Archived: Premier Care Direct

Updated 28 June 2018

Premier Care Direct is operated by Premier Care Direct Limited. The service opened 2009. It is an independent ambulance service with head office being based in Doncaster, South Yorkshire. The service primarily serves the communities of South Yorkshire.

The service provides patient transport services for renal patients who attend dialysis at Doncaster and Bassetlaw NHS hospitals. Since 2010, Premier Care Direct started to transport patients to the Dearne Valley facilities. In June 2017 the provider won the tender to provide services to transport renal patients to Sheffield and Healey dialysis facilities.

The service did not have a registered manager in place at the time of our inspection. There had been no registered manager since March 2016. The area manager was appointed in October 2017 and we were told that they were in the process of applying to become the registered manager for the service.

Updated 28 June 2018

Premier Care Direct is operated by Premier Care Direct Limited. It is an independent ambulance service with the head office being based in Doncaster, South Yorkshire. The service provides patient transport for renal dialysis patients.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 March 2018. A responsive inspection had been carried out on 5 December 2017 following concerns received by CQC about the service..

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 service did not have a registered manager in place at the time of our inspection. It is a condition of the provider’s registration that there is a registered manager in place. There had been no registered manager since March 2016 . This is a breach of the condition of the provider’s registration.
• The service had limited systems to monitor the quality and safety of the service. The service did not carry out any audits to measure the quality and effectiveness of the service delivered. There were potential risks to staff and patient safety, through lack of observation and monitoring of performance.
• Governance arrangements to monitor the quality and safety of the service were not robust.
• The service did not have an effective risk register. The service had not identified the risks associated with not meeting key performance indicators and the patient outcome, as well as adequate contingency during severe weather conditions. The service was unable to demonstrate how these risks were mitigated and escalated in order to protect patients.
• Policies and procedures were generic and had not been adapted for the service. Policies and procedures were not regularly reviewed and updated.
• The service did not ensure clinical waste was disposed of in accordance with the clinical waste regulations.
• Arrangements for safeguarding vulnerable adults and children were not robust. The service had not appointed a safeguarding lead. Not all staff had received safeguarding training at an appropriate level to ensure they were aware of their responsibilities. There was a risk therefore that staff would not be able to recognise and report potential safeguarding concerns.
• The service did not have an effective system to ensure all staff were up-to-date with mandatory training requirements.
• The service did not have an effective recruitment procedure. Appropriate criminal records checks through the disclosure and barring service (DBS) had not been carried out for each member of staff.
• Appraisals had not been carried out for staff that had been employed for 12 months.
• The service did not have an effective system for cascading and sharing any lesson learnt from incidents, accidents or complaints in order to improve the service and patients experience.
• The service was not meeting the Accessible Information Standard (AIS) to ensure people who have a disability, impairment or sensory loss get information that they can access and understand.

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

• The managers had developed a vision and strategy of the organisation.
• The service had undertaken a root cause analysis following the unannounced inspection on 5 December 2017.
• All vehicles and the ambulance station were visibly clean and systems were in place to ensure vehicles were well maintained.
• Staff demonstrated pride in their role and we heard examples where they had shown care and compassion when transporting patients. The service gained feedback from patients using a patient feedback form.
• All equipment necessary to meet the various needs of patients was available.
• The service had improved the incident, accident and complaints reporting procedure.

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 details of which are at the end of the report.

Ellen Armistead Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals

Updated 28 June 2018

Premier Care Direct is operated by Premier Care Direct Limited. It is an independent ambulance service with the head office being based in Doncaster, South Yorkshire. The service provides patient transport for renal dialysis patients.

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

We found practice the provider needed to improve in relation to recruitment, risk management and governance processes.

However, we also found:

• The managers had developed a vision and strategy of the organisation.
• The service had undertaken a root cause analysis following the unannounced inspection on 05 December 2017.
• Staff demonstrated pride in their role and we heard examples where they had shown care and compassion when transporting patients. The service gained feedback from patients using a patient feedback form.