The Care Quality Commission
  • Ambulance service

Archived: Buxton

Overall: Inadequate read more about inspection ratings

22 Dale Road, Buxton, Derbyshire, SK17 6NL 07979 640198

Provided and run by:
Peak Medicare Ltd

All Inspections

6 October 2020

During an inspection looking at part of the service

Buxton is operated by Peak Medicare Limited. The service provides emergency and urgent care mainly at event services. However, CQC does not have the power to regulate events. On occasions, the service treats and conveys patients to local NHS hospitals from events such as motorcycle speedway – this falls under the scope of registration.

The service was last inspected on 8 October 2019 and 5 November 2019. Regulatory non-compliance was found in respect of regulations 5, 12, 13, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We served warning notices in respect of regulations 17 and 19 and requirement notices in respect of regulations 5, 12, 13 and 18. The service was rated inadequate overall and placed into special measures.

We carried out a remote assessment on 14 June 2020, which resulted in a Notice of Proposal to cancel the service’s registration, in respect of the following regulated activities:

  • Transport services, triage and medical advice provided remotely.
  • Treatment of disease, disorder or injury.

We also served a Notice of Proposal to cancel the service’s registered manager in respect of those regulated activities.

We decided to serve this notice of proposal, rather than take urgent action at that time as the service informed us they were not carrying on any regulated activities. This was due to government restrictions stopping all events as a result of the ongoing COVID-19 pandemic.

The service submitted written representations against the notices of proposal to cancel their registration and the manager’s registration. However, these were not upheld and therefore two Notice of Decisions to cancel the registrations, were issued on 22 September 2020 and 8 October 2020 respectively.

We carried out a short notice announced focused inspection on 6 October 2020, in response to concerns that Buxton had recommenced providing medical cover for events, and potential provision of regulatory activity taking place.

Our focused inspection concentrated on the aspects of the key questions of safe, effective and well-led. We spoke with the registered manager, company director and an external consultant (commissioned by the service to assist with compliance). As a result of this inspection we took further urgent enforcement on 9 October 2020, to suspend the provider’s registration to prevent regulated activities from being carried out.

The main service provided by this service was urgent and emergency care.

We inspected this service using our focused inspection methodology. We did not update previous ratings of this service.

Our main findings were:

  • The service did not provide mandatory training in key skills, including the highest level of life support training, to all staff. They did not make sure everyone completed it.

  • Staff had limited support to understand how to protect patients from abuse. Not all staff had training on how to recognise and report abuse.

  • The service did not control infection risk well. Staff did not use equipment and control measures to protect patients, themselves and others from infection. Equipment was visibly dirty.

  • The maintenance and use of facilities, premises, vehicles and equipment did not always keep people safe. Staff did not manage clinical waste well.

  • We were unable to gain assurances that staff received adequate training to enable effective identification and timely escalation of patients at risk of deterioration.

  • The service had enough staff, but we could not find evidence they had the right qualifications, skills, training and experience to keep patients safe from avoidable harm and provide the right care and treatment.

  • The service did not have effective systems and processes in place to safely prescribe and administer medicines.

  • The service did not always provide care and treatment based on national guidance and evidence-based practice. Managers did not check to make sure staff followed guidance.

  • The service did not make sure staff were competent for their roles. There were no appraisal systems in place to review staff’s work performance and supervision meetings with them to provide support and development had not taken place.

  • Leaders did not have the skills and abilities to run the service. They lacked understanding of effective management techniques to address the priorities and issues the service faced. There was a lack of support for staff to encourage development in skills.

  • Leaders did not operate effective governance processes. Staff at senior levels were not clear about their roles, responsibilities and accountabilities. There was limited evidence to demonstrate that regular opportunities to meet, discuss and learn from the performance of the service had taken place.

  • Leaders did not effectively use systems to manage risks effectively. Risks lacked identified timescales to reduce their potential or actual impact.

Following this inspection, the service informed us they would voluntarily cease to provide regulated activities. Due to our inspection findings on 6 October 2020, we served an urgent notice to suspend the registration as a service provider in respect of regulated activities.

On 22 October 2020, the previous enforcement action (notices of proposal to cancel their registration and the manager’s registration ) representations period elapsed and the provider’s registration with us has now been cancelled. The provider is no longer registered to transport patients.

We did not rate this service during the inspection on 6 October 2020 due to the focused nature of our enquiries. The previous inspection rating was inadequate overall in October 2019.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

08 October 2019 and 05 November 2019

During a routine inspection

Buxton is an independent ambulance service operated by Peak Medicare Ltd. It provides an emergency and urgent care service as part of events medical cover, through which they occasionally convey patients from the event site to a local NHS hospital. Peak Medicare Ltd was not commissioned by other organisations to deliver services, all work being acquired through direct contact with event organisers. The service had four emergency ambulances to carry out the regulated activities.

The service provided medical cover at events. However, CQC does not have the power to regulate events work therefore we do not review that work within this report.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 8 October 2019 and 5 November 2019 and we gave the service three days’ notice of our inspection to ensure that managers were available to speak to. We spoke with the two directors, one of whom was the registered manager, and also a paramedic. The service contracts self-employed staff when needed so no other staff were available. No patients or relatives were available.

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 rate

This was the first time we rated this service. We rated it as inadequate because:

  • The provider was not assured that staff had training in key skills and understood how to protect patients from abuse. Staff were not recruited in a way that assured that they were sufficiently skilled or of character suitable for their roles. Staff did not collect safety information and use it to improve the service. While staff assessed risks to patients and acted on them, care records these were inconsistently completed. However, the service had enough staff to care for patients and keep them safe. The service controlled infection risk. They managed medicines well.
  • Managers did not monitor the effectiveness of the service and did not have access to good information. Managers did not make sure staff were competent. However, staff provided appropriate care and treatment. Staff worked well together for the benefit of patients and supported them to make decisions about their care
  • The service did not plan care to meet the needs of all the people present at the events they attended. They took account of patients’ individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders did not run services well because of the lack of systems and processes for management, governance and the assessment and mitigation of risks. Staff were not supported to develop their skills. Staff were not clear about their roles and accountabilities.
  • They were focused on the needs of patients receiving care and the community to plan and manage services and all staff were committed to improving services continually. Staff felt respected, supported and valued and service engaged well with patients.

Following this inspection, we told the provider that it must take some actions 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 two warning notices that affected Urgent and emergency services. Details are at the end of the report.

I am placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Heidi Smoult

Deputy Chief Inspector of Hospitals Midlands, on behalf of the Chief Inspector of Hospitals

03 October 2017

During an inspection looking at part of the service

Peak Medicare Ltd is registered to provide patient transport services, triage and medical advice remotely and the treatment of disease disorder or injury.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 October 2017, along with an unannounced visit on 15 October 2017.

The ambulance service provided bespoke medical cover to sporting events including medical care and treatment on site (this is not a regulated activity and is therefore not included in this report). The care and treatment provided during conveyance to hospital is regulated and was the focus of this inspection. The inspection took place in reference to the urgent and emergency services framework. 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.

Peak Medicare Ltd operates an independent ambulance service in North Derbyshire, primarily providing first aid and emergency response at motorsport events at Buxton Speedway and the Bell Vue circuit Manchester. Additionally they provide a first aid and emergency response service at community and national events held in the North Derbyshire area.

Services we do not rate

We regulate independent ambulance services but do not, currently, have a legal duty to rate them. We highlight good practice and identify where service providers need to improve. Taking regulatory action as necessary.

We found the following areas of good practice:

  • Scheduling included a paramedic lead plus a minimum of emergency technicians or first responders.

  • All vehicles and equipment was maintained and serviced regularly.

  • All vehicles were visibly clean with established cleaning schedules with commercial deep cleaning contracts in place.

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

  • Incident reporting policy.

  • Medicines management.

  • Mandatory training & Competencies.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, to help the service improve. We also issued the provider with six requirement notice(s) that affected urgent and emergency services]. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (area of responsibility), on behalf of the Chief Inspector of Hospitals

27 February 2014

During a routine inspection

We visited Peak Medicare Limited's base in Buxton where we met with the registered manager and reviewed documents and policies. While there we saw the three ambulances that Peak Medicare Limited had in their fleet. Peak Medicare limited offer a part time ambulance service, with their main focus at speedway events.

We spoke with a member of staff employed by Peak Medicare Limited for events that they have attended. The staff member said that they were very happy working for Peak Medicare Limited and also said: 'I do not have any concerns about Peak Medicare, I hope to carry on my career progression with Peak Medicare and I understand the values they have, The staff are treated extremely well and so are our patients.'

The registered manager explained that any patients seen at an event, be they speedway riders or members of the general public are seen in the privacy of an ambulance. Should the patient require further treatment at a hospital, a 999 call would usually be made to transfer the patient. However Peak Medicare Limited has on occasion transported the patient themselves.

19 March 2013

During a routine inspection

Peak Medicare Limited offers an ambulance service to local motor sport events in the Buxton area and to at the Belle Vue stadium in Manchester. The service grew out of the need to have medical cover and ambulance services present at motor sport events, specifically speedway racing, and latterly stock car racing.

At the time of our visit the service had three ambulances, and we inspected them all. We found them to be well equipped, and there were no concerns regarding infection control or the cleanliness of the vehicles. Staff are self-employed, and work for Peak Medicare Limited as bank staff specifically for events such as speedway or stock car racing.

We spoke with the Clerk of the course at Belle Vue speedway track about Peak Medicare Limited's involvement in events at the stadium. He said: "I have worked in tandem with Peak Medicare for the last 5 or 6 seasons. I am extremely happy to work with them,the pressure for both them and me is intense on race nights and I have 100% confidence in all they do. Suffice to say ,come race night I know the riders safety is in excellent hands."