Outdoor Medical Solutions Limited

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• 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

This means we looked for evidence that people were protected from abuse and avoidable harm. We reviewed the safety of people’s care and assessed whether the service had suitably trained staff and appropriate equipment to meet people’s needs. We also checked how the service communicated with other care providers to support continuity and safety of care.

At our last inspection we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

There was enough, suitably trained staff to keep people safe. There was a good incident reporting culture, and processes for learning to be shared. The service worked with people and other care providers to understand and manage risk.

Vehicles were visibly clean and adequately stocked. Staff understood infection control procedures. Medicines were managed well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learned to continually identify and embed good practice.

Incident reporting and duty of candour policies provided guidance to staff and subcontractors, and set out the workflow, responsibilities and timelines for incident reporting. Managers used systems to monitor incidents in line with policies and procedures.

Staff understood what incidents needed to be reported and they knew the reporting process. Records showed incidents were investigated and actions taken to share learning. Staff received verbal debriefs, with written documents required for more serious incidents. Leaders told us information and learning from incidents was shared with the hospital during weekly check-ins and monthly meetings.

Records showed managers completed audits of incidents and identified themes and trends. Learning from incidents was shared with staff.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The booking process captured information needed to provide good quality care. Staff followed processes to identify and plan resources for transports.

Staff told us the information received was occasionally incorrect, such as the wrong address. However, this information mainly came from the hospital, so was not due to the provider. Staff knew how to contact the hospital directly to resolve any issues.

Healthcare professionals working with the service told us communication was good, and ambulance crews provided a verbal handover to nurses upon arrival and passed on any important information.

Staff and subcontractors received training to ensure their own health and safety and that of others, supported by company policies.

The evidence showed a good standard.. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The service had up-to-date policies and procedures which defined staff responsibilities and detailed how to report safeguarding concerns for adults, children and young people.

Staff understood the safeguarding process and knew how to identify safeguarding concerns. They received role specific training in safeguarding adults and children. Staff completed training to level 3. The service had a safeguarding lead who was trained to level 5.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The hospital highlighted patient risks when necessary. Staff also knew who to contact for clinical support or to escalate concerns. There was an up-to-date escalation procedure for staff to follow when a patient’s health deteriorated during a non-emergency transfer.

We observed staff confirming key health information, such as allergies, with patients. Staff took time to ensure patients were comfortable, offering support while promoting independence whenever possible.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out daily checks to ensure vehicles were safe. Vehicles had up to date insurance, tax and MOT certificates, and were routinely inspected for safety.

The vehicles we inspected were clean and in good condition, with the required equipment, including satellite navigation, emergency equipment, bariatric stretchers and equipment specific for children. Vehicles had CCTV, for the safety of crews and people being transported.

There were processes to check the quantities of stock on vehicles. Vehicles carried suitable equipment in sufficient quantities to support patient care. Consumable products in vehicles and at base were in-date and suitable to use. Consumable supplies were stored in a locked cupboard at the base. However, we saw some masks were open to the environment and could be at risk of contaminations. We told staff, who removed them immediately.

The service had a process to check equipment was safe to use. Electrical equipment was safety checked. All equipment we checked was within the electrical safety date. There was a process to ensure defective equipment was removed from use.

Chemicals or substances hazardous to health (COSHH) were stored securely. COSHH risk assessments had been completed and were available for staff.

The Business Continuity and Adverse Weather policies outlined how the service planned to maintain operations and ensure access for all service users in the event of internal disruptions, such as utilities failures, as well as external challenges related to the geographical location and adverse weather conditions.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service employed enough staff to meet the needs of service users. Staff told us there were sufficient levels of staff to complete transfers safely. Leaders checked paramedics were registered with the Health and Care Professions Council (HCPC) both before and regularly during employment.

Recruitment files were checked and found to contain proof of identification, Disclosure and Barring Service (DBS) checks, references and employment history.

Staff received a company induction covering the initial training requirements for the role, as well as a 3-month probation review, as documented in company policy.

Staff completed a driving assessment as part of their induction, and driving standards were monitored regularly via a key fob system. Annual checks of driving licences were completed.

There was a schedule of mandatory training modules for all staff that was documented in company policy. There were processes to monitor and manage completion of training.

The staff were all self-employed, so did not receive annual appraisals, but there were regular feedback and one-to-one conversations. Staff performance was managed according to company policy.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

The service had up-to-date infection prevention and control (IPC) policies and procedures. The role of IPC lead was shared between the Managing Director and the Administration and Compliance Manager, who were responsible for ensuring the IPC policy was up-to-date and followed best practice guidance. They also monitored IPC practices by undertaking audits that covered cleanliness, inspections of personal protective equipment (PPE), sharps management, and observation of hand hygiene and PPE use.

Staff were alerted when patients posed a risk of infection. The service supplied appropriate personal protective equipment (PPE) for staff to carry out their duties safely.

Staff cleaned the vehicles daily, as well as after a person had been transported. The vehicles were deep-cleaned at least every 10 weeks. Testing was completed to check the effectiveness of cleaning.

Staff received training in preventing the spread of infections. If vehicles needed deep cleaning between jobs, staff told us they would travel back to base or use hospital equipment.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Responsibilities for medicines management were clearly defined within the Medicines Management Policy. Staff working at the service delivering care were guided by a set of Medicine Administration Protocols (MAPs) provided by the service. These MAPs detailed the safe management requirements for each medicine, including clear identification of the staff authorised to administer them by the Medical Director.

Although staff did not routinely administer medicines during patient transport, they were authorised and trained to administer oxygen if required.

Oxygen cylinders were in date and stored securely in line with national guidance.