St James Ambulance Service - St Albans

St James Ambulance Service is operated by St James’s Ambulance Service Ltd. The service provides a patient transport service for adults.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 12 December 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.

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 recognised incidents and knew how to report them. All incidents were investigated and lessons learnt were shared across the team.
• There was good compliance with mandatory training across the service. This included Mental Capacity Act (MCA) training and safeguarding vulnerable adults training.
• Staff completed training appropriate to their roles, responsibilities and the needs of the service. Staff appraisals were up to date.
• Staff showed understanding of MCA and safeguarding and were aware of their roles and responsibilities in escalating concerns.
• Vehicles were all up to date with servicing, tax and MOT requirements.
• Staff were aware of the limitations of their skills and service, appropriately referring high risk patients to other providers.
• Staffing level and skill mix was appropriate to meet the needs of patients.
• Policies were in line with national guidance and gave clear instructions for staff on their roles and responsibilities. There were appropriate policies in place with regard to business continuity and major incident planning.
• Staff displayed a caring and patient-focused approach to their work and ensured patients’ privacy and dignity were maintained. This was reflected in patient feedback.
• Staff provided us with examples of when they felt they had gone beyond their role to ensure patients had a comfortable journey.
• Feedback from the NHS providers that commissioned the service was extremely positive.
• The patient booking process meant patients’ individual needs were able to be identified.
• Patients had access to timely care and treatment.
• All patient transport ambulances were accessible to patients who required mobility assistance, including wheelchair users.
• Staff consistently told us that the managing director was approachable and visible.
• The managing director had an understanding and oversight of risks in his service. The risk register was comprehensive, up to date and reflective of the service.
• Senior managers took immediate and effective actions to address the concerns we raised during the inspection.
• There was evidence of innovation, including a new electronic application (app) that enabled drivers to input data and information about their patient journeys on their mobile phone. The app also contained a patient feedback questionnaire.

However, we also found the following issues that the service provider needs to improve:

• We found some consumable clinical supplies stored on the ambulances to be out of date. This was escalated during inspection and the items removed and disposed.
• We found two fire extinguishers not within their service dates. However, the fire extinguishers were removed and replaced following our inspection.
• Oxygen cylinders were not stored securely on the vehicles.
• Automated external defibrillator (AED) storage bags were not labelled so we were not assured the AEDs were easily identifiable in emergencies. However, the signage was improved following our inspection.
• Service policies did not always contain a completion or next renewal date. However, this was escalated and rectified after out inspection.
• The service did not complete hand hygiene audits, which is not best infection prevention and control practice.
• We found that staff personal details were not stored securely, with staff files located in an unlocked cupboard in the private address, and accessible to family and friends. However, this was escalated as a concern and a lock was installed following our inspection.
• The service could not provide evidence of a disclosure and barring service (DBS) clearance and certificate for one of their five employees. However, the service provided evidence of DBS clearance for the staff member following our inspection.
• The staff personnel files we reviewed did not all contain evidence of staff interviews and their two references.
• The service did not have a lone working policy or a process for checking when staff finished their duty safely.
• There were no formal systems to support patients whose first language was not English and patients with hearing impairments.
• Staff had not received training to support them to care for patients with dementia or learning difficulties. However, we saw evidence that the service was in the process of procuring this training from a commissioning NHS trust.
• Not all staff were able to articulate fully the strategy for the service. However, we observed that staff worked within the ethos of it.
• Minutes from governance meetings were not documented. Therefore, we could not be assured these meetings were effective in identifying risk and improving practice.

Following this inspection, we told the provider that it must take an action 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 one requirement notice that affected the patient transport service. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals