The Care Quality Commission
  • Ambulance service

SNP Medical

Overall: Good read more about inspection ratings

Office 15 Beaumont Enterprise Centre, 72 Boston Road, Leicester, Leicestershire, LE4 1HB

Provided and run by:
Mr Nicholas Stefen Pridden

All Inspections

04 November 2021

During an inspection looking at part of the service

We carried out an inspection of SNP Medical using our focused inspection methodology on 4 November 2021. The inspection was carried out due to concerns raised during the last inspection in May 2021. Regulatory breaches were identified during the inspection in May 2021 and the provider was issued with two warning notices and a requirement notice. This inspection was to review compliance with the actions required to be taken in relation to the breaches identified. We inspected four of the five key questions: safe, effective, responsive and well led.

Our inspection was an unannounced inspection (the provider did not know we were coming).

This service was placed in special measures in April 2020.

During this inspection we found that significant improvements had been made by the provider and that all appropriate actions had been taken to address the regulatory breaches identified at the last inspection in May 2021.

Following this inspection, we have not taken any enforcement action and we have re-rated the service to demonstrate the improvements made.

Our rating of this location improved. We rated it as good because:

  • The registered manager had improved processes for ensuring vehicle cleanliness.
  • A clinical waste contract had been set up to ensure the safe management of clinical waste.
  • Policies had been developed with the support of an external agency to ensure they referred to up to date guidance.
  • Regular meetings had been established with referring providers to discuss any concerns and issues.
  • All staff had completed safeguarding adults and children training appropriate to their role and were up to date with training requirements.

However:

  • We found that pre-employment recruitment checks were still not robust. Not all staff files fully complied with schedule three recruitment requirements.
  • There was limited use of performance and outcome information by the service and still no system of routine audits to monitor quality.
  • The service still did not have any measurable standards identified within its statement of purpose document to enable demonstration of achievement of service objectives and aspirations.
  • Governance systems were still not embedded to ensure the manager had full oversight of issues, concerns and quality.
  • Patient complaint information was still not displayed in transport vehicles.

24 May 2021

During a routine inspection

We carried out an inspection of SNP Medical using our comprehensive inspection methodology on 24 May 2021. The inspection was carried out due to concerns raised during the last inspection in January 2020. Routine engagement with the provider indicated that not all required improvements had been carried out by the service. We inspected the five key questions of: safe, effective, caring, responsive and well led.

Our inspection was an unannounced inspection (the provider did not know we were coming). Following our inspection, and review of the evidence, we issued two Section 29 Warning Notices for breaches of Regulation 15 and Regulation 17. We also issued a Requirement Notice for a breach of Regulation 19.

This service was placed in special measures in April 2020. Insufficient improvements have been made such that there remains a rating of inadequate overall. Therefore, we are taking action in line with our enforcement procedures to drive improvement. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement, we will consider the need to vary the provider’s registration to remove this location or cancel the provider’s registration.

Our rating of this location stayed the same. We rated it as inadequate because:

  • We found that although cleaning schedules were completed, the vehicles we saw during our inspection were dirty. We were not assured that the cleaning processes used were sufficient to control infection risks and protect patients.
  • There was no clinical waste contract for the provider to dispose of clinical waste and the service relied on being able to dispose of clinical waste at other provider sites.
  • There was no COSHH information for one of the cleaning products meaning staff did not have information available about how to safely manage this cleaning product.
  • We found a full oxygen cylinder stored on a spare stretcher in the area leading to the storage yard. There was no medical gas warning sticker displayed so staff and emergency services would not know of the potential risk in the event of a fire. The oxygen cylinder was not stored securely meaning it could be accessed without authorisation.
  • The non-patient transport vehicle was used to collect supplies, including any replacement oxygen cylinders. There was no process to secure the cylinders in the vehicle during transportation. There was no medical gas warning sticker displayed on the vehicle. This meant that the public or emergency services would not know of the potential risk in the event of an accident.
  • We found that pre-employment recruitment checks were not robust. Some staff files did not have evidence of references, appropriate Disclosure and Barring Service checks, or identification documents.
  • Although staff compliance with training had improved, there were still gaps in completion of required training. It was not clear what core training topics staff needed to complete
  • Staff, including the registered manager, were not trained to the appropriate level in adults or children’s safeguarding.
  • Although we were told that staff received an annual appraisal, there was no one to one or supervision process to monitor staff performance, competence and wellbeing outside of the annual appraisal process.
  • There were limited outcome measures used by the service and there was no system of routine audits to monitor performance.
  • The service did not have a contractual arrangement or service level agreement in place with the referring services. There was no requirement for any formal review of activity or performance of the service SNP provided to third parties.
  • We saw a range of policies which were within date for review, however the policies were not always fit for purpose. Policies were developed by the registered manager and an administrator but did not have clinical or expert input. Policies did not always reference appropriate guidance.
  • There was a devolvement of responsibility by the registered manager to third party providers for investigating incidents. There was no evidence of a process for regularly feeding back any learning from incidents and complaints to staff in the service.
  • The service did not have a measurable strategy to ensure sustainability of the delivery of high-quality care.

However:

  • Since our last inspection the service had developed a system for identifying and managing risks, meaning the registered manager now had oversight of the risks in the service.
  • Staff we spoke with described a positive culture within the service and told us they were happy in their work there.
  • We saw there was a communication booklet in each vehicle which facilitated staff to be able to communicate with patients who had additional communication support needs.
  • We found the registered manager to be accepting of areas identified during our inspection that required improvement. They demonstrated an appetite to get things right and make improvements following our inspection.

15 and 16 January 2020

During a routine inspection

SNP Medical is operated by Mr Nicholas Stefen Pridden. SNP Medical provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the location on the 15 and 16 January 2020.

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.

This is the first time we have rated the service. We rated it as Inadequate overall.

We found the following areas which were inadequate:

  • Staff did not have training in key skills. Staff did not understand how to protect patients from abuse, or manage safety well. The service did not control infection risk well. The service did not manage safety incidents well and did not learn lessons from them. Staff did not collect safety information and use it to improve the service.

  • Staff did not provide care and treatment in line with best practice. Managers did not monitor the effectiveness of the service or make sure staff were competent.

  • Leaders did not run services well, use reliable information systems or support staff to develop their skills. Staff did not understand the service’s vision and values. Staff did not always feel respected, supported and valued. They were not consistently focused on the needs of patients receiving care. The service did not engage well with patients and the community to plan and manage services and all staff were not committed to continually improving services.

We found the following areas which required improvement:

  • The service did not always plan care to meet the needs of local people. The service did not take account of patients’ individual needs in all circumstances. The service did not make it easy for people to give feedback. The service did not monitor access to the service and did not know how long people waited for treatment.

We found the following areas which were good:

  • The service had enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well.

  • Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.

  • 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.

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 two warning notices and two requirement notices that affected patient transport services. Details are at the end of the report. On the basis of the inspection finds, we have placed the service into special measures.

Heidi Smoult

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

31 October 2017 to 1 November 2017 and 14 November 2017

During a routine inspection

SNP Medical Ltd is operated by Mr Nicholas Stefan Pridden. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 October 2017 and 1 November 2017 along with an unannounced visit on 14 November 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:

  • Staff knew about the duty of candour and their roles and responsibilities of being open and transparent when things went wrong.

  • Staff demonstrated infection control practices in line with organisational policies. Staff used personal protective equipment, and we saw vehicles and equipment were visibly clean.

  • We inspected three vehicles. All vehicles had appropriate equipment and all equipment on the ambulances had been electrically tested, checked and maintained.

  • The provider stored records securely and we observed staff comprehensively completed patient report forms.

  • Staff knew their responsibilities regarding safeguarding children and vulnerable adults.

  • The provider used evidence-based guidance to inform staff practice and procedures. For example, staff procedures around needle stick injuries, using personal protective equipment and cleaning chemicals.

  • Staff assessed any care requirements prior to patient journeys by communicating with staff from other providers. Staff asked about pain management prior to transporting the patient.

  • We saw good communication and working with other patient transport providers and NHS hospital staff.

  • The provider checked staff driving licenses and ensured all staff had a valid disclosure and barring service (DBS) check and therefore legally able to undertake their role.

  • Staff received training on the mental capacity act (MCA) and dementia. Staff understood their roles and responsibilities concerning patient consent.

  • Staff described and demonstrated their passion for providing good patient care.

  • We observed positive interactions and relationships with patients. Staff displayed a supportive attitude and used encouragement and praise when supporting patients to move.

  • Staff communicated with patients in a way that enabled patients to understand what was happening.

  • Staff involved patients in what was happening, explaining and providing opportunities for questions.

  • We observed staff reassuring patients and communicating in a meaningful manner to alleviate fears patients may have had.

  • The service was flexible and was designed and delivered to meet patients and other provider’s needs.

  • Staff identified individual needs of patients. Staff treated patients on a case-by-case basis and said they would ensure patients were comfortable and meet any of their particular needs.

  • Staff used a communication book to communicate with patients living with dementia, learning disabilities and patients with speech impairments.

  • We saw a positive patient-centred culture. Staff were happy working for the provider and said they felt supported.

  • The provider had a customer charter, which demonstrated a commitment to values centred on treating people with respect and recognising their needs.

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

  • Staff did not always report incidents in accordance with the incident reporting policy.

  • The provider did not record, investigate or retain incidents meaning there was insufficient oversight to assess and monitor risks.

  • The provider did not assure us that staff had received appropriate training in manual handling and paediatric basic life support.

  • Staff did not demonstrate knowledge of storing medical gases in ambulances..

  • Staff did not receive regular meetings or support during their induction period.

  • The provider did not have any materials available in other languages.

  • There was not an effective system for the managing and handling of complaints with the provider had not documenting a complaint investigation in detail.

  • The provider did not have a vision or strategy for the service and staff we spoke with did not know in what direction the organisation was heading.

  • The provider did not audit or collect information regarding staff or organisational performance.

  • The provider did not effectively monitor or manage risk. The provider had not reviewed risk assessments since 2015 and some were not relevant to current service provision.

  • The provider had not tailored all policies to the organisation and some did not explain clearly what staff should do, how they should do it, and when they should do it.

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 two requirement notices that affected patient transport services. Details are at the end of the report.

Importantly, the provider must take action to ensure compliance with regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Heidi Smoult

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