Archived: Cartello Ambulance

Updated 9 June 2021

We inspected this service using our focused inspection methodology. We reviewed two of the five questions, are they safe and well-led.

We did not review the questions caring, effective and responsive to people's needs. This inspection was to follow up concerns from our inspection in October 2019 and other concerns raised through our intelligence and monitoring.

The main service provided was a non-emergency patient transport service (PTS).

The inspection was undertaken on 31 March 2021 as a short announced focussed inspection followed by an announced visit on the 7 April 2021.

The provider employed 30 patient transport service staff. The staffing consisted of a managing director, CQC and compliance manager, two team leaders who also carried out all in house training and one ambulance coordinator.

On inspection we reviewed 14 staff files and inspected four operational ambulances used for PTS. We spoke with two managers, one team leader, ambulance coordinator and seven staff members.

Updated 9 June 2021

Cartello ambulance is operated by Cartello Adams. The service was first registered with CQC in September 2014. It is an independent ambulance service in Hednesford, Staffordshire. The service primarily serves the communities of the West Midlands. The current registered manager has been in post since 2017. The service is registered for the regulated activities of patient transport services.

The service is registered to provide the following regulated activities:

• Patient transport service

During the inspection, we visited Hednesford (Staffordshire) location. The service provides regular

services, such as taking and picking up children with complex medical needs from school or day centres; however, since the pandemic of COVID 19, school run services have currently ceased until further notice.

Cartello ambulance main service is to supply ambulance vehicles to other private ambulance providers on a sub-contractor basis, transporting NHS patients discharged from hospital or attending outpatient appointments. The service was also contacted on an ad-hoc basis if other patient transport services were not able to meet patient demand. During the inspection, we visited the Hednesford location, where the office and garage, which housed the vehicles, were situated.

Cartello ambulance was last inspected on 15 and 22 October 2019. Following the inspection, the service was issued with two requirement notices which related to Regulation 13 HSCA (RA): Safeguarding service users from abuse and improper treatment and Regulation 17 HSCA (RA): Good governance. The service was also given five areas where they must improve, and additionally six areas where the service should improve. The provider shared their action plans with CQC.

In the reporting period of November 2020 and February 2021, CQC received information of concern about Cartello ambulance. A decision was made to carry out a focussed inspection of the safe and well led domains to investigate the concerns.

Updated 9 June 2021

Our rating for this service had improved because:

• The service provided mandatory training in key skills to staff and made sure everyone completed it.
• 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 risks. Staff used equipment and control measures to protect patients, themselves and others from infection.
• The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe
• Staff completed and updated risk assessments for each patient. 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. Managers regularly reviewed and adjusted staffing levels and skill mix.
• The service managed patient safety incidents. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned. When things went wrong, staff apologised and gave patients honest information and suitable support.
• 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. 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.
• 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 submitted to external organisations as required.
• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
• All staff were committed to continually learning and improving services. Leaders encouraged innovation.

However:

• The service did not have a completed policy in place around Disclosure and Barring Service (DBS) checks
• Not all records were stored securely.
• Oxygen cylinders were not stored upright, and empty and full cylinders were not kept separately, this was against the service policy.
• We were provided with a sample of governance meeting minutes. However, governance meeting minutes lacked evidence of recordings around risks. Risks and concerns were not rated or prioritised against a set of indicators. However, managers could describe the key risks and their area of responsibility.
• Some of the service offered by Cartello on their website was out of date and was no longer available.
• Risks and issues were identified however, these were not well documented within a risk register.