Archived: Paramed Ambulance Service Limited

Updated 2 July 2021

At the time of this inspection, the service provided patient transport services, commissioned by local short-term contracting arrangements with healthcare providers and mainly for patients being discharged from a local NHS hospital.

The service was registered in May 2018 and this was the first inspection of this service. The service was set up to provide paramedic led acute transfer services for patients needing hospital to hospital transfer for emergency and lifesaving treatment. During the pandemic, the service has mainly been providing patient transport services.

The service is registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely;
• Treatment of disease, disorder or injury;

The inspection was announced to the provider with two weeks’ notice and we shared the key lines of enquiry we use as part of our inspection framework. Prior to the inspection, we had held regular engagement meetings with the registered manager and the nominated individual as part of our monitoring methodology. Following information shared in these meetings, and with fundamental changes to the leadership, we instigated an urgent inspection. As we had not previously inspected the service, we undertook a comprehensive inspection, which also meant we could rate the service based on our findings. However, we were unable to inspect and rate caring as we did not have the opportunity to observe care provided by staff during the inspection.

There were no special reviews or investigation of the service ongoing by the Care Quality Commission (CQC) at any time during the 12 months before this inspection.

Activity (May 2020 to April 2021)

The service did not collect this data and could not tell us how many patient transport journeys had been completed over the last 12 months.

There was only one person employed by the service. The registered manager used bank staff to meet staffing requirements of the service. The service did not hold any controlled medicines.

Track record on safety:

• No never events
• No clinical incidents
• No complaints

Updated 2 July 2021

We rated the service as inadequate because:

Staff did not receive effective training in safety systems, processes and practices and there was insufficient attention to ensure staff received safeguarding training. Staff did not receive training on how to recognise if patients deteriorated during the ambulance journey. The service did not make sure staff were competent for their roles.

The service did not always control infection risks well. Standards of cleanliness were not maintained. The maintenance and use of equipment did not keep people safe and ambulance safety was compromised. The service did not have effective systems and processes to ensure medicines were always prescribed and administered safely.

There were limited risk assessments carried out for people who were conveyed by the service. Staff did not keep detailed records of patients’ care and treatment when they provided patient transport services. There was limited use of systems to record and report safety concerns, incidents and near misses.

The service did not have 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. The manager did not complete all necessary employment checks to make sure staff were of good character, competent and skilled to meet the needs of patients transported by the service.

The service did not provide care and treatment based on current national guidance and evidence-based practice.

Staff obtained verbal consent from patients receiving care, but this was not recorded. There were limited processes to assess and record if patients were subject to deprivation of liberty safeguards. The service was inclusive, but there were limited processes to assess and take account of patients’ individual needs and preferences. There was no evidence to show people could access the service when they needed it.

The registered manager did not have all the skills, knowledge and experience needed to run the service safely and effectively. They did not demonstrate oversight of what was happening on the front line of the service.

The registered manager did not operate effective governance processes throughout the service and with partner organisations. The service did not monitor response times so they could facilitate good outcomes for patients. The service did not use systems to manage performance and risks effectively. The service did not collect reliable data and not all information systems were secure.

However:

Staff assessed patients’ food and drink requirements to meet their needs during a long journey.

The service worked closely with systems partners, including another independent ambulance service and staff from the local NHS hospital who were responsible for patient discharges.

There were processes for people to give feedback and raise concerns about care received.

Updated 2 July 2021

We rated the service as inadequate because:

• Staff did not receive effective training in safety systems, processes and practices and there was insufficient attention to ensure staff received safeguarding training.
• The service did not always control infection risks well. Standards of cleanliness were not maintained. The maintenance and use of equipment did not keep people safe and ambulance safety was compromised.
• There were limited risk assessments carried out for people who were conveyed by the service. Staff did not receive training on how to recognise if patients deteriorated during the ambulance journey. Staff did not keep detailed records of patients’ care and treatment when they provided patient transport services.
• The service did not have 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. The service did not make sure staff were competent for their roles. The manager did not complete all necessary employment checks to make sure staff were of good character, competent and skilled to meet the needs of patients transported by the service.
• The service did not have effective systems and processes to ensure medicines were always prescribed and administered safely.
• There was limited use of systems to record and report safety concerns, incidents and near misses.
• The service did not provide care and treatment based on current national guidance and evidence-based practice.
• The service did not monitor response times so they could facilitate good outcomes for patients.
• Staff obtained verbal consent from patients receiving care, but this was not recorded. There were limited processes to assess and record if patients were subject to deprivation of liberty safeguards.
• The service was inclusive, but there were limited processes to assess and take account of patients’ individual needs and preferences. There was no evidence to show people could access the service when they needed it.
• The registered manager did not have all the skills, knowledge and experience needed to run the service safely and effectively. They did not demonstrate oversight of what was happening on the front line of the service.
• The registered manager did not operate effective governance processes throughout the service and with partner organisations. The service did not use systems to manage performance and risks effectively. The service did not collect reliable data and not all information systems were secure.

However:

• Staff assessed patients’ food and drink requirements to meet their needs during a long journey.
• The service worked closely with system partners, including another independent ambulance service and staff from the local NHS hospital who were responsible for patient discharges.
• There were processes for people to give feedback and raise concerns about care received.

Updated 2 July 2021

We rated the service as inadequate because:

• Staff did not receive effective training in safety systems, processes and practices and there was insufficient attention to ensure staff received safeguarding training.
• The service did not always control infection risks well. Standards of cleanliness were not maintained. The maintenance and use of equipment did not keep people safe and ambulance safety was compromised.
• There were limited risk assessments carried out for people who were conveyed by the service. Staff did not receive training on how to recognise if patients deteriorated during the ambulance journey.
• The service did not have 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. The service did not make sure staff were competent for their roles. The manager did not complete all necessary employment checks to make sure staff were of good character, competent and skilled to meet the needs of patients transported by the service.
• The service did not have effective systems and processes to ensure medicines were always prescribed and administered safely.
• There was limited use of systems to record and report safety concerns, incidents and near misses.
• The service did not provide care and treatment based on current national guidance and evidence-based practice.
• The service did not monitor response times so they could facilitate good outcomes for patients.
• There were limited processes to assess and record if patients were subject to deprivation of liberty safeguards.
• The service was inclusive, but there were limited processes to assess and take account of patients’ individual needs and preferences. There was no evidence to show people could access the service when they needed it.
• The registered manager did not have all the skills, knowledge and experience needed to run the service safely and effectively. They did not demonstrate they had oversight of what was happening on the front line of the service.
• The registered manager did not operate effective governance processes throughout the service and with partner organisations. The service did not use systems to manage performance and risks effectively. The service did not collect reliable data and not all information systems were secure.

However:

• Staff assessed patients’ food and drink requirements to meet their needs during a long journey.
• The service worked closely with systems partners, including another independent ambulance service and staff from the local NHS hospital who were responsible for patient discharges.
• There were processes for people to give feedback and raise concerns about care received.