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 clean and well-maintained. There was appropriate knowledge and use of PPE.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The vehicles displayed clear information on how to provide service feedback. Complaints could be made in person, telephone, mail, by QR code or by email.

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 though 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 service 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.

Patient’s views were sought through feedback. These forms included the likelihood of recommending the service, the politeness of the crew, the cleanliness of the vehicle and the overall satisfaction from the quality of the service.

The majority of feedback was very positive with many commenting on the friendliness of the staff.

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 transport 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.

There were systems in place to ensure risk assessments were undertaken when patients were booked, staff exhibited that they would know what risks there were and what to expect prior to attending the patient. For example, we saw records of a person who had a high BMI, staff recognised this would require a higher number of crew to attend with specialist equipment to transport the person safely.

The service followed policies and procedures to ensure safe management of patient’s care.

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, however there had been no safeguarding incidents in over 6 months.

Staff had received training on the Mental Capacity Act 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. These forms included prompts to ensure the staff completing them had given adequate detail and informed the appropriate teams internally and externally.

Staff told us patients had their individual risks assessed when a journey was booked. This included information on mental health issues, safeguarding, do not attempt cardiopulmonary resuscitation orders (DNACPR) and patients who were at risk of a fall. Transport was then booked depending on the patient’s requirements. For example, the number of crew, type of vehicle or specialist equipment needed.

Key information to keep patients safe was shared with crew members via their personal digital assistants at the start of their shifts.

Crews would make a dynamic risk assessment prior to each journey to reduce risks. If they had concerns, this would be communicated to the base controller for support or clarification.

Due to the nature of the service, clinical observations of physical indicators such as pulse, heart rate and oxygen saturation level were not undertaken during routine journeys.

Staff were trained in basic life support (BLS) should a patient deteriorate during a journey. Staff were expected to call 999 for an emergency ambulance should they identify a deteriorating patient who needed urgent support.

Staff who carried out secure mental health transport journeys 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 transporting 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.

Control staff completed booking forms with up-to-date and current data to ensure the crew had the most useful and relevant information available, including triggers and risks.

Patients felt the service provided was good and most people found the crew to be very polite. Most service users felt likely to recommend the service and overall felt very satisfied.

Staff told us there was enough vehicles and equipment to deliver the service provision and to provide safe care to patients.

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

The ambulance station shared their facilities with the front-line service. The service had multiple vehicles that could be used for PTS. The station and vehicles had CCTV cameras which monitored areas for security purposes. There was signage indicating the use of CCTV. Following the acquisition of additional space the service was 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 and the monitoring of temperature in the medicine storage room. Staff understood the issues and the need to rectify them. All vehicles were visibly clean and appeared to have regular reviews. Staff completed daily vehicle checks prior to the start of their shifts to make sure vehicles were road worthy and any specialised equipment such as emergency equipment on the secure mental health transfer vehicle were operational. The equipment reviewed was maintained and fit for purpose and staff had been trained how to use it properly. Cupboards were closed and organised on the vehicles. The service had enough suitable equipment to ensure safe care for patients. This included the specialised equipment required for transporting complex patients such as bariatric patients and secure mental health transfers.

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 (PDAs) 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 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.

Once employed by the service, in additional 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 regular 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.

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.

We reviewed patient feedback and saw patients felt the crews operated clean vehicles with the majority reporting the cleanliness of the service as ‘extremely clean’.

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 were 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 by 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.

Senior staff carried out infection prevention and control audits to make sure staff were following current relevant national guidance.

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