Transcare Secure Services - Birmingham

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Leaders had created a positive culture of safety-based openness and honesty. Concerns about safety were fully investigated. The managers’ ensured lessons were learnt to identify and embed good practices. There was a positive learning culture with staff managing incidents and safeguarding patients well. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. There were processes to ensure the service had enough staff with the right training, skills and qualifications to keep patients safe.

This key question has been rated good. This meant patients were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff knew how to raise incidents and concerns. Incidents and complaints were reviewed and fully investigated. Lessons were learnt to continually identify and embed good practice.

Patients experienced care based on the latest updates and learning which followed national updates and safety incidents. Patients and staff were encouraged and supported to raise concerns. After each transportation of a patient there was a team de brief and all staff could raise concerns, this was documented and reviewed by the manager.

Incidents were investigated and discussed at staff meetings and governance meetings to review trends and lessons learnt.

There had been 8 incidents reported in past 12 months. Themes included patient resistance to transfer and attempting to abscond. All incidents were investigated and actions taken. There was an annual review of all summaries, which all staff could access.

Staff we spoke with understood the duty of candour and applied this wherever necessary.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Safety and continuity of care was a priority throughout patients’ care journey. Patients care was discussed with the multidisciplinary team for the referring service and for where the patients was to be transported too, to ensure all needs were met.

There were clear processes and pathways for patient transfers. All patients were transferred separately. Each patient journey was risk assessed to ensure they had enough staff with the right skills to meet the patients needs. Leaders and staff worked closely with healthcare partners to ensure people were cared for in the most appropriate way during their journey. When in the best interest of the patient a family member or carer could accompany the patient on their journey.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff understood their safeguarding responsibilities and knew how to take appropriate action when necessary. The service had clear safeguarding policies for both children and adults which were available for staff to access. This included information and a flow chart about how to refer any safeguarding concerns to registered manager and the local authorities with contact details.

All clinical staff were trained to level 3 safeguarding adults and children. The registered manager had overall responsibility for reviewing and reporting safeguarding concerns.

Staff told us they documented on the post transfer documentation if interventions were used, such as restraints and if there were any safeguarding concerns raised. Staff documented on a body map screening tool and gave a description of the transfer; this also identified the staff that were involved in the intervention.

Patients were supported to understand their rights, including their human rights, rights under Acute services the Mental Capacity Act 2005 and their rights under the Equality Act 2010. Staff understood the importance of supporting equality and diversity and ensured care and treatment was in accordance with the act.

The service worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Safety was a priority that involved everyone, including staff as well as people using the service. Staff made sure that people understood the care and treatment that was being provided.

We saw risk assessments were carried out for each patient before, during and at the end of the journey.

There was a process in place to manage a deteriorating patient. Staff told us they would stop the journey in a safe place and carry out first aid and basic life support and call 999 for support.

Staff told us if they needed to stop the journey for a comfort break, they would attend a close by NHS hospital or a police station and phone ahead to alert them.

The service detected and controlled potential risks in the care environment. Staff mainly made sure equipment, facilities and technology supported the delivery of safe care.

The offices were in a shared building. These were locked at night, with security cameras. The 2 ambulances were stored in dedicated spaces in the car park. The car park was locked at night with security available during the day. Both vehicles had tracking devices.

The head office and ambulances were visibly clean and tidy with appropriate equipment available to maintain safe levels of care. Both ambulances had up to date MOTs (Ministry of Transport), tax, vehicle insurance and had been serviced in the last year. The service had breakdown cover. The registered manager could not provide proof of ownership of both vehicles during the assessment, however following the assessment provided evidence that they had applied for a replacement vehicle registration document.

We looked at 2 ambulances, both had suitable facilities to meet the needs of patients. Sterile equipment was stored in the ambulance and all equipment was in date. Sharps bins were available and were labelled correctly. The equipment was in sealed tagged bags, any equipment used would be reordered and replaced. A vehicle equipment list was checked prior to each journey. There was an inventory spreadsheet with all equipment and expiry dates that was checked and updated.

Handcuffs were stored in a sealed box in the front cab of the ambulance and would only be used when required by trained staff.

We were not assured that appropriate seat belts, harnesses or car seats were available for young children if required. Although the provider told us they would not accept transfer jobs for children under the age of 13 years, this was not clear in the policy and procedures. We raised this with the provider during our on site assessment. Following our assessment the registered manager provided evidence that the transfer policy and transfer request form had been amended to reflect that the service only provides transfers for individuals aged 13 years and above.

There was 2 AEDs (defibrillators) stored in the offices that would be taken out on each patient journey. The 2 AEDs where still under manufacturer’s warranty but there was no future maintenance plan. We raised this with the provider during our on site assessment. Following our assessment the registered manager provided evidence that a service and maintenance plan had been implemented.

The registered manager made sure there were enough qualified, skilled and experienced staff, who received support supervision and development opportunities. Staff worked together well to provide safe care that met people’s individual needs.

There were 4 full time staff, the registered manager, operations manager, clinical lead and administration support, there were 9 bank staff. The service employed registered mental health nurses (RMN’s) and health care assistants (HCA).

Most staff were employed as bank staff due to the nature of the business and unplanned work. When a call was received to transport a patient, the managers would send a message to all staff for their availability and plan the journey and staffing required.

The staffing and skill mix for each journey was planned to ensure there was always at least one staff member of the same sex as the patient on each journey. A RMN would be present for each journey as well as a dedicated driver and at least another 2 HCAs. Staff told us that the seating on the vehicles was arranged so that the staff sat to the side of each patient and not facing them. The service had enough staff to keep patients safe.

Nursing staff had completed their Nursing and Midwifery Council re-validation checks and updates to develop their competencies.

There were safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. We saw all staff had up to date Disclosure and Barring Service (DBS) checks. There was an up to date DBS policy that included individual roles and responsibilities and a process implemented to review when they required to be updated. This was an improvement from our last assessment and DBS checks were discussed at each governance meeting.

Staff received training appropriate and relevant to their role. All staff had an induction, and staff were provided with supervision as needed. Staff could access online training and some training was completed face to face. The registered manger and operations manager had completed the train the trainer for some courses and carried these out on site.

We saw 1 member of bank staff had not completed all the required training and had worked for the service, which was not in line with their policy. We raised this with the registered manager. Following our assessment the registered manager provided evidence that the member of staff had completed all the required training.

The service had an up to date restraint policy that included information on types of restraint, action to take and how to use handcuffs safely. Staff had been trained to use handcuffs and restraint techniques.

Training compliance data showed all staff had completed their mandatory training apart from the 1 member of bank staff, who completed the training following our on site assessment.

The team assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an up to date infection prevention and control policy that included information on hand hygiene, protective clothing and cleaning.

All areas in offices and ambulance visited were visibly clean, tidy and had suitable furnishings which were well-maintained.

The environmental cleaning was carried out by the staff who had enough equipment. We saw cleaning wipes were available in each ambulance.

Ambulances were cleaned by staff after each journey and checked daily and before each journey. A deep clean was carried out monthly by an external vehicle cleaning drive through company. However, we found there was no written evidence that the ambulances had been cleaned since 22.12.25, although they had been used to transport patients since that date. On viewing the 2 ambulances they were visibly clean. We raised this with the provider during our on site assessment. Following our assessment the registered manager provided information that the cleaning logs would be kept up to date and evidence of recent cleaning.

Staff followed infection control principles including the use personal protective equipment which was available on the ambulance. Hand-washing and sanitising facilities were available for staff and visitors in the offices and alcohol gel available on the ambulances. Clinical waste would be disposed of in the hospital after the journey was completed.

Cleaning audits were carried out. Any concerns would be raised directly with the staff at the time.

The service did not dispense any medication to patients, any medication required would be given to the patient prior to the journey commencing. This is documented in the patients records.

There were no medicines stored onsite and no medical gases on the vehicles or stored at the service.

The up to date medicines management policy clearly stated that staff do not administer medication. Any medication required would be administered prior to commencing the transfer by the referring provider. This had changed from our last assessment when staff were dispensing medication.

Processes were in place for managing medicines and safe storage. Medication travelling with patients would be stored in a sealed bag under the front seat.