Archived: South West Specialist Medics Ltd

Updated 30 November 2017

South West Specialist Medics provide a private ambulance service for patient transport in the UK. They collect patients from inbound flights to Bristol, Cardiff, London and Oxford airports, taking them on to their final destination. Southwest Specialist Medics also provide services to transport patients between UK destinations, such as care homes and hospitals. They provide ambulances and staff for these journeys.

Southwest specialist medics are registered with the Care Quality Commission to provide the following regulated activities:

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

South West Specialist Medics is operated by Southwest Specialist Medics Ltd. The service was registered with CQC in September 2016. It is an independent ambulance service operating from its base in Bristol. The registered manager for the service is Mr Stephen Wakeham who has been in post since September 2016. This was the first time the service had been inspected since its registration.

Summary

This was a focused inspection and therefore we did not inspect all domains. We inspected the safe and well-led domains, and also covered some aspects of the effective domain. We did not inspect the caring or responsive domains.

We found:

• Incidents that affected the health, safety and welfare of people using services were not investigated and actions were not taken to prevent recurrences.
• There was no record keeping for medicines being kept by the registered manager. We could not be provided with receipts or stock documents saying what he had or what was out with the ambulances.
• We were told all medicines were locked away in the cupboard in the registered manager’s office. When we inspected the ambulance we found there were packets of paracetamol in the cab doors. There were saline and glucose drips in a cupboard in the ambulance and the registered manager’s medical bag was also being stored there. The registered manager then left the medical bag, including the medicines, with a member of the public during the afternoon of the inspection.
• We found some consumables were out of date, including testing strips for blood glucose machines. We also found that alcohol wipes were used with the glucose machine, which could interfere with the results.
• There were no procedures or processes in place to make sure people were protected from abuse. There was no scrutiny or oversight of safeguarding.
• Although there was a safeguarding policy it was not fit for purpose. It described the process of reporting concerns or alerts to the police, but not the local authority. There was also nowhere identified for the recording of safeguarding incidents or any subsequent reporting and investigation.
• The safeguarding policy had a signatory sheet for all staff to confirm they had read and understood it. When asked, the registered manager said staff kept a copy of this and he could not provide assurance that all staff had read or understood the policy. The registered manager went on to say that safeguarding was covered in the staff handbook. There was no reference to safeguarding in this handbook at all.
• The ambulance was not kept clean. There was physical dirt and dust in the vehicle and in some areas there was rust. There were sweets on the floor and empty drinks bottles under the patient chairs. The ambulance looked physically dirty inside. There were no cleaning schedules or evidence that cleaning had taken place in any of the ambulances. This meant there was no way to identify shortfalls in infection control and take action as necessary.
• Although there was evidence that the vehicle we saw had equipment checks completed, they were not done to a high standard. The checklist stated the suction unit, defibrillator and heart monitor had been checked. However, when we looked at these items we found they did not have service stickers on them and could not get assurance from the provider that they were safe to use.
• There were no systems and processes in place for the provider to monitor thee service against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As there were no monitoring processes in place there was nothing to enable the provider to identify if safety and quality was being maintained.
• There were no systems or processes in place such as regular audits of the service to assess, monitor, and improve the quality and safety of the service. This was despite various policies identifying audits were required. The systems and processes were not continually reviewed to ensure they were fit for purpose.
• There were limited processes in place to seek feedback from people who used the service. The provider had no intention to review how feedback was collected or to use any feedback that was received to improve the service.
• There were no policies and procedures for obtaining consent to care and treatment. There were no policies or procedures that referred to patient consent and staff had no training in relation to consent, or the Mental Capacity Act 2005. There was no documentation, for example a patient care record, to confirm consent had been gained for care or treatment.
• The registered manager was unable to demonstrate they had the appropriate knowledge of applicable legislation including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014or understood the consequences of failing to take action on set requirements.
• We asked the registered manager how he was assured he was fulfilling the requirements of the Health and Social Care Act but he was unable to answer the question or provide us with any assurances.
• Some policies and procedures used by the organisation were copied from other organisations and had not been adapted to make them fit for purpose for the provider. These included the medicines management policy, the medicines competency assessments, and the risk register.

Updated 30 November 2017

South West Specialist Medics is operated by Southwest Specialist Medics Ltd. The service provides a patient transport service, as well as an emergency and urgent care service at events. Event only work is currently outside our scope of registration; therefore, we did not inspect this area of the provider’s service.

We inspected this service using our focused inspection methodology. We carried out an inspection on 28 July 2017 with 24 hours’ notice given to the provider to follow up on concerns we had received. We attempted to revisit the service and inspect further on 8th August 2017, but were unable to get a response when we arrived.

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? We did not inspect caring or responsive as part of this inspection, and due to significant concerns being found in the safe, effective and well-led domains we were unable to inspect these domains in their entirety.

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 are currently undertaking enforcement action against this provider and will publish the details of this once the processes have concluded. Following the inspection, a letter of concern was sent to the provider, detailing key concerns.

During this inspection we found:

• Incidents that affected the health, safety and welfare of people using services were not investigated and actions were not taken to prevent recurrences.
• There was no record keeping for medicines being kept by the registered manager.
• Medicines were not stored securely.
• We found some consumables were out of date, including testing strips for blood glucose machines.
• There were no procedures or processes in place to make sure people were protected from abuse. There was no scrutiny or oversight of safeguarding.
• Although there was a safeguarding policy it was not fit for purpose. There was no evidence staff had read the policy or had received training in safeguarding.
• The ambulance was not kept clean. There was physical dirt and dust in the vehicle and in some areas there was rust.
• Equipment in the ambulances did not have service stickers on them and we could not get assurance from the provider that they were safe to use.
• There were no cleaning schedules or evidence that cleaning had taken place in any of the ambulances.
• There were no systems and processes in place for the provider to monitor the service against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• There were no systems or processes in place such as regular audits of the service to assess, monitor, and improve the quality and safety of the service.
• There were limited processes in place to seek feedback from people who used the services. When feedback was received there was no processes in place to share the feedback with staff or make improvements to the service.
• There were no policies and procedures for obtaining consent to care and treatment. There was no documentation, for example a patient care record, to confirm consent had been gained for care or treatment.
• The registered manager was unable to demonstrate they had the appropriate knowledge of applicable legislation including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• The registered manager could not provide any assurance that the Health and Social Care Act was being adhered to.
• Some policies and procedures used by the organisation were copied from other organisations and had not been adapted to make them fit for purpose for the provider. These included the medicines management policy, the medicines competency assessments, and the risk register.

Professor Edward Baker

Chief Inspector of Hospitals

Updated 30 November 2017

This was a focused inspection and therefore we did not inspect all domains. We inspected the safe and well-led domains, and also covered some aspects of the effective domain. We did not inspect the caring or responsive domains.

We found:

• Incidents that affected the health, safety and welfare of people using services were not investigated and actions were not taken to prevent recurrences.
• There was no record keeping for medicines being kept by the registered manager. We could not be provided with receipts or stock documents saying what he had or what was out with the ambulances.
• We were told all medicines were locked away in the cupboard in the registered manager’s office. When we inspected the ambulance we found there were packets of paracetamol in the cab doors. There were saline and glucose drips in a cupboard in the ambulance and the registered manager’s medical bag was also being stored there. The registered manager then left the medical bag, including the medicines, with a member of the public during the afternoon of the inspection.
• We found some consumables were out of date, including testing strips for blood glucose machines. We also found that alcohol wipes were used with the glucose machine, which could interfere with the results.
• There were no procedures or processes in place to make sure people were protected from abuse. There was no scrutiny or oversight of safeguarding.
• Although there was a safeguarding policy it was not fit for purpose. It described the process of reporting concerns or alerts to the police, but not the local authority. There was also nowhere identified for the recording of safeguarding incidents or any subsequent reporting and investigation.
• The safeguarding policy had a signatory sheet for all staff to confirm they had read and understood it. When asked, the registered manager said staff kept a copy of this and he could not provide assurance that all staff had read or understood the policy. The registered manager went on to say that safeguarding was covered in the staff handbook. There was no reference to safeguarding in this handbook at all.
• The ambulance was not kept clean. There was physical dirt and dust in the vehicle and in some areas there was rust. There were sweets on the floor and empty drinks bottles under the patient chairs. The ambulance looked physically dirty inside. There were no cleaning schedules or evidence that cleaning had taken place in any of the ambulances. This meant there was no way to identify shortfalls in infection control and take action as necessary.
• Although there was evidence that the vehicle we saw had equipment checks completed, they were not done to a high standard. The checklist stated the suction unit, defibrillator and heart monitor had been checked. However, when we looked at these items we found they did not have service stickers on them and could not get assurance from the provider that they were safe to use.
• There were no systems and processes in place for the provider to monitor thee service against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As there were no monitoring processes in place there was nothing to enable the provider to identify if safety and quality was being maintained.
• There were no systems or processes in place such as regular audits of the service to assess, monitor, and improve the quality and safety of the service. This was despite various policies identifying audits were required. The systems and processes were not continually reviewed to ensure they were fit for purpose.
• There were limited processes in place to seek feedback from people who used the service. The provider had no intention to review how feedback was collected or to use any feedback that was received to improve the service.
• There were no policies and procedures for obtaining consent to care and treatment. There were no policies or procedures that referred to patient consent and staff had no training in relation to consent, or the Mental Capacity Act 2005. There was no documentation, for example a patient care record, to confirm consent had been gained for care or treatment.
• The registered manager was unable to demonstrate they had the appropriate knowledge of applicable legislation including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014or understood the consequences of failing to take action on set requirements.
• We asked the registered manager how he was assured he was fulfilling the requirements of the Health and Social Care Act but he was unable to answer the question or provide us with any assurances.
• Some policies and procedures used by the organisation were copied from other organisations and had not been adapted to make them fit for purpose for the provider. These included the medicines management policy, the medicines competency assessments, and the risk register.