The Care Quality Commission
  • Ambulance service

LIVES Headquarters

Overall: Good read more about inspection ratings

5-8 Birch Court, Boston Road Industrial Estate, Horncastle, Lincolnshire, LN9 6SB

Provided and run by:
Lincolnshire Integrated Voluntary Emergency Service

All Inspections

During an assessment of Emergency and urgent care

We undertook an assessment of LIVES Headquarters on 11 March 2025. We undertook a second assessment visit on 21 July 2025 to enable us to re-rate the service.

This was a risk-based assessment, following breaches of regulation identified at a November 2023 assessment and further whistleblowing concerns raised directly to CQC around poor culture and leadership.

LIVES Headquarters provides medical response to emergency situations across Lincolnshire. All work was allocated through the local NHS ambulance service.

The service had two commissioned services. The Community Emergency Medicine Services (CEMS) which operated from 8 am to 8 pm daily, brings the Emergency Department to the patient, meaning patients could be treated at scene and often avoided having to go to hospital. They also had a Falls Response Unit which responded to calls from 6am to 2am daily. This service helped people after falls and related injuries and was delivered by non-registered health care professionals

The service also had a team of voluntary staff who made up the community first responders and medic responders: Levels 1-4. They logged on from their own homes and travelled in their own vehicles to patients allocated by the local NHS ambulance service. They were split into 24 districts across the county based on their geographical locations. There were different grades (also referred to as levels) of these staff. This ranged from level 1 who were in their mentorship period and had some competencies signed off. Level 2 were community first responders. Level 3 responders had a year's experience and had completed FREC level 3. Level 4 were FREC level 4 trained.

Levels 5-8 were medic responders. From this pool of volunteers there was also a MEDIC50 team which comprised of more highly skilled volunteers who had critical care skills. These have a dedicated vehicle and would only respond in a team of two. Work was allocated based on individual skills and competencies.

From April 2023 to April 2024 the service had 2,737 CEMS call outs, 2,424 falls team call outs and 4,140 community first responder call outs.

The service is registered with CQC for the regulated activity transport services, triage and medical advice provided remotely, and treatment of disease, disorder, or injury. The service is also registered for the regulated activity of diagnostic and screening procedures and surgical procedures.

The service has a Registered Manager who has worked at the service since 2016.

We previously carried out an unannounced inspection on 14 November 2023 where we rated the service as requires improvement in safe, effective and well-led key questions. We identified breaches to regulation 17 Good Governance and Regulation 18 Staffing.

We carried out an unannounced assessment on 11 March 2025 to follow up on previous regulatory breaches and in response to information of concern. On that occasion we found that the service had improved in the areas where the breaches had been previously identified. We subsequently re-visited the service in July 2025 to assess the other key questions to enable us to re-rate the service.

During an assessment of the hospital overall

LIVES Headquarters had two commissioned services. The Community Emergency Medicine Services (CEMS) which operated from 8 am to 8 pm daily, brings the Emergency Department to the patient, meaning patients could be treated at scene and often avoided having to go to hospital. They also had a Falls Response Unit which responded to calls from 6am to 2am daily. This service helped people after falls and related injuries and was delivered by non-registered health care professionals.

The service also had a team of voluntary staff who made up the community first responders and medic responders. They logged on from their own homes and travelled in their own vehicles to patients allocated by the local NHS ambulance service.

14 November 2023

During a routine inspection

We rated this location as requires improvement because:

  • Staff records were not always easy to find or review because of the multiple systems that were in use. The service had high turnover and sickness rates.
  • The service did not submit any required safeguarding notifications to us.
  • There was no staff infection, prevention control audits in place.
  • Staff did not always complete and update risk assessments for each patient.
  • The service did not have an in date home office licence for controlled drugs at the time of our inspection.
  • The service also did not provide any training for staff in restraint. The service did not mandate that staff completed training in recognising or responding to patients with mental health needs.
  • Clinical audits were not always completed consistently. Staff did not consistently record patients pain scores.
  • Work was not always allocated in a timely way by the ambulance trust.
  • There had been a recent period of instability in leaders in the service. Not all staff felt respected, supported, and valued. At the time of our inspection the service did not have a business continuity policy that reflected current service provision.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The design, maintenance and use of facilities, premises, vehicles, and equipment kept people safe. Staff managed clinical waste well.
  • The service managed patient safety incidents well.
  • The service provided care and treatment based on national guidance and evidence-based practice. The service monitored and met agreed response times so that they could facilitate good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. All those responsible for delivering care worked together as a team to benefit patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families, and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
  • The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

16 January 2018

During a routine inspection

LIVES Headquarters is operated by Lincolnshire Integrated Voluntary Emergency Service and is registered to provide patient transport services, triage and medical advice remotely and the treatment of disease, disorder or injury.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 16 January 2018.

The ambulance service provided patient transport services as well as bespoke first aid and medical cover to public events including treatment on the event site (this is not a regulated activity and is therefore not included in this report). The care and treatment provided when transporting patients between locations and to a hospital is regulated and was the focus of our inspection. 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 people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by LIVES was patient transport. Where our findings on patient transport services – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the patient transport services core service. See patient transport services for main findings.

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 areas of good practice:

  • Incidents were reported and any learning was shared.
  • Comprehensive policies were in place covering all aspects of safe and effective patient care and treatment.
  • Medicines management was robust.
  • The ambulance and equipment were clean, well maintained and serviced regularly.
  • Staff were trained to deliver care and treatment following current clinical guidance and showing compassion and empathy to patients.
  • Staff responded to patient’s individual needs.
  • The organisation was well-led and had a strong patient focussed ethos with processes in place to promote clear clinical governance.
  • The senior leadership team were able to respond quickly to any issues in order to improve outcomes for patients.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central), on behalf of the Chief Inspector of Hospitals

31 May and 6 June 2013

During a routine inspection

We were unable to speak with people who use the service due to confidentiality issues.

We saw patient feedback from a recent patient survey. People had responded positively to questions about their experience. One comment read, "It was reassuring to have someone to arrive so quickly to help". Another comment read, "Very professional, caring attitide, good explanation of checks and communictaion skills."

We saw people's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We saw the equipment kits provided to first responders were fit for purpose. We saw people were protected from unsafe or unsuitable equipment because the provider ensured the equipment was properly maintained and first responders made regular safety checks.

We saw there were policies to protect people from the risk of their personal information being shared inappropriately with others.