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Archived: APMS Ambulance Service Limited Good

Reports


Inspection carried out on 31 March 2021

During an inspection looking at part of the service

APMS Ambulance Service Limited provides patient transport services (PTS). The service opened in 1997 and registered with the Care Quality Commission (CQC) in December 2015. It is an independent ambulance service in Peterborough. The service primarily serves the communities of the Peterborough and Cambridgeshire region but also offers PTS services out of county on request.

Following our previous inspection of this service on the 18 and 23 November 2020, we told the provider it must take action to bring services in line with legal requirements. This action related to the patient transport service. The provider submitted an action plan outlining the steps they were taking to improve.

On 19 March 2021 CQC received information of concern in relation to the recruitment of individuals employed with APMS Ambulance Service Limited. Due to the significance of the concerns on 24 March 2021 we served an urgent notice of suspension of registration as a service provider, in respect of all regulated activities, under Section 31 of the Health and Social Care Act 2008.

We carried out an urgent focused inspection on 31 March 2021, which corroborated concerns in relation to the providers recruitment practices and staff records. Due to the lack of assurance that the provider could address the concerns prior to the end of the suspension period on the 9 April 2021, we extended the urgent suspension until the 14 May 2021.

On the 23 April 2021, the registered manager voluntarily cancelled their registration as the registered manager of the service. On the 27 April 2021, the provider told us that no progress had been made in relation to responding to the concerns identified during our inspection and the provider was looking to sell APMS Ambulance Service Limited.

On the 5 May 2021, the provider told us they had made no progress towards addressing the concerns we identified during inspection. There was no post inspection action plan and a new registered manager had not been appointed for the service. The provider told us that they had been in liaison with several interested parties with a view to selling APMS Ambulance Services Limited and not going to continue to provide regulated activities.

An application to cancel APMS Ambulance Service Limited registration and cancel all the activities we regulate was received on 10 May 2021 and we cancelled the providers registration for all regulated activities on the 13 May 2021.

To get to the heart of patients’ experiences of care and treatment, we normally ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? During this urgent responsive inspection, we looked at parts of the safe and well led domain.

We found that:

  • Leaders did not ensure that patients, staff and the public were protected from abuse.
  • Leaders did not consistently follow the providers recruitment policy.
  • Leaders did not demonstrate integrity and honesty in relation to the management of the service.
  • The provider did not apply effective governance processes for the employment of staff, specifically those with criminal records.
  • Leaders did not demonstrate a culture of openness and honesty within the service which may have placed patients and staff at risk.

Inspection carried out on 18 November & 23 November 2020

During an inspection looking at part of the service

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.

Inspection carried out on 13 & 21 February 2018

During a routine inspection

APMS Ambulance Service Limited is operated by APMS Ambulance Service Limited. The service provides a patient transport service (PTS).

We inspected this service using our comprehensive inspection methodology. We carried out our announced inspection on the 13 February 2018, along with a short notice announced inspection on the 21 February 2018.

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.

The main service provided by this service is patient transport services. However, APMS Ambulance Service Limited also supplied paramedics, first responders, and first aiders to provide first aid cover at organised sporting and public events such as stock car racing, horse shows, and motorcycle speedway, amongst others.

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 areas of good practice:

  • Staff maintained vehicles and equipment to ensure they were visibly clean and fit for use.

  • Staff complied with mandatory training requirements and the staff we spoke with during our inspection gave examples of additional training they received to fulfil their roles and responsibilities.

  • Staff maintained the ambulance station, office, and storage areas to ensure they were visibly clean and safe from any trip or fall hazards. Within the ambulance station, clear signage was in place warning staff of the dangers in relation to Control of Substances Hazardous to Health Regulations 2002 (COSHH) and other key health and safety issues.

  • Staff we spoke with during our inspection described a positive working culture, with approachable managers and flexibility in their working hours.

However, we also found:

  • The provider had no formal eligibility criteria to assist in the assessment of patients in order to minimise risk. An eligibility criteria enables the provider to identify which patients it can convey, and meet their needs. For example, bariatric (Morbidly Obese) patients, or patients with mental health needs, or patients that are self-funding their transport.

  • We found some consumables within ambulances past the manufacturer’s recommended expiry date despite staff having completed checks on the ambulance prior to our inspection. This meant on occasion, staff did not complete equipment checks comprehensively in line with the provider’s requirements.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals