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Medisec Ambulance Service Limited Good

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 3 September 2019

During a routine inspection

Medisec Ambulance Service is operated by Medisec Ambulance Service Limited. The service provides patient transport services.

The provider has been registered with CQC as Medisec Ambulance Service Limited since December 2011. The service has had a registered manager in post since December 2011.

The service provided patient transport services to hospitals from a patient’s home, patients discharged form hospital to their home, and secure transport to and from mental health hospitals to acute hospitals and court. Medisec Ambulance Service is commissioned by an NHS Mental Health Trust to undertake transport services.

We inspected this service using our comprehensive inspection methodology. We informed the service of our inspection, to ensure people we needed to speak with could be made available. We carried out this short notice inspection on 3 September 2019.

The service had 30 staff, five ambulances and a safe custody ambulance it used to carry out the regulated activity for both adults and young people aged between 12 and 18 years old.

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.

We rated the service as Good overall. We had not previously rated this service.

  • The service had systems to provide assurance of safety regarding the premises, vehicles and equipment which were well maintained and clean.

  • Staff received comprehensive training in safety systems on employment and this was regularly refreshed. All staff were up to date with mandatory training and there were effective systems to monitor this.

  • Staff received support through supervision and appraisal.

  • There was a system to ensure thorough recruitment checks were undertaken.

  • Staff undertook risk assessments and took precautions to protect patients and themselves from harm.

  • Staff had been trained and understood their responsibilities to report safeguarding concerns.

  • There was a process to ensure staff understood the Mental Capacity Act (2005) and how to apply the principles in practice.

  • The service investigated incidents, including complaints, and took appropriate remedial action.

  • Managers were visible, approachable and respected by staff. Staff felt valued and well supported.

  • Feedback from patients and commissioners was very positive. We observed friendly and attentive staff.

  • People could access the service when they needed it.

  • The service took steps to support patients with complex needs and those in vulnerable circumstances.

  • Staff completed accurate records of patients’ care and treatment and kept them securely.

  • Staff respected their managers and felt supported and valued by the organisation.

  • The service measured its performance against standards agreed with commissioners.

  • There were effective arrangements to manage risk. The risk register identified operational risks and described safeguards to manage those risks, it was regularly discussed and updated.

  • There was an effective governance framework which provided a holistic understanding and assurance of safety, quality and patient experience.

Nigel Acheson

Deputy Chief Inspector of Hospitals South

Inspection carried out on 29 March 2017

During an inspection looking at part of the service

A focused responsive inspection of Medisec Ambulance Service Limited was carried out on 29 March 2017. This was an unannounced inspection.

We previously carried out a comprehensive inspection of the service between 14 and 20 September and 6, 7 and 10 October 2016. Following this inspection, we served an urgent notice on Medisec Ambulance Service Limited, suspending their registration as a service provider. This was in respect of the regulated activity transport services, triage and medical advice provided remotely from 12 October 2016 until 30 November 2016 at or from the location Medisec Ambulance Service Limited, Unit 1, Mount Pleasant Road, Southampton, SO14 0SP. The provider was required to demonstrate they were compliant with the identified regulations by 30 November 2016.

Our main findings were :

At the follow up inspection on 29 and 30 November 2016, we checked whether the provider had made the required improvements and found that the provider had developed robust recruitment processes. The provider had started governance processes, and planned to provide patient transport services within the restraints of the number of staff employed. The suspension of registration was removed on 30 November 2016.

At this focused responsive inspection on 29 March 2017, we checked on the recruitment processes and associated records. We found that that the improvements had been sustained following the removal of the suspension of registration of the provider on 30 November 2016. We found that the governance systems set up were in use and saw minutes of the governance meetings that had taken place. We inspected and saw that the workflow system for patient transport planning was robust and encrypted, it held information relating to the jobs, the teams assigned to the jobs and there was password protection of the system.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

Please refer to previous inspection report for information on our key findings at the previous inspection and actions we have asked the provider to take.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 29 & 30 November 2016

During an inspection looking at part of the service

This focused inspection was carried out on 29 and 30 November 2016.

A comprehensive inspection of the service was carried out on 14 and 20 September 2016 and 6, 7 and 10 October 2016. This identified the provider was in breach of regulation 19 (Fit and Proper Persons Employed) and Schedule 3 of the Health and Care Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were inadequate recruitment checks on employees prior to commencement of employment and there were inadequate and ineffective systems for identifying, assessing and monitoring the safety and quality of the service.

Following the inspection we served an urgent notice on Medisec Ambulance Service Limited, suspending their registration as a service provider in respect of the regulated activity transport services, triage and medical advice provided remotely from 12 October 2016 until 30 November 2016 at or from the location Medisec Ambulance Service Limited, Unit 1, Mount Pleasant Road, Southampton, SO14 0SP. The provider was required to demonstrate they were compliant with the identified regulations by 30 November 2016.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

At the inspection on 29 and 30 November 2016 we checked whether the provider had made the required improvements and found:

  • The provider followed robust recruitment processes to ensure all staff working in the service were of a good character, had the necessary skills, qualifications, competencies, and experience and were sufficiently healthy to carry out their role.

  • The provider had developed a governance processes that included systems to assess, monitor and improve the quality and safety of the service. The provider should ensure the new processes for monitoring the quality and safety of the services are fully implemented and followed.

  • The provider had a plan to provide and develop their patient transport service within the restraints of the present number of staff employed.

Please refer to previous inspection report for information on our key findings at previous inspection and action we have asked the provider to take in relation to other aspects of the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 14 September, 20 September, 6, 7 and 10 October 2016

During a routine inspection

Medisec Ambulance Service Ltd. predominantly provides transport for adults and children with mental health disorders, as well as the transport and supervision of people in, section 136 suites whilst awaiting mental health assessment. The services are provided under contract with an NHS trust and a service level agreement with another NHS trust and they provide services on request from an ambulance NHS trust.

We undertook a planned comprehensive inspection of Medisec Ambulance Service Ltd on the 14 and 20 of September and again on the 6 and 7 of October 2016 and 10 October 2016, to follow up significant concerns.

The provider operates services from a single location, an ambulance station. There were no other locations as part of this business.

CQC does not currently have the power to rate independent ambulance services.

Our key findings were as follows:

  • There were inadequate recruitment checks on employees prior to commencement of employment as detailed in regulation 19 (Fit and Proper Persons Employed) and Schedule 3 of the Health and Social Care Act (2008).

  • There were inadequate and ineffective systems for identifying, assessing and monitoring the safety and quality of the service.

  • There was insufficient attention to safeguarding children and adults. Some managers and staff lacked an understanding about safeguarding.

  • Staff did not receive training about recognising mental health issues.

  • There was recording of risk assessment but where there were risks identified, no actions taken as a result of the assessment.

  • The service had no formal system for recording of complaints and there was no evidence of learning form complaints .

  • There was no evidence of learning or changes in practice in response to incidents. Incidents were not reviewed on a regular basis and there was no system to review trends.

  • There was no central recording of risk and no systems in place to reduce these risks.

However,

  • Patient’s individual needs were noted when the booking was taken and arrangements made to meet them.

  • Staff were trained to talk to patients who were violent or aggressive to calm them down.

  • Feedback documentation we reviewed from patients and relatives was positive and commented on the caring attitude of staff.

There were areas of poor practice where the service needed to make improvements.

Following the inspection we used out urgent powers to suspend registration of the service until 30 November 2016. This action was taken in response to our significant concerns of the immediate risk to vulnerable patients arising from the inadequate pre employment recruitment checks and lack of assurance that staff were suitable and safe to undertake this work. We told the provider what was required for the service to continue in relation to pre-employment recruitment checks, quality and safety monitoring.

The registered provider had to make necessary improvements and provide evidence of assurance on the following:

  • Evidence that all staff carrying on the regulated activity for Medisec Ambulance Service Limited had full and complete recruitment files, to ensure they were fit to be employed in carrying out the regulated activity, in line with regulation 19 (Fit and Proper Persons Employed) and Schedule 3 of the Health and Social Care Act (2008).
  • Confirmation that the level of service was viable in order that service users were not at put at risk because of insufficient resources.
  • Governance processes were improved in line with Regulation 17 (Good governance) of the Health and Social Care Act (2008). This included systems and processes to assess, monitor and improve the quality and safety of the services are established and operated effectively.

Action the service MUST take to improve

The service must:

  • Implement systems and processes to assess, monitor and improve the quality and safety of the services.
  • Ensure incidents that affect the health, safety and welfare of people using services are investigated and actions taken to prevent recurrences.
  • Implement and monitor systems to ensure children and adults are safe from abuse.
  • Ensure all staff have a full understanding of duty of candour.
  • Ensure the service has a business continuity plan in place.

  • Ensure a system is developed and implemented to manage complaints that includes learning from complaints.

  • Ensure staff receive training about recognising mental health issues.

  • Design and implement a system to record and monitor risks.

  • Ensure policies and procedure in place to detail what monitoring staff should do to manage deteriorating patients.

Action the service SHOULD take to improve

The service should:

  • Consider implementing a Medisec Ambulance Service Limited  driver training programme.

  • Ensure all staff receive regular updates on mandatory training.

  • Review the medicine management policy and the controlled drugs policy to ensure they are relevant to the service provided.

  • Ensure regular audits of compliance of vehicle daily inspection forms.

  • Ensure potential risks when planning services are identified and mitigated.

  • Consider implementing assurance systems taking into account relevant and current evidence-based guidance, standards, best practice and legislation to provide effective care.

  • Ensure key performance indicators are identified and monitored so as to provide assurance the service was meeting the target it had been set.

  • Ensure staff competency assessment and formal supervision meetings are recorded and monitored.

  • Ensure staff have access to information on policies when working remotely.

  • Consider designing and implementing systems to support people to manage their own health.

  • Ensure all crews are provided with equipment to discharge their role effectively.

  • Ensure systems are in place to monitor safety of staff whilst working remotely.

  • Consider designing and implementing systems to engage with the public.

We informed the service of our serious concerns immediately after the inspection and took immediate action.

Professor Sir Mike Richards

Chief Inspector of Hospitals