Archived: ION Pinewood

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly using comprehensive systems to enable reviews. Staff understood and managed risks. The facilities and equipment met the needs of people, were well-maintained and clean. There was appropriate knowledge and use of PPE.

At our last assessment, we rated this key question as Requires Improvement. At this assessment, the rating has changed Good.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff reported incidents and near misses using a personal digital assistant. All staff were aware of how to raise an incident and demonstrated how to use the system. They understood what constituted an incident and said they were encouraged to report incidents.

The general manager, with support from other staff, investigated incidents.

Staff explained how information about incident and complaint investigations were used to prevent similar situations occurring in the future, with findings and resulting actions being discussed and cascaded to the team through meetings, email correspondence and staff bulletins.

Staff told us they always tried to resolve any issues or complaints at the time they were raised. If this was not possible, patients could be referred to team mentors or a more senior member of staff. There was an emphasis placed on listening to the patient to identify their needs and to address their concerns in a manner that improved outcomes for them, wherever possible.

Staff understood the need to be open and transparent with patients and give patients and families a full explanation if things went wrong. If concerns could not be resolved informally, patients were supported to make a formal complaint.

The service had processes in place to raise and review concerns from complainants effectively. Staff were able to escalate concerns and seek support from their on-call manager for advice at the time of an incident. Staff were encouraged to complete reflective practice documents, the trust provided evidence of actions and learning from these. The service’s complaints policy supported the principles of providing duty of candour and being proactive in the management of complaints, from discussions with a manager it was confirmed duty of candour was understood. Incidents were reported and logged with clear information detailing which manager was responsible for the management of the incident and what actions were to be taken.

The service had recently appointed a new operations manager to help standardise working practices between all the iON ambulance sites.

Staff had established and maintained good links with the providers who used their services. They worked together to ensure the needs of the patient were met safely by identifying and managing risks proactively and effectively. Staff told us patients were never left alone in the back of vehicles.

The service was contracted through a local ambulance provider, but the controller was responsible for covering these shifts with the appropriate teams and for allocating the required vehicles. There were 3 clinical crews, of which 2 would go to a hospital base and 1 would remain at the home base. Staff showed that they knew their vehicles and what was required onboard including emergency equipment and sharps bins.

Staff received training specific to their role on how to recognise the signs of abuse and training was actively ongoing. Staff reported they felt comfortable escalating issues to leadership, they used a personal digital assistant to report safeguarding referrals. They demonstrated a good understanding of what constituted abuse and gave examples of when they had raised safeguarding concerns in the past, however there had been no safeguarding incidents in over 6 months.

Staff had received Mental Capacity Act training and consent training, they had a good understanding of informed and implied consent and discussed how they supported patients who may lack capacity.

Safety was promoted in recruitment procedures and employment checks. Enhanced Disclosure and Barring Service (DBS) checks were completed and reviewed before staff worked for the service. DBS checks help employers make safer recruitment decisions and help prevent unsuitable people from working with vulnerable groups.

The service had up to date policies for safeguarding and the data provided showed all staff had completed level 1 and 2 adult and children safeguarding training. Clinical staff were taught level 3 safeguarding with annual refreshers. The service provided thorough safeguarding referral forms which were to be completed when referring to safeguarding authorities. Safeguarding information was reported to their partnered ambulance provider. These forms included prompts to ensure the staff completing them had given adequate detail and informed the appropriate teams internally and externally.

Key information to keep patients safe was shared with crew members via their personal digital assistants. If staff had concerns, they could communicate with the base controller and clinical leads for support or clarification.

Staff understood behaviours that could be challenging and demonstrated their abilities to de-escalate scenarios if needed. Relevant staff had completed Prevention and Management of Violence and Aggression (PMVA) course. This gave staff the knowledge and skills to effectively manage and reduce the risks when working with complex patients. Staff were trained in restraint and knew it was only to be used as a last resort. Restraint had not been used in the service and crews were proud they had effectively managed patients without this being needed.

The service had policies in place to ensure care was safe and risks were managed. Staff were competent and understood the need for consideration and proportionate approach when assessing a patient. Staff were communicative with their patients and involved them in their care to ensure person-centred care was provided.

Staff told us there was enough vehicles and equipment to deliver the service provision and to provide safe care to patients. The ambulance station shared their facilities with the patient transport service (PTS). In addition, the service had specialised secure mental health and bariatric vehicles.

Staff reported the site was a work in progress, but that there were plans to smarten and develop it.

The station had CCTV cameras which monitored areas for security purposes. There was signage indicating the use of CCTV. There was CCTV available in the vehicles for which one manager had access to the footage.

Following the acquisition of additional space the service was in the process of designing and re-developing the area. The current buildings had been made safe and secure. Only authorised personnel could access areas where records and computers were kept; a staff pass code was required to enter. Most areas were clutter-free, however, the equipment store was untidy and cluttered. It was supposed to be locked, however, it was observed on more than one occurrence to be unlocked. The main drugs storage area was left with the key in the door, but this was quickly resolved. We identified concerns with a sharps bin in which a controlled drug was seen inside and would be easy to retrieve. A sharps bin had been dated from 2021 but had not yet been collected. The temperature probe in this room was not working. We were told the monitoring of temperature in the medicine storage room would alert to two managers, however both those managers were both off on this day. We were informed this was a one-off and records were provided to evidence this. Staff understood the concerns and the need to rectify them.

All vehicles were visibly clean and appeared to have regular reviews. The service had enough suitable equipment to ensure safe care for patients. Staff completed daily vehicle checks prior to the start of their shifts to make sure vehicles were road worthy and equipment was operational. The equipment reviewed was maintained and fit for purpose and staff had been trained how to use it properly. Fire extinguishers were suitably restrained and the cupboards were closed and organised on the vehicles.

The service had processes in place to track vehicle cleaning, maintenance and servicing. The documentation we reviewed showed the vehicles were compliant with road tax and MOTs. Vehicle checks were completed on the personal digital assistants which were allocated to each vehicle. If faults were identified, these flagged and senior staff would decide the course of action such as immediate repair or if the vehicle was to be taken off the road. The station kept records regarding the status of their vehicles which showed the service had a good overview of their fleet. Keys to the vehicles were stored securely in locked cupboard and key safes when outside of the driver’s possession which meant vehicles could not be used without authorisation.

Dedicated staff were responsible for checking and replenishing any consumables. Consumables storerooms were tidy and well organised. We checked a sample of consumable items for expiration dates in the storeroom and on the vehicles and found they were in-date.

There were safety systems in place to ensure clinical waste was managed responsibly with training provided for staff at induction.

The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care.

Rotas and shift patterns were aligned to demand by senior staff. There was an internal system staff used if a shift needed to be filled last minute, i.e. due to sickness. Flexible working was facilitated to fit around people’s personal circumstances, if needed.

There were robust and safe recruitment and induction practices to make sure all staff were suitably experienced, competent and able to carry out their role.

Once employed by the service, in addition to mandatory and statutory training, staff were encouraged to attend training courses, such as the first response emergency care level 3 (FREC3) course and prevention and management of violence and aggression (PMVA) course.

Managers supported staff to progress through development meetings and yearly constructive appraisals of their work. Staff had the opportunity to discuss training needs and were supported to develop their skills and knowledge. Staff told us they found the appraisal process useful and they were encouraged to identify any learning needs they had, and any training they wanted to undertake.

Staff required to drive in their role completed a driving assessment and driving was continuously assessed by the station team mentors. If needed, staff would be referred back to the operations manager, who was a driving trainer, for retraining.

Debrief sessions were arranged, if needed, to support staff and to improve services following any significant events or incidents. We spoke with many staff who felt opportunities for personal and professional progression were good within the organisation.

The staff knew when they were assigned to work and were crewed appropriately to ensure safe staff skill mix levels. Staff with the relevant training and qualifications were assigned by the control team to the appropriate vehicle to carry out their duties. There were processes in place to ensure staff had regular appraisals with training and skills documented and updated. Crews were built of paramedics which operated as emergency medical technicians for the partnered local ambulance service as the organisation did not have a controlled-drugs license.

Poor or variable performance was identified through the appraisal process, complaints, incidents and feedback. Staff were supported by their managers to improve their practice where indicated.

There were robust and safe recruitment and induction practices to make sure all staff were suitably experienced, competent and able to carry out their role.

Staff had access to and used personal protective equipment (PPE) for example disposable aprons, face masks and gloves. Hand sanitisers, clinical wipes and PPE were available on all vehicles we reviewed.

The ambulance station offices and communal areas we reviewed were mostly visibly clean and tidy. There were notices detailing the importance of arms being bare below the elbow and there were posters displaying hand washing techniques at sink areas.

We found equipment on vehicles designed to prevent and control infections and manage any bodily fluid spillages. This included vomit bowls, urine bags, and spill kits. These kits enabled staff to clean safely and effectively. The vehicles we viewed were cleaned to a high standard with PPE, decontamination wipes and hand sanitisers available.

The station had dedicated areas where vehicles would be cleaned, including a power-washer for cleaning the exteriors of vehicles.

We were told linen was returned to clinical locations and not laundered with the organisation.

A whiteboard was used to document once a vehicle had been cleaned. We were told deep cleans were completed in house. We found the vehicles we inspected were clean, tidy and well prepared.

The cleaning supplies room was clean and organised, with hot water available.

The service had an infection prevention and control policy in place. Senior staff carried out infection prevention and control audits to make sure staff were following current relevant national guidance. The risk register had oversight of risks including maintaining PPE supplies, undertaking hand hygiene audits and monitoring sickness trends, these would be discussed and reviewed at weekly meetings with the operations manager and head of HR.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.