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Yormed Ambulance Station Requires improvement

Reports


Inspection carried out on 3 to 5 July 2019

During a routine inspection

YorMed Ambulance Station is operated by YorMed Limited. We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the service on 3 to 5 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 people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The service provided mainly patient transport services at the time of inspection. The service was also engaging with commissioners to obtain emergency and urgent care contracts. Where our findings about 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 core service.

Our rating of this service is requires improvement. The service was not previously rated.

We found the following areas that the service provider needed to improve:

Patient deterioration was not always recognised, escalated and managed safely. The service did not investigate patient safety incidents in a way that supported learning. Patient record forms were not consistently completed to an acceptable standard.

Some contracts for the delivery of services were under review as assurance of the safety of services was sought by commissioners.

Governance processes were not fully effective and the service did not use systems effectively to manage risks and performance.

The registered manager was unaware of his responsibility as safeguarding lead to ensure statutory notifications were submitted by the service.

The service did not have a formal process to monitor performance and make improvements. No performance or quality monitoring reports were prepared.

Defects of vehicles and equipment were not always attended to promptly and vehicle and equipment maintenance logs were not available for inspection.

Few staff had undergone a formal appraisal of their work performance.

Leadership did not provide sufficient assurance high quality services would be delivered. The strategy to turn the vision for the service into action required development with relevant stakeholders.

However:

Staff understood how to protect patients from abuse and staff had training on how to recognise and report abuse.

Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean.

Staffing levels and skill mix were planned flexibly to meet workload requirements. The service provided mandatory training in key skills to all staff.

The service supported staff competence for their roles with induction and training and ambulance staff had undergone emergency driver training.

The service took account of patients’ individual needs and preferences and made reasonable adjustments to help patients access services. Staff received training to support patients with dementia needs or other needs caused by reduced capacity.

The service had a mainly open culture although not all staff felt they could raise concerns.

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. We also issued the provider with 10 requirement notices that affected patient transport services. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals

Inspection carried out on 09 April 2019

During an inspection to make sure that the improvements required had been made

YorMed Ambulance Station is operated by YorMed Limited. The service provides a patient transport service and event medical cover.

We carried out a focused unannounced inspection on 09 April 2019 in response to some information of concern, received by the Care Quality Commission (CQC) regarding the patient transport service.

A focused inspection differs to a comprehensive inspection, as it is more targeted looking

at specific concerns rather than gathering a holistic view across a service or provider.

In our comprehensive inspections, 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?

Focused inspections do not usually look at all five key questions; they focus on the areas indicated by the information that triggers the focused inspection. Although they are smaller in scale, focused inspections broadly follow the same process as a comprehensive inspection.

We inspected but did not rate the safe, effective and well-led domains. We did not inspect caring and responsive. The focus of our inspection related to mandatory training, safeguarding, cleanliness, infection prevention and control, hygiene, staffing, the safe management of medicines, staff competence, the culture within the service and governance processes including the management of risk, issues and performance.

The service has one location. We looked at the vehicle storage, preparation and storage areas and two ambulances. We reviewed 13 staff files, training records, rotas, and provider policies and procedures. We spoke with five members of staff which included permanent and bank staff and the managing director who was also the Registered Manager.

The main service provided by this service was patient transport services.

Due to the focused nature of the inspection we did not rate the service or inspect all key lines of enquiry within each domain.

On 08 May 2019 we served two warning notices under section 29 of the Health and Social Care Act 2008. The warning notices related to Regulation 17, (1)(2) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance and Regulation 19 (1), (2)(a) – Fit and proper persons employed. The warning notices require the provider to take action to ensure systems and processes are established to ensure effective governance arrangements and effective staff recruitment and training are in place. We have given the provider one month to make the necessary improvements.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals