The Care Quality Commission
  • Ambulance service

Grange Farm

Overall: Requires improvement read more about inspection ratings

The Old Arena, Grange Farm, Repps Road, Martham, Great Yarmouth, NR29 4RA 0845 862 6911

Provided and run by:
Ikon Ambulance Services Ltd

Important: This service was previously registered at a different address - see old profile
Important: We are carrying out a review of quality at Grange Farm. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

16 May 2023

During an inspection looking at part of the service

Our rating of this location improved. We rated this service as requires improvement. As we did not rate against all the key lines of enquiry the service retains its inadequate rating for effective and requires improvement rating for responsive. This means the overall rating of the service is requires improvement.

On this inspection we found that:

  • 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. The service controlled infection risk well. They had set up systems to manage medicines.
  • Leaders set up services using reliable information systems to monitor performance. Most staff understood the service’s vision and values. Staff felt respected, supported and valued and were clear about their roles and accountabilities. Staff were committed to continually improving services.

29 November 2022

During an inspection looking at part of the service

We carried out an inspection of Grange Farm using our focussed methodology under the core service framework of Emergency and Urgent Care and Patient Transport Services.

The inspection was a focussed inspection to follow up concerns from our inspection of the service on 6 September 2022, when we imposed an urgent suspension on the registration of the service. As this was a focussed inspection, we did not inspect all elements of the key questions. We reviewed elements of three of the five questions: are services safe, effective and well led. We did not review the questions: are services caring and responsive.

The previous overall rating for the service of inadequate remains.

Our inspection was announced the day before we conducted onsite visit. We gave the provider short notice of the inspection date to ensure their availability on the day.

Following our inspection, we issued an urgent notice to suspend the registration of the service further. We issued a notice of proposal to cancel the registration of the provider. We took this action because there was a high risk that a service user may be or will be harmed. We had serious concerns about both services and suspended Grange Farm’s registration for 6 months, preventing them from operating regulated activities during that time.

We told the provider that they must take action to comply with the regulations.

For details of the individual services, see the service sections of this report.

We rated this service as inadequate because:

  • The service managers continued to be unable to demonstrate a full understanding of their roles and responsibilities and the duties delegated to them by the Health and Social Care Act 2008
  • Safety systems, processes and standard operating procedures were still not fit for purpose.
  • The service did not evidence that staff had training in key skills. The service did not manage safety well. The service did not control infection risk well. Staff did not assess all risks to patients. They did not manage medicines well. The service did not manage safety incidents well and did not learn lessons from them. Staff did not collect safety information to improve the service.
  • The service did not monitor response times. Managers did not monitor the effectiveness of the service and could not evidence that staff were competent. Staff were not supervised or managed effectively.
  • Leaders did not have the necessary experience, knowledge, capacity, capability or integrity to lead effectively. There was no stable leadership team. There were limited examples of leaders making a demonstrable impact on the quality or sustainability of services. Leaders did not run services well using reliable information systems. Leaders did not support staff to develop their skills.

06 September 2022

During a routine inspection

We rated Emergency and Urgent Care and Patient Transport Services as inadequate.

Following our inspection, we issued an urgent notice to suspend the registration of the service. We took this action because a person will or may be at risk of harm. We had serious concerns about both services and suspended Grange Farm’s registration for 12 weeks, preventing it from operating regulated activities during that time.

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 will reinspect the service to check that improvements have been made. We will produce another report of that inspection and include an update of our actions.

For details of the individual services, see the service sections of this report.

This is the first time we have rated the service. We rated this service as inadequate because:

  • Safety systems, processes and standard operating procedures were not fit for purpose. The service did not evidence that staff had training in key skills. The service could not evidence that staff could protect patients from abuse and did not manage safety well. The service did not control infection risk well. Staff did not assess all risks to patients. They did not manage medicines well. The service did not manage safety incidents well and did not learn lessons from them. Staff did not collect safety information to improve the service.
  • The service did not monitor response times. Managers did not monitor the effectiveness of the service and could not evidence that staff were competent. Staff were not supervised or managed effectively.
  • The service did not account for patients’ individual needs.
  • Leaders did not have the necessary experience, knowledge, capacity, capability or integrity to lead effectively. There was no stable leadership team. There were limited examples of leaders making a demonstrable impact on the quality or sustainability of services. Leaders did not run services well using reliable information systems. Leaders did not support staff to develop their skills.

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

However:

  • Key services were available 7 days a week.
  • The service had adequate supplies of personal protective equipment at the base and within vehicles.
  • The service had enough suitable equipment including defibrillation equipment and manual handling aids.
  • The service had enough staff to care for patients.

13/07/2017

During a routine inspection

Grange Farm is operated by Ikon Ambulance Services Ltd. Grange Farm supplies paramedics, emergency technicians, first responders, and first aiders to provide first aid cover and patient transport services (PTS) at organised sporting and public events such as stock car racing, horse shows, and agricultural shows amongst others.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 July 2017.

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 PTS. Where our findings on Grange Farm for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the PTS core service.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • The ambulance we inspected was visibly clean, staff completed daily records of hygiene routines and ambulance inspections. Staff maintained consumables and stock to ensure stock was in date and fit for purpose.

  • The registered manager ensured that policies and procedures were up to date and reviewed in line with set review dates.

  • The online electronic event management system was effective and enabled the registered manager to allocate staff and resources in line with specific event risk assessments.

  • Staff stored patient report forms securely within the ambulance and the ambulance station. In the main, staff completed patient report forms to a good standard. The registered manager reviewed these for themes, trends, and took appropriate action where staff failed to complete these appropriately.

  • Staff maintained the ambulance station, office, and storage areas to ensure they were visibly clean and safe from any trip or fall hazards. Within the ambulance station, clear signage was in place warning staff of the dangers in relation to COSHH (Control of Substances Hazardous to Health Regulations 2002) and other key health and safety issues.

  • Medication was stored and maintained appropriately. The registered manager was in the process of implementing a new medications policy and updating existing patient group directions (PGD) at the time of our inspection.

However, we also found the following issues that the service provider needs to improve:

  • We found three small oxygen cylinders stored within the main ambulance station, secured against the wall with a metal chain and pad lock, on the floor, on a small metal tray at the side of an ambulance. Ideally these cylinders should be sited away from any sources of heat or ignition, have warning notices posted prohibiting smoking and naked lights within the vicinity of the store and be secure enough to prevent theft and misuse (British Overseas Chemical (BOC) guidance).

  • The registered manager did not ensure that staff received appropriate disclosure and barring scheme (DBS) checks, in line with DBS guidance.

  • The registered manager did not maintain a risk register or overarching quality assurance and governance system to measure the performance of the service or manage any risks associated with the safe operation of the service.

Following this inspection, we told the provider that it should take some actions to comply with the regulations. Details are at the end of the report.

Name of signatory

Heidi Smoult

Deputy Chief Inspector of Hospitals on behalf of the Chief Inspector of Hospitals.