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Nerams Ltd Requires improvement Also known as NERAMS LTD Head Office & Training Centre


Inspection carried out on 13 August 2019

During a routine inspection

Nerams Ltd operate under the same name, Nerams Ltd . At the time of this inspection the service was not carrying out any regulated activity. The service had previously provided a patient transport service transporting dialysis patients to and from appointments from their place of residence for Clinical Commissioning Groups (CCG`s) and hospitals in the North – East region which started in June 2018. The service withdrew from their PTS contracts after 19 days because the volume of transfers exceeded what had been identified in the specifications of the service tender

The service now provides event medical coverage providing first aid cover and/or ambulance support at planned events, site rescue safety, providing a confined space medical rescue team and first aid training. These services are not regulated by the CQC and were therefore not inspected.

The inspection covered current working practices not specific to the services which were not regulated and reviewing evidence from when the provider was carrying out patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried an unannounced visit to the providers headquarters at Stanhope, County Durham and their satellite station at Washington, Tyne and Wear on 13 August 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 people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated it as Requires improvement overall because,

  • The providers safeguarding lead was not trained to level three safeguarding, however, following the inspection, the provider submitted evidence showing the safeguarding lead had been trained to safeguarding level three.

    The safeguarding reporting guidance in the providers safeguarding policy and staff advice flow chart was not correct and if followed could have delayed a referral being made resulting in further harm to the individual concerned, however, following the inspection, the provider submitted evidence showing the safeguarding policy and flow chart had been amended so referrals were made immediately to the local safeguarding authority or department.

  • The provider did not carry out limited infection prevention control audits, following the inspection the provider submitted evidence of a vehicle cleaning audit carried out in September 2019. No other infection prevention control audit evidence was supplied

  • Medical gases were not stored in accordance with current legislation, however, following the inspection the provider submitted evidence showing they had taken measures to ensure oxygen and Entonox cylinders were stored securely.

  • The service did not have an effective system for the identification, mitigation and monitoring of risk.

  • Paper patient record forms at the Washington site were not stored securely or collected regularly so they could be reviewed and audited, however, following the inspection the provider submitted evidence of two PRF audits carried out in September 2019.

  • Five of the nine current staff files, and one of the five PTS files of staff no longer working for the provider, were reviewed they did not have references.

  • There were no multinational cue cards for patients whose first language was not English or communication aids for patients with visual or hearing on the vehicles inspected.

However, we found the following areas of good practice:

  • The service maintained a comprehensive computer-based training matrix to record levels of staff training compliance and when refresher training courses were due.

  • There was evidence of hand hygiene observations being carried out in January, April and August 2019.

  • The 14 different consumable items we inspected were all found to be in date.

  • Ambulances appeared to be visibly clean and well maintained.

  • The 55 policies we reviewed were in date, version controlled, and the date of last review recorded.

  • The service had an ethical policy, an anti-bribery policy, a whistleblowing policy, hospitality and gifts policy to support staff culture all were in date.

  • The service had a computer-based document control register which ensured all documents and records were created, accessed and managed effectively.

Following this inspection, we told the provider that it should make 9 improvements, even though a regulation had not been breached, to help the service improve Details are at the end of the report.

Name of signatory

Ann Ford

Deputy Chief Inspector of Hospitals (area of responsibility), on behalf of the Chief Inspector of Hospitals