Specialist Medical Transport - North

⚠ The service did not have systems and processes to ensure staff assessed and made plans to respond to the risks presented to service users in carrying on the regulated activities. The service did not maintain appropriate records to evidence that service users’ risks and needs were assessed and met prior …

⚠ Staff did not complete or update risk assessments for each patient to remove or minimise risks. We did not see evidence that staff were made aware of specific risks relating to each individual patient in advance of arriving to undertake the transfer, for example, patients’ mental health risks, including risks …

⚠ Staff did not support patients to make informed decisions about their care and treatment. National guidance and legislation to gain patients’ consent was not followed. The service had not ensured care was provided with the consent of service users, or ensured staff had the training and experience required to consider …

⚠ Managers could not provide copies of service users’ risk assessments which evidenced the need to apply mechanical restraint or to use the cell area of the vehicles. There was no rationale or decision-making processes adequately recorded. Whilst staff said they took account of a patient’s history they did not complete …

⚠ The provider told us five staff were trained to drive under ‘blue lights. However, there was no evidence of accredited blue light driver training on file for any staff member.

⚠ Managers could not evidence that incidents were investigated appropriately or used to identify opportunities for learning. None of the incidents had been investigated appropriately or used to identify lessons learned or to improve the service.

⚠ The service did not provide mandatory training in key skills to all staff and make sure everyone completed it. Managers did not maintain or have access to complete records of training delivered to staff which meant the service could not provide assurance that all staff had the training required to …

⚠ The service had not implemented effective processes to safeguard service users from the risk of improper treatment and/or abuse. The provider had a safeguarding policy although this was not fit for purpose because it did not provide clear guidance and expectations of the process staff were expected to follow to …

⚠ None of the staff, including managers at the service location, had received training in safeguarding adults or children at level 3 or above. There was no evidence that all staff had received the required training in safeguarding to recognise and respond to the risk of abuse, and keep service users …

⚠ We saw a member of staff working prior to receiving DBS clearance.

⚠ Managers we spoke with did not know who the provider’s safeguarding lead was and were unsure who was undertaking the roles since the last lead had left the service. The service did not have clear processes to report safeguarding concerns to external agencies including local authorities and CQC.

⚠ Journeys were not planned or carried out with consideration of patient’s hydration, food and toileting needs particularly where journey times might be long. Managers told us that drinks were not provided.

⚠ The service did not have effective governance and systems and processes to identify, assess, record, manage and mitigate risks in the delivery of the service. Governance systems did not operate effectively to identify the risks found by the inspection team.

⚠ The service did not have clear criteria or service specification to ensure staff assessed whether they were able to meet the needs of the service users prior to accepting bookings.

⚠ Staff did not keep detailed records of patients’ care. Records were not comprehensive but were stored securely. Managers had audited all of the records that were reviewed, however, the audits had not effectively identified the errors or omissions we found.

⚠ The service did not have a local risk register.

⚠ The provider did not audit records appropriately to identify gaps or omissions and take appropriate action. Audits were not effective or standardised and did not identify errors or omissions in documentation.

⚠ Four of the staff files did not have evidence showing references had been obtained for the staff prior to commencing their employment. Three staff files did not include evidence showing staff had been interviewed. Six of the staff files had no evidence of training records. Most staff files we reviewed …

⚠ The service had no clear system to inform patients how to raise a complaint. There was no signage in vehicles or complaint process on the services website.