal risk register in place at the service and therefore we had no assurances that risks were being tracked and managed to mitigate risks.
  • There was limited provision on ambulance vehicles to support people who were unable to communicate verbally or for whom English was not their first language.

However, we also found the following areas of good practice:

  • The service had a system for handling, managing and monitoring complaints and concerns.

There were areas of poor practice where the service needed to make improvements.

Following the inspection, we used our urgent powers to suspend registration of the service until 16 May 2017. This action was taken in response to our significant concerns of the immediate risk to patients. We found that care and treatment was not provided in a safe way and there were no effective governance systems in place within the organisation. Staff providing care or treatment did not have the skills, competence and training to do so safely. For example, in medicines management, risk assessments, risks of infection control and equipment. We also found that there was a lack of systems and processes in place to protect patients from abuse and improper treatment.

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. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

2 December 2013

During a routine inspection

We spoke with a relative of a young person who used the service and a matron who used the service for school events. Both spoke highly of the service. The relative said "I am more than happy with the service provided for my son. We use them on a daily basis and the service is excellent. We get regular crews who know my son well and understand his needs. They are punctual, flexible and nothing is too much trouble". The matron said "I have used them for five years and they provide an excellent and appropriate service. We often change our match schedule at short notice and they always accommodate us and rise to the mark".

People we spoke with told us they felt involved in the service and care provided and that communication was excellent. We looked at assessments for people who used the service and saw that people had been involved in the process.

The provider had taken steps to ensure people's safety. All ambulance staff had been trained in safeguarding vulnerable children and adults. The ambulance staff we spoke with demonstrated a good knowledge of abuse and what to do if they suspected abuse was happening.

The provider had appropriate recruitment and selection procedures in place. References were sought and backgrounds were checked to ensure people were of good character.

The provider monitored the quality of service it provided. Service user surveys were conducted every six months, audits were conducted and complaints were dealt with appropriately.

7 February 2013

During a routine inspection

We spoke with three people who use Alpha Care for patient transport or event cover. They told us that the staff were 'fantastic' and 'very professional'. One person said they were '100% involved' in the transport of their family member and that their family member was 'relaxed and confident' with Alpha Care staff.

People who used the service and staff members told us that the office staff made sure that all the information about patient and event requirements was correct. This meant that correctly qualified staff and the right equipment were allocated to each job.

There was a clear infection control policy which we saw was followed. Vehicles were clean and precautions were taken to minimise the risk of cross contamination.

There was an effective assessing and monitoring tool in place.