Archived: APMS Ambulance Service Limited

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.