15 August 2017
During a routine inspection
BM Ambulance Service is operated by BM Ambulance Service Limited. They are an independent medical transport provider based in Ashford, Kent. The service provides patient transport, medical cover at events, and a repatriation service. The service employed trained paramedics, ambulance technicians, ambulance care assistants and registered nurses.
We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 15 August 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:
- The internal incident reporting process was robust. There was a system to ensure all incidents were recorded and monitored, with learning and outcomes shared with staff.
- Equipment was available and appropriately serviced and maintained.
- Vehicles had appropriate safety checks, were maintained and checked daily.
- Staff understood their responsibilities to protect patients from avoidable harm. Staff knew about safeguarding and what constituted abuse.
- Policies and procedures were in place for cleaning and deep cleaning ambulances. Ambulances were visibly clean and staff followed infection control procedures including being bare below the elbow and using personal protective equipment.
- Patient records were held securely and included appropriate information. The service regularly audited these.
- Staffing levels were sufficient to meet patient needs.
- Staff were confident in assessing and managing specific patient risks, and processes were in place for the management of a deteriorating patient.
- Staff could plan appropriately for patient journeys using the information provided by the booking system.
- Staff had been trained in mental capacity and showed awareness of consent issues.
- Staff helped patients feel comfortable and safe. Staff responded with compassion when patients needed additional help or support.
- Patients and their relatives / carers received emotional and practical support from ambulance crews. Staff respected the needs of patients, promoted their well-being and respected their individual needs.
- Staff respected patient’s dignity, independence and privacy.
- Staff we spoke with were committed and passionate about their roles. They provided excellent care.
- The service used its vehicles and resources effectively to meet patients’ needs. Specially adapted ambulances were available to accommodate bariatric patients.
- Food and drinks were available to patients / relatives / carers on board the vehicles.
- Information about how to make a complaint was available in all of the vehicles we inspected. Staff knew about the complaints and compliments system. Patients knew how to access the service’s complaints and compliments process.
- The service had a robust process in place to respond to feedback from patients and members of the public.
- The service encouraged feedback from patients through satisfaction surveys.
- The staff we spoke with liked working for the service. There was an open culture and staff were focused on providing person-centred care.
- All staff felt supported by the managers of the service and said the managers were competent, approachable and accessible should they require any advice.
However, we also found the following issues that the service provider needs to improve:
- There were no formal systems to ensure staff had appraisals.
- Most of the policies and guidance were not specific to the roles, responsibilities and size of the service.
- There were no effective governance arrangements to evaluate the quality of the service and improve delivery.
- There was no formal risk register in place, which limited the service’s ability to monitor their risks and put plans in place to mitigate them.
- There was no documented vision and strategy for the service.
- The ‘Equal Opportunities Policy’ (March 2017) referred to a whistleblowing policy which did not exist.
Information on our key findings and actions we have asked the provider to take is listed at the end of the report.