Archived: APMS Ambulance Service Limited

Updated 9 June 2021

On 19 March 2021, the Care Quality Commission (CQC) received concerns in relation to APMS employees who had criminal convictions of a serious nature.

We urgently requested information from the provider including up to date employee lists, a copy of the providers recruitment policy alongside recruitment checks and disclosure barring service (DBS) checks for the specific employees named by the Police. On 24 March 2021, CQC attended a professionals meeting with Police and other key stakeholders. Following this meeting due to ongoing concerns in relation to the provider and a lack of assurance that patients and staff were being safeguarded within the service, we immediately served a Notice of Decision under Section 31 of the Health and Social Care Act 2008 to urgently suspend all of the providers regulated activities from the 24 March 2021 until the 9 April 2021.

In order to follow up on our concerns we carried out a responsive inspection on the 31 March 2021 and interviewed the nominated individual, the registered manager and reviewed eleven employee personnel files. During our inspection we found no evidence of harm caused to any patients or staff due to the provider failing to carry out the appropriate checks on all employees. However, the lack of effective recruitment processes, employee checks and poor governance posed a serious risk to people using the service.

Updated 9 June 2021

We carried out an urgent inspection of this service on the 18 and 23 November 2020 due to anonymous concerns received in relation to the staff culture, incident reporting and safety. We did not inspect the caring domain as we were unable to observe staff supporting patients when carrying out their patient transport journeys.

This was the first time we inspected the service using our ratings methodology. We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. All staff understood their responsibilities to safeguard patients from abuse and neglect and had appropriate training and support. Staff recognised incidents, near misses and reported them appropriately.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use equipment and the service maintained accurate, up to date records for the servicing and cleaning of all equipment and vehicles.
• The service had enough staff with the right qualifications, skills, experience and training to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed. Service managers matched staffing levels to patient need and could increase staffing when care demands rose.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and were easily available to all staff providing care. The service used systems and processes to safely administer, record and store medicines.
• Staff assessed patients’ food and drink requirements to meet their needs during a journey.
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies. Staff were encouraged to complete additional training and staff records showed a range of additional competencies completed by staff to meet the needs of patients.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences.
• People could access the service when they needed it and received the right care in a timely way. The service monitored, and met, agreed response times so that they could facilitate good outcomes for patients.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.
• Managers were visible and approachable in the service for patients and staff. Staff and managers described an open culture where patients, their families and staff could raise concerns. Staff told us there was an open-door to managers who were responsive to their needs and listened to their concerns.

However:

• Managers did not ensure that staff followed up to date guidance. We found several of the service’s policies and procedures out of date for review, including the safeguarding adults and children polices, which did not refer to the most up to date guidance for staff.
• Data supplied by the service showed that appraisal rates were low.
• Managers did not effectively operate the service’s governance processes and the service’s governance policy and risk register were out of date for review.
• The leadership team did not maintain accurate or up to date records of meetings to demonstrate they discussed risks, performance or the day-to-day activities of leaders within the service.
• The service had a vision for what it wanted to achieve but no strategy to turn it into action. The service was working with an external governance provider to develop an action plan, service strategy and overarching governance processes.

Updated 30 December 2020

This was the first time we inspected the service using our ratings methodology. As this was a focused inspection we did not inspect all the domains. We inspected and rated safe, effective and responsive as good. Although we found the service largely performed well, it did not meet legal requirements relating to governance and policy management. This meant we could not give well-led a rating higher than requires improvement.