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:
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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).
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There were inadequate and ineffective systems for identifying, assessing and monitoring the safety and quality of the service.
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There was insufficient attention to safeguarding children and adults. Some managers and staff lacked an understanding about safeguarding.
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Staff did not receive training about recognising mental health issues.
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There was recording of risk assessment but where there were risks identified, no actions taken as a result of the assessment.
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The service had no formal system for recording of complaints and there was no evidence of learning form complaints .
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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.
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There was no central recording of risk and no systems in place to reduce these risks.
However,
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Patient’s individual needs were noted when the booking was taken and arrangements made to meet them.
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Staff were trained to talk to patients who were violent or aggressive to calm them down.
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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.
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Ensure the service has a business continuity plan in place.
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Ensure a system is developed and implemented to manage complaints that includes learning from complaints.
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Ensure staff receive training about recognising mental health issues.
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Design and implement a system to record and monitor risks.
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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:
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Consider implementing a Medisec Ambulance Service Limited driver training programme.
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Ensure all staff receive regular updates on mandatory training.
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Review the medicine management policy and the controlled drugs policy to ensure they are relevant to the service provided.
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Ensure regular audits of compliance of vehicle daily inspection forms.
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Ensure potential risks when planning services are identified and mitigated.
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Consider implementing assurance systems taking into account relevant and current evidence-based guidance, standards, best practice and legislation to provide effective care.
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Ensure key performance indicators are identified and monitored so as to provide assurance the service was meeting the target it had been set.
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Ensure staff competency assessment and formal supervision meetings are recorded and monitored.
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Ensure staff have access to information on policies when working remotely.
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Consider designing and implementing systems to support people to manage their own health.
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Ensure all crews are provided with equipment to discharge their role effectively.
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Ensure systems are in place to monitor safety of staff whilst working remotely.
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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