Riviera Ambulance Service Limited provides a patient transport service specialising in NHS and private sector mental health transfers throughout the United Kingdom.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 22 August 2017 and revisited the service on 30 August 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.
Following this inspection we used our enforcement powers to urgently suspend the registration of Riviera Ambulance Service Limited, and the Registered Manager, to protect the safety and welfare of patients. The suspension started on Wednesday 13 September and continued until Wednesday 25 October.
We re-inspected the service on 17 October 2017, following a request from the provider and receipt of an action plan identifying changes which had been made to the service. The provider was able to demonstrate a significant number of changes and improvements had been made to the service in response to the breaches identified in the suspension notice served on 13 September 2017. In light of this, we lifted the both the Registered Manager's and the provider's suspension of registration from Wednesday 25 October. A report of our findings at this re-inspection will follow in due course.
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 many areas of serious concern:
- The registered manager was unfamiliar with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
- Incident reporting was not embedded, incidents were not adequately investigated and relevant learning was not shared with staff.
- A thorough assessment of the patient’s need was not taken and recorded.
- Information provided to the service was not acted on, for example information from the referring units with regards to patient risk.
- There were no policies or procedures available for staff to follow with regards to capacity and consent.
- The registered manager was not working in accordance with the code of practice for health and adult social care and the prevention and control of infection, and related guidance 2015.
- There was no evidence infection, prevention and control risks associated with patients were collected during the initial booking stage or during the verbal handover from the unit to the crew.
- There was a lack of detail around risk management in relation to identification of risks and strategies to manage or mitigate them.
- The registered manager and the staff had not received the correct level and frequency of safeguarding training, to ensure staff were aware of their responsibilities to act upon any allegations of abuse. There was no system or process to ensure allegations of abuse were raised with the appropriate organisation to safeguard patients.
- There was no assessment of patients’ capacity in line with the Mental Health Act 1983.
- Neither the crew nor the registered manager received training on the Code of Practice: Mental Health Act 1983 despite the service specialising in the transport of mental health patients.
- The registered manager was not up to date with relevant nationally recognised guidance appropriate to the services they provided. For example, the management and storage of oxygen was not in line with national guidance. Neither the registered manager or the staff had an understanding of the National Institute for Health and Care Excellence guidance ‘Violence and aggression: short term management in mental health, health and community settings (NG10)’.
- There were no policies and procedures available for the crew to follow when they supported patients with medicines on transfers. Crews did not record when they supported patients with taking their medicines during a journey.
- Staffing and recruitment procedures did not ensure required information was obtained to meet the legal requirements, including Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had no system of appraisal to formally monitor staff. Crew members’ competence to carry out their role following their induction period or when using blue lights on the ambulance were not assessed.
- There were no governance arrangements in place to assess and monitor the service in terms of quality, safety, performance and risk.
- The recruitment procedure did not safeguard patients against unsuitable staff, and there was no process to review the fitness of the employees.
- Professional body registers were not checked to ensure appropriate staff had a current registration.
- The registered manager did not have an understanding of the duty of candour regulation and there were no policies or procedures with regards to this within the service.
- The provider was not monitoring the how long each crew member spent driving.
- The provider did not have a document to identify eligibility criteria for determining the types of patients suitable to travel with them. There was also no policy or procedure available for the management of the deteriorating patient.
However, we also found the following areas of good practice:
- Records demonstrated all vehicles were properly maintained.
- Vehicles were designed to ensure patients detained under the Mental Health Act 1983 were safely transported.
- Staff spoke about the patients they transported in a caring and insightful way.
- We received 14 comment cards from patients which provided consistently positive comments about Riviera Ambulance Service Limited.
- The provider had some flexible capacity to cope with the differing levels of demand for their service.
- The crew understood the need to keep patients calm and happy throughout their journey and where possible tried to accommodate the patient’s wishes.
- Riviera Ambulance Service Limited provided a service which was flexible to meet the need of the organisations they worked for.
- The registered manager was responsive to ideas suggested by staff to improve the service.
Amanda Stanford
Deputy Chief Inspector of Hospitals (South)