The Care Quality Commission
  • Ambulance service

Archived: PREMIER MENTAL HEALTH PATIENT TRANSPORT LTD

Overall: Inadequate read more about inspection ratings

Unit 17, Cornishway East, Galmington Trading Estate, Taunton, TA1 5LZ 0800 044 3919

Provided and run by:
PREMIER MENTAL HEALTH PATIENT TRANSPORT LTD

Important: This service was previously registered at a different address - see old profile
Important: We served a suspension notice on the registration of Premier Rescue Ambulance Services Limited. This is because we believe that a person will or may be exposed to the risk of harm if we do not take this action.

All Inspections

29 September 2021

During an inspection looking at part of the service

We carried out a focused inspection of Premier Mental Health Patient Transport Limited on 29 September 2021. The inspection was conducted to review what actions and improvements had been made since our last inspection on 23 June 2021. At our inspection on 29 April 2021, we suspended the service for two months until 5 July 2021. When we re-inspected on 23 June 2021, we found improvements had not been made to a satisfactory extent and we extended the suspension for a further four months to 6 October 2021. At our inspection on 29 September 2021 we found some requirements we made of the organisation had not been satisfactorily addressed:

  • Staff training records continued to fail to provide assurance as to whether staff were trained as required.
  • Policies remained incomplete or unfit for the purpose of assessing and monitoring the service delivered.
  • The provider did not ensure all staff had the legal employment checks. The recruitment process still failed to ensure safety checks for new staff were completed. References did not always match the job histories of some staff.
  • The provider continued to fail to monitor the effectiveness of the service or have the capability to carry out assurance effectively.
  • There remained inadequate processes to determine the risk to patients who were transported.

23 June 2021

During an inspection looking at part of the service

We carried out a focused inspection of Premier Mental Health Patient Transport Limited (formerly known as Premier Rescue Ambulance Services) on 23 June 2021. The inspection was conducted to review what actions and improvements had been made since our last inspection in April 2021 where we suspended the service for a period of 2 months. We found some concerns had not been satisfactorily addressed therefore the service suspension was extended to 6th October 2021. We found:

  • There were no reliable systems to ensure staff had the training required to keep service users safe. The training records did not provide assurance as to whether staff were trained as required. Systems did not support the registered provider to be assured that staff had undertaken mandatory training.
  • Policies were either incomplete or unfit for the purpose of assessing and monitoring the service delivered. There was no policy for raising concerns, speaking up, nor was there a COVID-19 staff testing policy.
  • The provider did not ensure all staff had the required employment checks. The recruitment process did not ensure safety checks about new staff were completed. There were no risk assessments for staff where references were missing and no explanations of any gaps in employment history.
  • The provider did not monitor the effectiveness of the service nor have adequate processes to determine the risk to service users transported.
  • The provider did not have a written formal plan or process to ensure staff were aware of changes to business practices and policies.
  • There were no mechanisms for incidents to be identified correctly and no one within the organisation was trained to investigate them. Therefore, there was a risk that incidents would not be recorded and learning following incidents would not occur.

However:

  • There was an improvement in the cleanliness of the vehicles and equipment from the previous inspection in April 2021. There were cleaning schedules, guidance and checklists for staff to refer to for cleaning the vehicles. All equipment was present, in date and stored correctly.
  • The provider had implemented new daily and weekly checks of the vehicles to ensure they were in good condition and well maintained.

29 April 2021

During a routine inspection

Our rating of this location went down. We rated it as inadequate because:

There were no reliable systems to ensure staff were trained adequately for their roles to keep patients safe. There was very limited assurance staff had training in key skills, understood how to protect patients from abuse or managed safety well. The provider did not control infection risks well. Staff did not always assess risks to patients and the provider was not able to assure us staff were adequately trained to be able to safely monitor patient conditions. Staff did not keep good care records for patient monitoring of their physical or mental health conditions during transfer. There was a basic system for staff to identify, report, receive feedback or share learning about incidents and concerns but it was not accurate or embedded in the service. The recruitment process did not ensure safety checks about new staff were used to protect patients.

The provider did not monitor the effectiveness of the service or make sure staff were competent. The provider did not always meet and monitor agreed response times. The provider planned care to meet the needs of local people but did not take account of patients’ individual needs. It was not easy for people to give feedback.

Managers of the provider did not have the capability to run services well. Staff were not supported to develop their skills. Managers showed little understanding of the safety and business priorities and how to manage them. There were no reliable and consistent systems to provide oversight of safety and quality of care delivered. Managers were not clear about their legal responsibilities of providing care under the regulated activities. Managers tried to support staff but opportunities for staff development were limited. Managers wanted to provide a safe service and wanted to put the patient at the centre of their service planning but were not clear on how to achieve this. There was no consistent, embedded system for gathering and reviewing feedback, incident reports or reviewing risks. There were electronic processes for gathering patient views which limited opportunity to feedback and there was no evidence of how these were discussed or actioned. The provider had no vision and values to apply them in their work.

However:

Staff assessed patients’ food and drink requirements. People could usually access the service when they needed it.

25 February 2020

During a routine inspection

Premier Rescue Ambulance Service Limited is operated by Premier Rescue Ambulance Service Limited. They provide a patient transport service to people living in Devon and Somerset and the surrounding areas. If required, the service reaches further out into the south west to provide patient transport services. The service provides non-emergency ambulance transport for people with mental health conditions, most of who are detained under the Mental Health Act 1983. The service also provides transport for non-detained patients, for example patients who are voluntarily going into hospital for referral or treatment.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 February 2020.

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 this service was patient transport.

We rated it as Requires improvement overall.

  • Managers had not trained any staff to level four in safeguarding to support and advise staff.
  • Limited auditing of the service did not provide assurance of safety on an ongoing basis.
  • Safety incidents were not monitored and there were no recorded actions and learning
  • There were no governance processes to monitor service performance or make any changes for improvement despite tools being in place.
  • Patient records did not contain information about risks and how they minimised these or any details about medical condition.
  • Managers had no records to demonstrate staff were competent in meeting the needs of patients.
  • A system for supervision and appraisals of staff had not been fully developed and implemented.
  • The service had a criteria for patients they could meet the needs of but this was not documented.
  • Managers did not use their information systems to monitor the quality of the service. Audits had not been devised to provide assurance of safety on an ongoing basis. There were gaps in the process and records of recruitment of new employees

We found good practice in relation to patient transport:

  • Infection control procedures had been reviewed and updated. A clinical waste contract had been implemented.
  • The service had enough staff to care for patients and keep them safe.
  • Staff had training in key skills and understood how to protect patients from abuse.
  • Staff worked well together with other agencies for the benefit of patients.
  • The provider planned their service to meet the needs of local people and took account of patients’ individual needs.
  • The service operated 24 hours, seven days a week to meet the needs of patients who used their service.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

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 three requirement notices that affected patient transport services. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South), on behalf of the Chief Inspector of Hospitals