The Care Quality Commission
  • Ambulance service

Archived: Jigsaw House Cheshire

Unit 3-4, The Oaks, Stanney Mill Lane, Little Stanney, Chester, Cheshire, CH2 4HY (01829) 732615

Provided and run by:
CRG Clinical Services Ltd

Important: The provider of this service changed. See old profile

All Inspections

6 May 2021 10 May 2021

During an inspection looking at part of the service

We did not rate this service at this inspection.

  • Equipment checks were not always fully completed effectively as we found a number of out of date items.
  • There was a lack of complete recording of patient early warning scores on patient records we reviewed.
  • Not all aspects of the patient records were being audited to provide effective monitoring of all aspects of patient outcomes.
  • The organisation did not always have clear governance structures in place to ensure oversight of services. We found that when audits had been completed there was no evidence of any action plans to improve standards of care when required. We also found that there were no actions or follow up to actions recorded following meetings where standards of care were discussed and improvements were required.
  • Whilst the service had a clinical strategy in place, at the time of the inspection there was no evidence of an action plan to support the implementation of the strategy or any evidence of monitoring the strategy on a regular basis.
  • There was a lack of assurance that performance was being monitored effectively as there was no service specific contract in place between the service and their commissioners to clearly outline performance measures for the service provided.

However,

  • All staff were up to date with face-to-face mandatory training in key topics to ensure they could provide safe care to patients.
  • The service controlled infection risk well. Documentation was in place for assurance about completion of cleaning and infection prevention and control of vehicles. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, and premises visibly clean.
  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. They managed medicines well. Safety incidents were managed well and learned lessons from them.
  • Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. All staff were committed to continually improving services.

30 April 2019

During an inspection looking at part of the service

Jigsaw House and Lincolnshire Resource Centre is operated by CRG Clinical Services Ltd t/a Jigsaw Medical. The service provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection of Jigsaw Medical head office and Lincolnshire Resource Centre on 30 April 2019 as a result of information given to CQC. We did not rate this service at this inspection.

In order to respond specifically to the concerns raised to us, we looked at predominantly the safe and well led domains. Throughout the inspection, we took account of what people told us, what we found on inspection, and what staff told us.

During the inspection, we visited the Lincolnshire resource centre in Heckington and Jigsaw House, head office to Jigsaw medical, Chester. We spoke with 20 members of staff including the chief executive, managing director, operations manager, clinical mentor, registered paramedics, technicians, emergency care assistants and operations staff. We reviewed documentation including policies, staff records, training records and call log sheets. We also looked at five ambulances.

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.

We found good practice in relation to medicines management:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned.

  • Mandatory training was 100% compliance for paramedics and 86% for Technicians at Lincolnshire.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • There were systems to monitor the maintenance of the vehicles used by the service.

We found areas of practice that could be improved in relation to medicine management and equipment:

  • Procedures and protocols did not clarify which medicines staff of different grades were authorised to administer.

  • Training requirements to ensure medicines were administered safely were not defined.

  • Medical gases were not stored correctly to meet health and safety requirements.

  • Paramedics did not have access to clinical protocols and patient group directions (PGDs) for medicines they may be required to administer.

  • Lincolnshire resource centre was not equipped with essential equipment

  • Ambulances were not equipped with paediatric adaptations for trolleys to convey young children in line with guidance.

And in other areas:

  • Safeguarding referral forms were not always processed in a timely manner.

  • The provider should consider how staff are made aware of changes and feel supported. The provider should ensure that all staff receive timely appraisals.

  • Policies and procedures were out of date.

Ann Ford

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