Archived: SMS Base

Updated 2 October 2019

SMS Base is operated by Salop Medical Services (UK) Ltd . The service registered with us in April 2018. It is an independent ambulance service in Telford, Shropshire. The service primarily serves the communities of the Shropshire, but also facilitates the transfers of adults and children transfers out of the county.

The service has had a registered manager in post since it registered with us. The registered manager is also the provider/company director.

The service is registered to provide a patient transport service. People who used the service were supported by staff during transportation between services such as; their own homes, hospitals and care homes. The service had completed 129 patient transport jobs from 1 January 2019 to 8 July 2019. The provider had two ambulances that were used for this purpose.

At the time of this inspection seven staff were contracted by the provider to carry out patient transport work.

This was the service’s first comprehensive inspection.

Updated 2 October 2019

SMS Base is operated by Salop Medical Services (UK) Ltd . The service is registered to provide a patient transport service. People who used the service were supported by staff during transportation between services such as; their own homes, hospitals and care homes.

During our inspection we identified that the service was also providing treatment of disease, disorder or injury in the form of emergency and urgent care during transportation from events to emergency departments. The service was not registered to do this and was therefore carrying on a regulated activity unlawfully. We informed the provider of this and requested that they stopped providing this part of their service until they were registered with us correctly.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 9 July 2019.

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 staff told us, what records showed and how the provider understood and complied with the Mental Capacity Act 2005. Due to the type of service, we were unable to observe patient care or speak with people who had used the service.

This was the service’s first comprehensive inspection. We rated it as Inadequate overall.

We found areas of practice that were inadequate:

• The service did not ensure staff completed mandatory training in key skills to enable them to safely carry out their roles. This meant we could not be assured that staff knew how to care for patients safely and protect them from harm.

• Staff did not have the required level of training on how to recognise and report abuse. Staff did not always understand how to protect patients from abuse. Safety systems and processes did not keep people safe.

• Effective systems were not in place to ensure people were protected from the risk of infection. Suitable equipment and control measures to protect patients, themselves and others from infection were not in place on the ambulances. We could not be assured that ambulances were cleaned in accordance with best practice guidance.

• The vehicles used to transport patients and the equipment within them were not safe or adequately maintained. This placed people who used the service at risk of harm. We could not be assured that staff and visitors to the service’s registered premises were protected from the risks associated with fire.

• Staff did not complete risk assessments for patients. Therefore, we were not assured that risks to patients and staff were removed or minimised risks.

• Staff identified patients who were clinically deteriorating. However, we could not be assured that appropriate action was taken to ensure the safety and wellbeing of deteriorating patients.

• The provider could not evidence that 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 and treatment.

• Staff did not keep detailed records of patients’ care and treatment. Records that were maintained were not clear. This meant we could not be assured that patients had received safe care.

• We could not be assured that staff gave administered medicines in line with national guidance. This placed people at risk of harm.

• The service did not manage patient safety incidents well. Staff did not always recognise incidents and near misses and they did not always report them appropriately. There was limited evidence to show that the registered manager investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations.

• The service could not evidence that care and treatment was based on national guidance and evidence-based practice, meaning that patients could receive ineffective care.

• Staff could not show that they assessed patients’ food and drink requirements to meet their needs during a journey. This placed patients at risk of receiving inappropriate and unsafe support with regards to their nutrition and hydration needs.

• The service did not monitor any agreed response times so that they could facilitate good outcomes for patients.

• The service did not make sure that staff were competent in their roles, placing patients at risk of receiving ineffective care. The registered manager did not appraise the staff’s work performance and did not hold supervision meetings with them to provide support and development.

• We were unable to establish if the staff worked effectively with other agencies to provide good care.

• We were unable to establish if staff gave patients practical support and advice to lead healthier lives.

• There were no records to evidence that national guidance was followed to gain patients’ consent. Staff did not receive the training required to ensure they knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. This placed patients at risk of receiving care in an unlawful manner.

• The service did not plan and provide care in a way that met the needs of local people and the communities served.

• The service did not take into account the individual needs and preferences of patients, meaning that people may not be able to access the care they need.

• Accessible systems were not in place to ensure people could give feedback and raise concerns about care received. People and their families were not invited to express their views on the care and support provided by the service.

• At the time of inspection, the registered manager/provider did not have the knowledge and skills required to manage the service and staff safely and effectively, therefore we were not assured that they had the capacity to deliver high-quality, sustainable care. However, they were visible to the staff.

• There was no current strategy in place that detailed realistic objectives and plans for high-quality and sustainable delivery of care. The service had no statement of vision or values in place for staff to strive to achieve.

• Systems were not in place to ensure the service had an open and honest culture.

• Effective governance processes were not in place to assess, monitor and improve the safety and quality of care.

• Systems were not in place to manage performance effectively. Risks were not identified and action was not taken to reduce their impact. This placed patients and staff at risk of harm.

• Information that staff required to provide safe, effective care was not available, placing patients and staff at risk of harm.

• The provider did not actively and openly engage with patients, staff, equality groups, the public and local organisations to plan and manage services. This meant systems were not in place to respond to what patients and staff think about the quality and safety of care.

• Effective systems were not in place to encourage learning, innovation and improvement at the service.

• We were unable to establish if people could access the service when they needed it.

• We were unable to establish if staff treated patients with compassion and kindness. Systems were not in place to ensure patients were consistently treated with dignity and the service could not evidence that they considered patients’ individual needs.

• We were unable to establish if staff provided emotional support to patients, families and carers to minimise their distress. Systems were not in place to ensure staff understood patients’ personal and cultural needs.

• We were unable to establish if staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

However, we found the following areas of good practice:

• Staffing levels were assessed and planned for to ensure the right number of staff were available.

• The registered manager/provider was visible to the staff and worked alongside them delivering patient care.

Following this inspection, we took urgent action and suspended the provider’s registration to prevent them from transporting patients. We told the provider that it must take some actions to comply with the regulations. We also issued the provider with a requirement notice to address a less urgent concern. Details of regulatory breaches can be found at the end of the report.

I am placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 2 October 2019

The main service provided was non-emergency patient transport. Therefore, we used our patient transport services core framework to inspect the service.

The service also provided first aid and medical cover for events which is not within our scope of registration. However, on occasions, the service transports patients from an event site to hospital in the event of emergency treatment being required. This falls under our scope of regulation. However, the service was not registered with us to do this, so we told them to stop providing this part of their service until they were correctly registered to do so.

We rated the service as inadequate in the safe, effective, responsive and well-led domains and were unable to rate the caring domain as we could not observe or gain direct feedback about patient care. This led to an overall rating of inadequate.

Updated 27 September 2019

Salop Medical Services (UK) Limited provided urgent and emergency care from its SMS Base location in Telford.

We undertook a focussed inspection in January 2019, looking at specific areas under the safe key question. Therefore, we have not provided a rating for this service.

We found areas of concern in relation to mandatory training, safeguarding procedures, the premises and equipment used by the service, management of deteriorating patients and the handling, storage and administration of medicines.