Archived: Thames Valley Ambulance Service

Updated 23 December 2016

Thames Valley Ambulance & Paramedic Service Limited is an independent ambulance service providing patient transport services and ambulance work for events, on both a regular and occasional basis. The service has one location based in Milton Keynes.

The service is registered for the regulated activities of transport services, triage and medical advice provided remotely and the treatment of disease, disorder or injury.

The service was last inspected in December 2015 and concerns were found about the safety and quality of care and treatment provided. The provider was requested to take action to ensure compliance with regulations 12, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this basis, the registered provider had conditions placed on their registration to ensure safe working practices and that patients were protected.

We inspected, but have not rated, elements of three of the five key questions including, safety, effectiveness and well-led.

Updated 23 December 2016

We carried out a focused unannounced inspection on 24 May 2016 to follow up on the service’s actions to address concerns found on the last inspection in December 2015. As this was a focused inspection, we did not inspect every key line of enquiry under the three key questions we inspected (safe, effective and well led). We have not rated the three key questions inspected. Whilst improvements had been made in a number of areas, further work was required to demonstrate full compliance with some of the breaches of regulations identified at the last inspection. The regulations that were breached during the last inspection were regulations 12, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014).

On this inspection, we found that the service demonstrated compliance with regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Are services safe at this service

During the last inspection, there were serious concerns that care and treatment were not being provided in a safe way for patients. During this inspection, we found:

• Generally, some improvements had been made to address some of the safety concerns that had been identified at the last inspection.
• Policies and procedures within the service generally had improved and were relevant for the staff groups employed.
• The service generally had an appropriate understanding of safeguarding vulnerable adults and children, and had a policy and procedure surrounding this.
• Medicines management had improved and all medicines were kept securely.
• Equipment storage and suitability had been reviewed and all items of single use equipment were in date and stored correctly on vehicles.
• Environmental risk assessments, including fire safety, had now been completed by the service.
• Oxygen storage facilities had improved since our previous inspection, and that all cylinders were appropriately stored.

Some concerns raised during our previous inspection had not been fully resolved including:

• Not all vehicles were secure meaning there was a risk of tampering to equipment contained within them. The premises where vehicles were stored was secure.
• Infection control concerns were still apparent within some vehicles, including dirty surfaces and open clinical waste storage. Deep clean procedures were not always timely.
• Regular audits were not undertaken and therefore learning did not take place from review of procedures and practice.
• There was no assurance that vehicle repairs and maintenance were carried out by suitably qualified staff.
• Whilst staff within the service had attended some appropriate mandatory training for their role, not all staff had had the required level of mandatory training.
• Not all patients using the service had had a robust risk assessment completed.

Are services effective at this service

During the last inspection, there were concerns that there were not systems in place to ensure staff were suitable, experienced and competent for their role. During this inspection we found:

• Recruitment procedures had improved to ensure that competent and experienced clinical staff were employed by the service to care for patients. However, there were not effective processes in place for ensuring non-clinical staff were suitable for their role.

However, some concerns raised during our last inspection had not been fully resolved including:

• There were no systems in place to ensure staff were suitably appraised or received clinical supervision.
• There were not effective processes in place for ensuring non-clinical staff were suitable for their role.

Are services caring at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services responsive at this service

This was a focused inspection and we did not consider this as part of the inspection.

Are services well led at this service

During our last inspection, we had significant concerns regarding the governance and risk management processes within the service. During this inspection, we found that:

• Several new policies and procedures had been put into place to support staff in their role.

However, some concerns raised during our previous inspection had not been fully resolved including:

• There were not effective, robust systems in place to assess, review and monitor risks

within the service. An audit process was not in place to allow oversight of quality and safety within the service.

• There was still no registered manager or nominated individual in place to ensure regulatory oversight of the service.
• The policy for safeguarding adults and children did not provide staff with clear guidance on how to make a referral and to whom.

The service must take action to ensure that:

• Robust governance and risk management systems are in place and understood by all staff.
• Staff are supported in their roles by effective supervision and appraisal systems and ongoing training.
• Effective processes are in place for ensuring non-clinical staff are suitable for their role.
• Vehicles servicing and security must be maintained.
• Appropriate infection control procedures are in place to minimise the risk of acquired infections.
• Ensure that a registered manager is in place to provide regulatory oversight of the service.
• All staff receive appropriate mandatory training for their role.
• All patients’ using the service have a risk assessment completed to identify any potential risks to their health and safety.

Importantly, the provider must take action to ensure compliance with regulations 7, 12, 15, 18, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 23 December 2016

As this was a focused inspection, we inspected, but did not rate, elements of safe, effective and well-led key questions. We did not inspect caring and responsive key questions. Whilst some improvements had been made in a number of areas, further work was required to demonstrate full compliance with all of the breaches of regulations identified at the last inspection. We found that:

• Generally, some improvements had been made to address some of the safety concerns that had been identified at the last inspection.
• Policies and procedures within the service had generally improved and were relevant for the staff groups employed.
• The service generally had an appropriate understanding of safeguarding vulnerable adults and children, and had a policy and procedure surrounding this.
• Medicines management was appropriate and medicines were kept securely.
• Environmental risk assessments, including fire safety, had now been completed by the service.
• Oxygen storage facilities had improved since our previous inspection, and all cylinders were appropriately stored.
• Equipment storage and suitability had been reviewed and all items of single use equipment were in date and stored correctly on vehicles.

However, we also found that:-

• There was no appraisal or clinical supervision systems in place: this was being considered by the service.
• Not all vehicles were not secure meaning a risk of tampering to equipment contained within them.
• Infection control concerns were still apparent within vehicles, including dirty surfaces and open clinical waste storage. Deep clean procedures were not always timely.
• Regular audits were not undertaken and therefore learning did not take place from review of procedures and practice.
• There was no assurance that vehicle repairs and maintenance were carried out by suitably qualified staff.
• There was still no registered manager in the service.
• Not all staff had had the required mandatory training for their role.
• Not all patients had had a robust risk assessment carried out.