The Care Quality Commission
  • Ambulance service

Hearts First Ambulance Service Limited

Overall: Requires improvement read more about inspection ratings

Unit L, Houndswood Gate, Harper Lane, Radlett, Hertfordshire, WD7 7HU (01923) 894212

Provided and run by:
Hearts First Ambulance Service Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

17 May 2022

During a routine inspection

Our rating of this service went down. We rated it as requires improvement because:

  • Not all staff had training in key skills. Central training records were not consistent with staff files we viewed and we could not be certain the service controlled infection risk well.
  • The service did not ensure medicines were stored at safe temperatures and some incidents were not fully investigated.
  • The service did not monitor response times and managers did not always make sure staff were competent.
  • Information and governance systems were not reliable and some staff were not clear about their roles and accountabilities.

However:

  • The service had enough staff to care for patients and keep them safe. Most staff understood how to protect patients from abuse. They assessed risks to patients, acted on them and kept good care records.
  • Staff provided good care and treatment and assessed patients’ food and drink requirements. Managers had started to monitor the effectiveness of the service. Staff worked well together for the benefit of patients and supported them to make decisions about their care.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • 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. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

3 December 2019

During a routine inspection

Hearts First Ambulance Service Limited is operated by Hearts First Ambulance Service Limited. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 3 December 2019.

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.

We rated this service as Good overall.

  • 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.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean.
  • The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them.
  • Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave bank and locum staff a full induction.
  • Records were clear, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff assessed patients’ food and drink requirements to meet their needs during a journey.
  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools.
  • The service had started to monitor response times so that they could facilitate good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers were on target to appraise staff’s work performance and provided support and development.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. The service made reasonable adjustments to help patients access services.
  • People could access the service when they needed it and received the right care in a timely way.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • At the time of our inspection, a staff survey was being undertaken.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

However:

  • The service provided mandatory training in key skills to all staff but there was no target and not all staff completed it.
  • Staff did not always complete and update risk assessments for each patient.
  • Staff did not always keep detailed records of patients’ care and treatment.
  • Leaders and staff did not actively engage with patients, equality groups, the public and local organisations to plan and manage services. This was due to the type of service being ran, which was a one-off transport, for which the service did not keep patient contact details.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central), on behalf of the Chief Inspector of Hospitals

5 July 2017 and 17 July 2017

During a routine inspection

Hearts First Aid Training Limited, trading as Hearts First Ambulance Service provides repatriation services and patient transport services on an ad hoc basis.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on the 5 July 2017, along with a further unannounced visit to the service on the 17 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.

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:

  • All vehicles were of a high standard and maintained regularly by a reputable company. They were designed specifically in mind for the specifications of the services work.

  • The compliance manager had commenced new processes and procedures since being in post from May 2017.

  • Policies that were in place gave clear instructions for staff on their roles and responsibilities. Most of these were largely based on national guidance and recommendations.

  • We saw that each member of staff completed local induction training on commencing employment within the service. The compliance manager or director would supervise the induction process.

  • Staff completed training appropriate to their roles, responsibilities and the needs of the service.

  • Staff had completed Mental Capacity Act training and were aware of their roles and responsibilities in ensuring consent and escalating concerns.

  • Staff had received safeguarding training for children, level 2 and 3. There was a lead for safeguarding, who had completed level 4. We were given an example of a safeguarding referral they were currently referring and were assured of their processes.

  • Facilities were appropriate to the needs of the service. Ambulances were secure.

  • There was a clear vehicle maintenance log, which included MOTs and required vehicle services.

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

  • Recruitment processes need to be more robust to ensure that legal compliance and consistency is maintained for all candidates.

  • There was no framework in place for the service to describe its governance arrangements. We found that reporting arrangements to ensure effective information sharing were weak.

  • There were no formal arrangements for clinical staff to receive annual appraisals.

  • There was no formal risk register or similar tool used.

  • There was not an accompanying policy to inform staff what type of incident to report or what would be done once a report was received.

  • The service had no formal policy or guidelines for the transfer of patients living with dementia or a learning disability.

  • There were new policies in place, however, these were not clearly dated when created or when they were for review.

  • There was no formal audit process or audit calendar in place, although we saw some evidence of audits that had commenced from June 2017.

  • The service did not have a patient group direction for all necessary medicines used within the service. Staff had not all received competency checks for medicines administration.

  • There was no process to monitor temperatures in the vehicles where medications were permanently stored.

  • Mental Capacity Act training compliance for staff was at 66%.

  • The service did not formally record any details of one to one discussions with staff or clinical supervision.

  • There were no formal team meetings.

  • The service did not have a formal vision or strategy.

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 four requirement notices that affected the patient transport service. Details are at the end of the report.

Edward Baker

Chief Inspector of Hospitals (Central Region)