Archived: Secure Care Uk

Secure Care Uk is operated by Mr Sam Alan Bull. Secure Care Uk predominantly provides transport for adults, children and young people (CYP) with mental health disorders, as well as the transport and supervision of people in section 136 suites whilst awaiting mental health assessment. The 136 suite is a place of safety for those detained under Section 136 of the Mental Health Act (1983) by the police following concerns that they are suffering from a mental disorder. The provider had contracts with NHS trusts and independent hospitals. They also provided bed watches on request. During a bed watch, staff observed the patient continuously to maintain their safety.

We inspected this service using our comprehensive inspection methodology. This was a partial inspection of the service. The physical inspection of vehicles, ambulance station and talking with staff all took place at the provider’s address in Hastings. This inspection did not include the other sites the provider has in the North of England and in the Midlands.

We carried out the announced part of the inspection on 17 October 2017, along with an unannounced visit to the ambulance station on 25 October 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.

We regulate independent ambulance services but we do not currently have a legal duty to rate them at the time of this inspection . 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:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Staff reported all forms of restraint as incidents.
• The registered manager had an understanding of the duty of candour regulation and there was guidance on its use within the service.
• Records showed vehicles at this ambulance station had appropriate safety checks, were maintained and checked daily.
• Staff could plan appropriately for patient journeys using the information provided by the booking system.
• There was good communication between the control staff, crews and external providers.
• Staff helped patients feel comfortable and safe. Staff respected the needs of patients, promoted their well-being and respected their individual needs.
• Staff we spoke with were committed and passionate about their roles. They provided excellent care.
• The service encouraged feedback from patients through satisfaction surveys.
• Leaflets were available in different languages and in easy read format.
• Staff we spoke with liked working for the service. There was a positive 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 approachable and accessible should they require any advice.
• All staff had received appraisals.

However, we found the following issues that the provider needs to improve:

• Incidents were not adequately investigated and relevant learning was not shared with staff.
• Staff at this ambulance station did not always complete the cleaning and vehicle safety checklists.
• The external door to the ambulance station was open on arrival at the unannounced inspection.
• The service did not have equipment for children and young people.
• Oxygen cylinders were stored incorrectly.
• Management lacked awareness of safeguarding children and adults at risk.
• There were ineffective storage of patient records.
• Some of the policies and guidance were not specific to the roles, responsibilities and type of service provided.
• There were no policies or guidance for the transport of children, monitoring at 136 suites and bed watches.
• Staff were unaware of how to contact the translation service.
• Staff were unaware of the organisation’s visions and strategy for the service.
• Governance arrangements were not robust enough to identify and minimise risks. There was a lack of oversight and self-assurance to compliance with the fundamental standards.

Following the inspection, we told the provider of our intentions to place conditions on their registration for transporting children and young people (CYP). This action was taken in response to our significant concerns of the immediate risk to this patient group arising from the inadequate pre-employment checks, lack of policies, lack of equipment and lack of assurance that staff were suitable and safe to undertake this work. In response, the provider took voluntary suspension of this service until they had made all the necessary improvements. The provider submitted a statutory notification to remove under 18s from its registration.

We also used our legal powers to request information from the provider following inspection; however, the provider did not completely fulfil this request. Therefore, we have been unable to gain assurance about some aspects of staff training.

The service did not have established and effective systems and processes to assess, monitor and improve the quality and safety of the services. This was a breach of a regulation. You can read more about it at the end of this report.

We also told the provider it must take some action to comply with its registration 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 one requirement notice. Details are at the end of the report.

We informed the service of our serious concerns immediately after the inspection and took immediate action.

Amanda Stanford

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