The Care Quality Commission
  • Ambulance service

Transcare Secure Services - Birmingham

Overall: Good read more about inspection ratings

Gee Business Centre, Holborn Hill, Birmingham, B7 5JR (0121) 517 0000

Provided and run by:
Transcare Secure Services

All Inspections

During an assessment of Patient transport services

We returned to this provider to carry out this assessment to review if improvements had been made following the last assessment in June 2024.

We assessed all quality statements across the safe, effective, caring, responsive and well-led key questions and have combined the scores for these areas to give an overall rating of good.

During an assessment of the hospital overall

Transcare Secure Services Ltd is an independent ambulance service operating predominantly in Birmingham and the Midlands area. The service opened in 2018 and the current registered manager has been in place since opening. The registered manager is the owner.

The service transports adults and children over 13 years of age and those detained under the Mental Health Act (MHA) or Mental Capacity Act (MCA). The service provides patient transport from local NHS trusts and independent health providers to other locations such as hospital and places of safety.

This service employs the registered manager, an operations manager, an administrator and Registered Mental Health Nurses (RMN) and health care assistants, both substantive and bank staff.

The service has 2 patient transport vehicles in use.

In the past 12 months, 31 transfers were completed, 5 were planned transfers and 26 were classed as emergency transfers.

Transcare Secure Services was last inspected in June 2024. These key questions were rated as good for safe, caring, responsive and effective and requires improvement for well led. The provider was issued a warning notice for Regulation 17, due to not all staff having an up-to-date Disclosure and Barring Service (DBS) check and staff not being trained in medicines management.

At this assessment all key questions have been rated as good. This meant people were safe and protected from avoidable harm.

During an assessment of Patient transport services

We rated the patient transport service as requires improvement overall. We rated effective and well-led as requires improvement and safe, caring and responsive as good. Safety was prioritised, the environment was safe and visibly clean, and the service had enough staff to ensure patients were cared for and kept safe and risks were assessed. However, there were concerns identified around medicine management. There was no plan in place for monitoring the effectiveness of the service and not all staff were identified as being competent to deliver all aspects of care. However, patients' needs were assessed, and their transfer reflected their needs. Staff worked in harmony and patients were at the centre of their care. We were unable to assess first-hand how staff treated patients as no transfers took place during our onsite assessment. However, the feedback received by the service was positive and demonstrated that staff were kind and caring. Patients had access to the care and treatment they required and accessed it in ways that met their personal circumstances. The service did not have effective governance systems in place. However, leaders were approachable and there was a positive culture which was focused on continuous learning and improvement. Following the assessment, a warning notice under section 29 of the Health and Social Care Act 2008 was issued. This was because the service had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Effective systems to ensure the safe management of medicines was not in place and the service had failed to establish systems to ensure the safe recruitment of staff. This was because systems were not in place to ensure Disclosure and Barring Service checks were carried out for all prospective staff. Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During an assessment of the hospital overall

We rated the patient transport service as requires improvement overall. We rated effective and well-led as requires improvement and safe, caring and responsive as good. Safety was prioritised, the environment was safe and visibly clean, and the service had enough staff to ensure patients were cared for and kept safe and risks were assessed. However, there were concerns identified around medicine management. There was no plan in place for monitoring the effectiveness of the service and not all staff were identified as being competent to deliver all aspects of care. However, patients' needs were assessed, and their transfer reflected their needs. Staff worked in harmony and patients were at the centre of their care. We were unable to assess first-hand how staff treated patients as no transfers took place during our onsite assessment. However, the feedback received by the service was positive and demonstrated that staff were kind and caring. Patients had access to the care and treatment they required and accessed it in ways that met their personal circumstances. The service did not have effective governance systems in place. However, leaders were approachable and there was a positive culture which was focused on continuous learning and improvement. Following the assessment, a warning notice under section 29 of the Health and Social Care Act 2008 was issued. This was because the service had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Effective systems to ensure the safe management of medicines was not in place and the service had failed to establish systems to ensure the safe recruitment of staff. This was because systems were not in place to ensure Disclosure and Barring Service checks were carried out for all prospective staff. Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

28 September 2022

During an inspection looking at part of the service

We carried out an inspection of Transcare Secure Services - Birmingham using our focused methodology under the core service framework of Patient Transport Services (PTS).

This inspection was a focused inspection to follow up concerns from our inspection of the service on 23 August 2022, when we imposed an urgent suspension on the registration of the service. As this was a focused inspection, we did not inspect all elements of the key questions. We reviewed elements of two of the five questions: are services safe and well-led? We did not review the questions: are services caring, effective and responsive to people's needs. The previous overall rating for the service of inadequate remains.

Our inspection was announced. We gave the provider short notice of the inspection date to ensure their availability on the day.

We found some areas of residual concern:

  • There was no young children restraint training for staff.
  • The service had not had the opportunity to test if new forms to monitor the quality of the service were effective.
  • Not all policies had been reviewed and updated in response to concerns raised at our last inspection.
  • There was no evidence the manager had attempted to engage with other organisations who commissioned the service in order to review and assess its performance.

However,

  • Most policies and quality monitoring processes had been reviewed and updated
  • Staff refresher training had been undertaken by most staff.
  • The manager was taking action to train staff in safe child restraint.
  • The service had engaged the use of external professionals and advisers in order to implement an effective action plan.

We found the provider had taken sufficient action to ensure the urgent suspension notice was not extended past its expiry date of 30 September 2022. However, the service remains in special measures. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

23 August 2022

During a routine inspection

We carried out an inspection of Transcare Secure Services - Birmingham using our comprehensive methodology under the core service framework of Patient Transport Services (PTS). The service has not been previously inspected.

Our inspection was announced. We gave the provider short notice of the inspection date to ensure their availability on the day. We undertook a site visit on 23 August 2022.

This was the first time we inspected the service. We rated it as inadequate because:

  • The service did not provide mandatory training in key skills to staff or ensure staff had completed training through other employers. Safeguarding systems, processes and standard operating procedures were not effectively implemented to keep people safe. The service did not always control infection risk well. Processes were not in place to ensure the maintenance and use of facilities, premises, vehicles and equipment kept people safe. Risk assessments were not always completed. Assessments of the risks identified lacked detail and did not demonstrate how risks would be mitigated. Patient booking and transfer documentation was not fully completed by staff. The service did not always follow best practice when storing and transporting medicines. The service did not have an effective process for reporting, investigating and learning from incidents.
  • The service could not evidence that it provided care and treatment based on the most up to date national guidance and evidence-based practice. Managers did not routinely check to make sure staff followed guidance. The service did not monitor response times. Systems to make sure staff were competent for their roles were ineffective. The service did not ensure all staff had received training in the Mental Health Act (MHA), Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
  • The service did not have formal arrangements in place for working with other organisations to plan care. The service was not always inclusive of patients’ individual needs. We could not determine if people could access the service when they needed it. The service collected information about times from journey referral to the time of patient collection, but this was not monitored. It was not easy for people to give feedback and raise concerns about care received.
  • Leaders did not demonstrate they had the skills and abilities to run the service. Leaders did not always understand or manage the priorities and issues the service faced. The service did not have a clear vision for what it wanted to achieve or a robust strategy to turn it into action. There was no evidence the service promoted equality and diversity in daily work or provided opportunities for career development. Leaders did not operate effective governance processes, throughout the service or with partner organisations. Staff did not have regular opportunities to meet, discuss and learn from the performance of the service. Systems were not in place to manage performance effectively. The manager did not collect and use data to understand performance or make decisions and improvements. Leaders did not actively engage with patients, staff or the public to plan and manage services. The service was not committed to continually learning and improving services.

However:

  • Staff understood how to protect patients from abuse. Staff understood how to respond to a patient at risk of deterioration. The service employed enough staff with the right skills and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Records were generally stored securely.
  • Staff considered patients’ food and drink requirements to meet their needs during a journey. Staff in the service worked together as a team to benefit patients. They supported each other to provide good care. Staff supported patients to make informed decisions about their care and treatment. They generally followed national guidance to gain patients’ consent.
  • The service provided care in a way to support local services in meeting the needs of local people and the communities served.
  • Leaders were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

We did not rate caring as we had insufficient information to rate. We did not observe any patient care.

We have taken enforcement action as a result of this inspection to promote patient safety. We served a notice of suspension to the provider on 25 August 2022 with immediate effect until 30 September, under Section 31 of the Health and Social Care Act 2008. We have told the provider that it must take some actions to comply with the regulations and a review of these actions will be completed at the end of the suspension.

We are placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.