6 and 7 October 2016
During an inspection looking at part of the service
Work & Activity First Aid Limited, (trading as WAFA Emergency Medical Vehicles) was a private, family-run ambulance service that provided patient transport and high-risk transfer services. They had a contract to provide patient transport services for the local council, they carried out various patient transport and transfer work for the NHS on a sub-contractor basis, and provided services on request from organisations and individuals.
We carried out an unannounced inspection of Work and First Aid Activity (WAFA) on 6 and 7 October 2016. This was a focused unannounced inspection (focusing on key areas of the service) in response to concerns received about the safe care and treatment of service users.
Our inspection focused on three out of the five key questions to assess whether the ambulance services provided were safe, effective, and well-led. During the inspection, we noted information relevant to the responsive domain and this is included in this report. We did not inspect the caring domain.
The provider operated from a single location, an ambulance station. There were no other locations registered as part of this business.
CQC does not currently have the power to rate independent ambulance services.
Our key findings were as follows:
- Staff did not always recognise concerns, incidents or near misses. When concerns were raised or things went wrong, the approach to reviewing and investigating causes was insufficient. There was little evidence of learning from events or action taken to improve safety.
- There were no mechanisms in place to provide staff with appropriate training to perform their role, and no assurance that all staff had received mandatory or other role specific training.
- WAFA did not have systems and processes implemented for identifying and reporting safeguarding concerns and staff did not fully understand how to raise or report safeguarding concerns.
- There was a failure to assess the risk of, and to prevent, detect and control the spread of infection.
- Premises, equipment and facilities were not risk assessed, maintained or serviced in a way that kept people safe from harm.
- WAFA failed to ensure the proper and safe management of medicines. Arrangements for managing medicines and medical gases did not keep patients safe.
- Management, storage, completion or retrieval of patient records was not sufficient to keep people safe from harm.
- Managers did not have an understanding of risk or its management relating to patient safety or the business. There were no processes or systems in place for the identification of, capturing, and managing of risks to people who use the services. Opportunities to prevent or minimise harm were missed.
- WAFA failed to ensure all staff had the relevant employment and registration checks before or during their employment. This put vulnerable patients at risk of abuse or harm.
- Safety was not a sufficient priority. There were no systems in place to assess, monitor and improve quality and safety. There was no evidence of measurement or monitoring of safety performance.
- There was insufficient assurance in place to demonstrate that people received effective care. There was no system in place for monitoring people’s outcomes of care and treatment.
- WAFA did not provide any evidence that relevant and current evidence-based guidance, standards, best practice and legislation were used to develop how services, care and treatment were delivered. Care or treatment was based on discriminatory decisions rather than an assessment of a person’s needs.
- WAFA did not operate an effective system to ensure the staff employed were suitably qualified and competent as required under Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Arrangements for recruitment and for using temporary staff did not keep people safe at all times.
- There was limited understanding of the Mental Capacity Act 2005 and consent. Processes and systems did not allow for concerns to be recorded and acted upon.
- Restraint and deprivation of liberty were not recognised and there were no processes or systems in place to guide staff where restraint and deprivation of liberty may apply.
- There were no systems and processes to manage concerns or complaints and no evidence the service used concerns and complaints to improve the quality of care.
- Leaders did not have the necessary knowledge, or capability to lead effectively. The registered manager had no understanding of the Health and Social Care Act 2008, or what his responsibilities were to ensure compliance.
- Governance systems and processes were not in place or operated effectively to assess, monitor and improve the quality and safety of the service.
- There was no process for carrying out audit, and opportunities for continuous improvement and learning were missed.