EMS HQ Also known as EMS Ambulance HQ

EMS HQ is operated by Uniblue Ltd. The service provides emergency and urgent care and patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the short- notice announced part of the inspection on 13-14 August 2019.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

This service was last inspected on 10 April 2019 using our responsive focused inspection methodology which related to information of concern. This service was last inspected on 10 April 2019 using our responsive focused inspection methodology which related to information of concern. Following that inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We issued the provider with two warning notice relating to emergency and urgent care, Regulation 17 Good governance and Regulation 19 Fit and Proper Persons, for the purposes of a regulated activity of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our last comprehensive inspection was in July 2018, at this inspection we told the provider that it should make improvements, even though a regulation had not

been breached, to help the service improve.

During this inspection, we visited the service headquarters in Skipton and an ambulance garage/storage facility in Morecambe. We inspected five patient transport ambulances and we reviewed 19 staff files, training records, rotas, and company policies and procedures. We spoke with two company directors, one of whom is the registered manager, and four other staff members.

There were no special reviews or investigations of the service ongoing by the CQC at any time during the 12 months before this inspection.

At this inspection, we inspected all five domains (safe, effective, caring, responsive and well led). We rated the service ‘requires improvement’ overall, with safe, effective, responsive and well-led, each rated as ‘requires improvement’. We could not rate caring as we did not observe any patient, relative or carer interaction.

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

• The service did not have robust arrangements in place to ensure staff employed were fit and proper for their role, with the right skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service had not fully embedded processes to complete all necessary pre-employment recruitment checks as required.
• We had concerns about health and safety signage in the garage area.
• We had concerns about the arrangements for monitoring the cleaning of vehicles.

However, we also found:

• The ambulance vehicles we inspected were clean and well maintained.
• Monitoring of mandatory training compliance had improved since the last planned inspection.
• The staff we spoke with said the culture within the service was positive and they felt listened to by managers.
• An electronic system had been introduced to record staff HR information.

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 issued the provider with regulations notices in relation to Regulation 12: Safe Care and Treatment, Regulation 17 Good Governance and Regulation 19 Fit and Proper Persons, for the purposes of a regulated activity of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Details are at the end of the report

We inspected the service’s headquarters, including the garage, storage areas and five ambulances. The service also has a garage and storage facility at Morecambe which was inspected by another team on the same day. We reviewed 19 staff files, staff training records, rotas, and company policies and procedures. We spoke with two of the company directors and seven other members of staff.

Track record on safety:

• No recorded never events
• No clinical incidents reported
• No serious injuries

The service had received no complaints from July 2018 to August 2019.

This was our first rating of this service. We rated it as Requires improvement overall.

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 notice(s). Details are at the end of the report.

Ann Ford

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

EMS HQ is operated by Uniblue Limited (also known as EMS Ambulance) and provides patient transport and urgent care services.

We inspected this service using our responsive inspection methodology. We carried out a focused, unannounced inspection on 10 April 2019, following specific concerns identified.

Due to this being a focused inspection, we did not inspect all five domains (safe, effective, caring, responsive and well led) and we did not rate the service. We inspected the safe, effective and well-led domains, specifically key lines of enquiry relating to: mandatory training; safeguarding; cleanliness, infection control and hygiene; staffing and staff competence; medicines; culture within the service; governance; and management of risk, issues and performance.

We inspected the service’s headquarters, including the garage, storage areas and two ambulances. The service also has a garage and storage facility at Morecambe which was inspected by another team on the same day. We reviewed 21 staff files, staff training records, rotas, and company policies and procedures. We spoke with two of the company directors and four other members of staff.

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

• The service did not have robust arrangements in place to ensure staff employed were fit and proper for their role, with the right skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service did not complete all necessary pre-employment recruitment checks as required.
• We were not assured the service always had staff with the right qualifications, skills, training and experience or that managers had the information they needed to monitor this. The service had not kept records of staff rotas. Managers had recently identified and begun to address this problem.
• We were not assured that there were appropriate systems and processes in place to report, record and monitor safeguarding concerns. This meant there was a risk that safeguarding concerns were not reported or escalated to the local authority as appropriate.
• We were not assured the service systematically improved service quality and safeguarded high standards of care. We found the service had failed to comply with its own policies, some policies were not sufficiently robust and insufficient records were kept.
• We were not assured that risks to the service, patients and staff, were properly identified, monitored and mitigated.

However, we also found:

• The ambulance vehicles we inspected were clean and well maintained.
• Levels of mandatory training and compliance had improved since the last planned inspection.
• The staff we spoke with said the culture within the service was positive and they felt listened to by managers.

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 issued the provider with two warning notices in relation to Regulation 17 Good Governance and Regulation 19 Fit and Proper Persons, for the purposes of a regulated activity of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Details are at the end of the report.

Ann Ford

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