Archived: Devon and Cornwall Ambulance Service

Updated 6 August 2018

Devon & Cornwall Ambulance Service is operated by Devon & Cornwall Ambulance Service Ltd and undertakes the following regulated activities:

Transport services, triage and medical advice provided remotely.

Treatment of disease, disorder or injury.

The service was registered with CQC in April 2018 and so has not been inspected previously by CQC. It is a small independent ambulance service located in Bude,Cornwall. The service has one ambulance and a small staff team with the only permanent staff being the management team. The service covers the south west and wider country with patient transport and from air ambulance locations to hospital or home. The service provides events cover, which is not within the scope of this inspection.

The service has had a registered manager Mr Jamie Sprake, in post since April 2018.

Updated 6 August 2018

Devon & Cornwall Ambulance Service is operated by Devon & Cornwall Ambulance Service Ltd. The service offers ambulance transport under the regulated activities of:

Transport services, triage and medical advice provided remotely.

Treatment of disease, disorder or injury.

The service also provides outside of CQC scope event cover and medical repatriation. In England, the law makes event organisers responsible for ensuring safety at the event is maintained, which means that event medical cover comes under the remit of the Health & Safety Executive. The activities at Devon & Cornwall Ambulance Service regulated by the CQC are transport services, triage and medical advice provided remotely and the treatment of disease, disorder or injury.

The non-event service at Devon & Cornwall Ambulance service is small. The service had been registered with CQC on 14 April 2018 and the management told us they had undertaken approximately four journeys since then. These had all been transfers of patients to their homes, from a variety of locations. We requested information from the provider regarding the scale of the service, but this was not provided. The provider does not have any commissioning agreements and no formal written service level agreements with other providers.

Following concerns raised with us we carried out a focussed unannounced visit on 14 May 2018 and looked specifically at the areas of safe and well led. We inspected this service using our focused inspection methodology.

Throughout the inspection, we took account of 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 found the following issues that the service provider needs to improve:

• There were no systems to record and receive feedback from incidents. Learning from incidents was not evident. There was no evident track record for patient safety.
• There was no evidence that mandatory training was completed to keep patients safe.
• There were no systems, processes or practices available to allow frontline staff to report adult and children safeguarding incidents.
• An adequate standard of cleanliness and hygiene was not maintained and so placed patients and those involved in the service at risk of cross infection.
• We found the provider did not have a safe management and administration system for ensuring all clinical equipment was working properly.
• There was no audit or checks to establish consumable items and sterile supplies were in date and safe for use.
• There was no audit trail of where the above equipment had come from and stock numbers would indicate they had all come from different batch sources.
• The management of medicines was inadequate and unsafe. This included the records of how and when medicines were obtained, records of administration and disposal, stock checks and security.
• The storage of medical gas cylinders was not safe and secure and placed staff and patients at risk.
• Patient records were not stored securely and risked a breach of patient confidentiality.
• The assessment of patient risk was not completed and so patient safety could not be assured. There were no assessments and safety checks for monitoring and managing risks to patient and staff safety.
• Skill mix and how competencies were maintained were not available and so patient safety could not be assured.
• Recruitment procedures to ensure the safety of service users were not recorded.
• The director of operations was unclear about how auditing at the company took place and so quality measurement and assessment of the service was not undertaken.
• There was a lack of processes to assess, monitor and mitigate the risks relating to the health and safety and welfare of patients and others.
• The leadership team did not have the capability to run the service effectively due to the lack of understanding of responsibilities, scope and use of governance.
• There was no evidence that culture of the service was part of the director’s focus or direction.
• There were no systems to seek the views of the public and staff about the service available. There was no evidence or assurances Devon & Cornwall Ambulance was engaging with the public or its staff.

As a result of the above, CQC urgently suspended registration of the following regulated activities until 15 August 2018 to allow the provider to address the issues identified at the inspection:

Transport services, triage and medical advice provided remotely.

Treatment of disease, disorder or injury.

This means the provider cannot carry out these regulated activities. We will re-inspect the service before this date to gain assurance that sufficient progress has been made to ensure the service meet standards of quality and safety, before lifting the suspension of registration.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

Updated 6 August 2018

Devon & Cornwall Ambulance Service is operated by Devon & Cornwall Ambulance Service Ltd and has one ambulance. The service provides a patient transport service to a range of places including hospitals, clinic appointments and their homes. The service provides a repatriation service from air ambulance flights to hospitals. The service has been registered with CQC since 14 April 2018 and had undertaken approximately four journeys.