first4care

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. We reviewed the safety and cleanliness of vehicles.

Our rating of this assessment service group remained the same. At the last inspection this assessment service group was rated good. At this assessment the rating is good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

Score: 3

The service had a proactive and positive culture of safety, based on openness and honesty. Managers listened to concerns about safety, investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Managers had a clear process for investigating incidents. As the service carried out work for multiple different providers, incidents came through from different sources and in different formats. All incidents and complaints were filtered through the same responsible person and then investigated. Where appropriate, managers took statements from staff and liaised with other services involved.

Staff were aware of how to report an incident. Staff raised incidents directly to the third-party provider such as an NHS hospital, using a form on electronic devices. Staff also submitted a copy of the incident to managers at this service. During the assessment staff explained how to raise an incident and told us they would get feedback from management. The service had an incident reporting policy in place.

Staff described learning and improvements following incidents. For example, changing equipment or changes to training. Managers kept staff updated with changed using an app to provide feedback, face to face feedback and regular staff newsletters.

Score: 3

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Most of the patient activity undertaken by the service was to provide patient transport services to other healthcare providers. Patients were usually taken home following discharge or taken to or from regular appointments.

Staff completed an electronic log for each journey that was undertaken. Leaders were assured appropriate action was taken by staff as patient transfer documentation for all journeys were sent to the office and leaders could review.

During the assessment we observed that staff had a good understanding of the needs of a patient who was booked for transport. Staff saw some patients regularly and could recognise if there were additional issues, staff provided examples of when they raised additional concerns with hospital staff, care home staff and families.

Crews would also ask about tissue viability for patients when taking patients home following discharge.

Score: 3

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had the appropriate policies and procedures in place for reporting and processing safeguarding. Staff had access to policies for safeguarding adults and children which were appropriately updated and reviewed. Staff we spoke with during the assessment all understood the process. Safeguarding incidents were reported directly to the relevant safeguarding team within the local authority as well as to the third-party healthcare provider where the patient was receiving care or treatment. Similarly to incidents, all incidents were also reported through to the office. The service had a safeguarding lead. Staff were able to provide examples of dealing with safeguarding incidents, both witnessed and reported.

Staff were appropriately trained at the service. All staff had safeguarding training up to level 3 for safeguarding adults and children. The service had an appropriately trained safeguarding lead.

Score: 3

The service worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

If a patient journey was assigned to the crew and upon arrival it was assessed they did not have the correct equipment they would not undertake a journey and let the third-party provider know.

The service had a process in place for deteriorating patients and staff understood and could explain the process.

Assessments included patient’s consent to travel. Staff explained the risks of refusing transfer to the patients.

Score: 3

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

Staff had access to appropriate equipment, such as wheelchairs and stretchers, to keep patients safe. This was managed effectively. Each piece of equipment received a 6 monthly service. The service worked with a third party company that carried out both routine maintenance and breakdown repair. However, we saw a ripped chair that was being used on an ambulance that was transporting patients. When this was reported it was immediately actioned and repaired by the service.

The service managed its vehicles safely. We saw vehicle records demonstrating that MOT, tax, insurance and servicing was up to date. Staff kept vehicles well stocked. Staff carried out stock checks and submitted a daily vehicle checklist. Staff told us all vehicle issues were reported and logged along with broken and faulty equipment. All consumable stock checked was in date and safely stored.

Staff disposed of clinical waste in clinical waste bins at hospital sites.

Score: 3

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. The service was staffed by ambulance care assistants.

Staff worked in pairs to provide patient transport. When staff worked alone at the base on non-patient facing work, the service had a lone working policy and process. Staff told us they felt staffing was safe.

The service had safe recruitment processes in place. We reviewed staff files and found they contained appropriate checks for identity, references, driving licenses, and disclosure and barring service checks.

Staff were appropriately trained for their role. The service had a comprehensive mandatory training schedule. If staff were not up to date with mandatory training, they were given reminders. If staff continued to not complete mandatory training, they would not be given shifts. The service provided additional training and development for staff.

The service had frameworks in place for new staff. Supervision was available if required. The service had 5 mentors with 1 flexible mentor who could assist and audit staff practice.

Score: 3

The service assessed and managed the risk of infection well. Staff detected and controlled the risk of it spreading.

Whilst on the assessment the location was visibly clean, tidy and well organised. The service had cleaning equipment on site available for deep cleans. Vehicles were deep cleaned on a three-monthly basis and checked at base, but also deep cleaned when required if there had been an infected patient or bodily fluid spillage. The service had records and procedures for deep cleaning and general cleaning of vehicles. As vehicles did not usually return to site staff would submit cleaning records daily using an app to the office, these forms were audited and checked.

Whilst on assessment we observed staff clean equipment and wash their hands before and between each patient.

Staff completed infection control training as part of the mandatory training programme and had good knowledge of infection, prevention and control processes.

Staff had access to appropriate personal protective equipment (PPE) and we observed staff used it appropriately during the assessment. The crew room had all the required PPE available.

Score: 3

The only medicine used by staff was oxygen. Oxygen cylinders were stored and managed safely at the ambulance base and on ambulances. The service did not have any other medicines on site or on ambulances. There were no lock boxes for medicines on ambulances. Staff did not administer any medicines apart from oxygen. The service had an oxygen administration policy which reflected national guidance.

If a patient being transported had any medicines, they needed to be in the people’s possession and the patient needed to have capacity to decide to carry their medicines.