The Care Quality Commission
  • Ambulance service

Archived: Unit 1

Overall: Good read more about inspection ratings

Snaygill Industrial Estate, Keighley Road, Skipton, North Yorkshire, BD23 2QR (01756) 802112

Provided and run by:
Mr. David Ogden

Important: The provider of this service changed. See new profile

All Inspections

28 to 29 January 2020

During a routine inspection

Unit 1 is operated by Mr. David Ogden. The service provides non 999 responder emergency and urgent care and patient transport services.

We undertook a comprehensive inspection of the service on 28 and 29 January 2020.

The service was rated as good overall.

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.

The main service provided and inspected was patient transport services. Where our findings on patient transport for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the patient transport care core service using this statement: See Patient Transport for main findings.

Our rating of this service improved. We rated it as Good overall, we found the following areas of good practice:

  • The service provided mandatory training in key skills to all 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 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 managed clinical waste well.

  • 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, agency and locum staff a full induction.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • 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.

However, we found the following issues in relation to medicines management which the provider needed to improve:

  • The medicines management policy was not fit for purpose

  • Medicines stocks and medicines stored in bags included out-of-date items.

  • Checks of controlled medicines were not documented accurately and an up-to-date register of controlled medicines was not maintained.

  • Patient Group Directions which were being used did not conform to legal requirements.

  • We found a lack of assurance as to the safety of medicines being stored in the medicine fridge.

  • Medical gases were not stored safely.

  • Medicines audits were not robust as stock checks were not completed each month and the audit completed a few days prior to this inspection had not identified the out of date medicines.

  • Governance arrangements for the management of medicines were not robust or consistent.

We shared our concerns as to the safety of medicines management with the provider at the inspection and the provider undertook to take immediate action to mitigate the risks identified to ensure the safety of the service.

Following this inspection, we told the provider that it must take eight actions to comply with the regulations and that it should make two 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 both emergency and urgent care and patient transport services. Details are at the end of the report.

Sarah Dronsfield

Head of Hospitals Inspection North East, on behalf of the Chief Inspector of Hospitals

13-14 May 2019

During an inspection looking at part of the service

Unit 1 is operated by Mr. David Ogden . The service provides emergency and urgent care and a patient transport service (PTS).

We conducted a follow up inspection of the emergency and urgent care service following the unannounced inspection on 9 January 2019 and a focussed inspection of the patient transport service (PTS) on 13 and 14 May 2019.

The PTS had not previously been inspected.

Following the unannounced inspection on 9 January 2019 we told the provider it must take 20 actions to comply with the regulations and it should make 15 improvements, even though a regulation had not been breached. We also issued the provider with two enforcement notices that affected emergency and urgent care. The service was rated as inadequate overall.

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.

The main service provided was patient transport. Where our findings on patient transport for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the patient transport care core service using this statement: See Patient Transport for main findings.

We found the following issues that the service provider needs to improve:

Our rating of this service improved. We rated it as Inadequate overall because:

  • There was no evidence of a holistic understanding of performance with safety, quality, activity and financial information.

  • The service did not hold staff meetings or carried staff surveys or routinely collected, reviewed and acted upon staff feedback to improve the service.

  • Medicines were not kept with their patient information leaflets as per pharmacy guidance and the controlled medicines log book did not conform to guidance for controlled medicine documentation.

  • The contents of the paramedic bags lacked standardisation. The bags did not have the same contents or a stock list to ensure used items were replaced.

  • The service did not have an induction procedure for new staff or carried out a training needs analysis of staff to identify training requirements.

  • There was no evidence the provider had a system to check staff had read, understood and adhered to company policies.

  • There were not robust checks in place to ensure vehicle check lists were completed daily or at the start of each shift and any equipment issues highlighted.

  • We did not see any evidence of a detailed operating procedure or protocol to provide guidance for staff on the management of deteriorating patients.

  • There was no patient information collected in addition to what was on the patient booking from which was provide by the NHS trust requesting the PTS service.

However, we found the following areas of good practice:

  • There was evidence that all medical devices had been tested in accordance with the manufacture’s recommendations.

  • All staff mandatory training was recorded on a spreadsheet which highlighted which courses staff had attended and when the date of the refresher was due.

  • We reviewed12 staff files, all had enhanced Disclosure and Barring Service (DBS) checks.

  • The four patient record forms we reviewed had a pain score and evidence of national early warning score (NEWS) and modified early warning score (MEWS) reviews.

  • There was evidence of a multilingual phrase book available for patient’s on board both ambulances we inspected.

  • All the services` vehicles were on the ministry of transport (MOT) reminder service from the Government online system.

  • The service had a risk register with 47 current risks identified. The risks were rated by number and severity. There were risk owners, mitigation and dates for finalisation.

Following this inspection, we told the provider that it must take 26 actions to comply with the regulations and that it should make 25 other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices and two enforcement notices that affected both emergency and urgent care and patient transport services. Details are at the end of the report.

Sarah Dronsfield

Head of Hospitals Inspection North East, on behalf of the Chief Inspector of Hospitals

7 August 2019

During an inspection looking at part of the service

Unit 1 is operated by Mr. David Ogden . The service provides emergency and urgent care and a patient transport service (PTS).

We conducted a follow up inspection of the emergency and urgent care service, following an unannounced inspection on 9 January 2019, and a focussed inspection of the patient transport service (PTS) on 13 and 14 May 2019. The PTS had not previously been inspected.

Following the inspection, we told the provider that it must take 26 actions to comply with the regulations and that it should make 25 other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices and two enforcement notices that affected both emergency and urgent care and patient transport services.

We carried out a re-inspection of the service on 7 August 2019 focussing only on the areas highlighted in the two enforcement notices issued to the provider following the inspection carried out on 13 and 14 May 2019, in relation to Regulation 12 and Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the provider had taken action and was compliant in relation to the areas in the enforcement notices applicable to both Regulation 12 and Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The main service provided by this service was patient transport services . Where our findings on for example, medicines, also apply to other services, we do not repeat the information but cross-refer to the core service.

Sarah Dronsfield

Head of Hospitals Inspections North East, on behalf of the Chief Inspector of Hospitals

9 January 2019

During a routine inspection

Unit 1 is operated by Mr. David Ogden . The service provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 9 January 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 inspected the urgent and emergency care service we did not inspect the patient transport service .

We found the following issues that the service provider needs to improve:

  • Policies in relation to clinical adverse incidents, non-clinical adverse incidents and adverse incidents with a third-party provider were out of date at the time of the inspection.

  • The duty of candour policy was not dated and there was not a date when the policy became live and there was no review date.

  • There was no evidence the service carried out any infection prevention control audits (IPC) audits.

  • The service did not formally monitor and record adherence to infection control policies and procedures.

  • There was no evidence of any vehicle cleaning audits and daily vehicle cleaning and deep cleans were not recorded.

  • Five automatic external defibrillators (AEDs) were checked during inspection, three had no evidence of having been portable appliance tested (PAT) tested and one of the AED`s did not have a date when the machine was operational.

  • There was no risk assessment for the storage of gas cylinders.

  • There was no standard moving and handling equipment on board the urgent and emergency care ambulance such as a slide sheet, transfer board or slings for stretcher/chair transfers.

  • During the inspection ten patient record forms (PRF`s) were reviewed. All the records were on headed paper that was in a previous company name. All the PRF`s had omissions including times, dates, signatures and professional designations, seven records omitted a pain score, nine records omitted allergy status, there was no evidence of deteriorating patient pathways, there was no evidence of national early score (NEWS) or modified early warning score (MEWS) and there was no evidence of any pathways being utilised. Six of the ten PRF`s had no hospital handover information recorded.

  • There was no system for tracking the movements of medicines obtained by the service.

  • There were no recorded audits of stock management or expiry checks, no evidence of daily controlled drugs checks and there was not a record of general stock rotation or expiry checks.

  • Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to ensure staff received an annual appraisal and recorded these. During this inspection there was no evidence the service had a staff appraisal system.

  • Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to develop clear guidance for staff on the transfer of children not accompanied by a responsible adult. During this inspection we found no evidence the service had developed the guidance.

  • The service did not have an induction procedure for new staff.

  • There was no evidence the service held regular governance meetings which had a set agenda, with minutes and actions.

  • Following the last inspection in December 2017 the service was given a must do action to improve the service which was, to develop a system for identifying, reducing and controlling risk. During this inspection we saw no evidence the service had a risk register and there was not a system for identifying, reducing and controlling risk.

  • Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to develop some clinical quality indicators related to the safety of the service and monitor performance against these. During this inspection we saw no evidence the service had developed clinical quality indicators.

However, we found the following areas of good practice:

  • All staff mandatory training and safeguarding training was recorded on a spreadsheet which highlighted which courses staff had attended and when the date of the refresher was.

  • All the services` vehicles were on the ministry of transport (MOT) reminder service from the Gov.uk online system which sent out an alert e mail a month then two weeks before the vehicle service was due.

  • The premises including the store rooms and medicine storage were visibly clean, tidy and well laid out.

  • The medicines were stored securely within a locked store room. Separate medicine stores were further secured behind a locked cupboard.

  • Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to ensure staff completed training updates in basic life support and the use of automated electronic defibrillators. During this inspection we saw evidence staff had received this training.

  • Following the last inspection in December 2017 the service was given an action it should take to improve the service which was, to ensure staff were provided with communication aids and a translation service to aid communication with patients who have difficulty in understanding English or have communication needs. During this inspection there was evidence of a multilingual phrase book available for patient’s on board both ambulances we inspected.

  • The ambulance we inspected had a supply of patient information/feedback forms, which briefly detailed how to make a complaint and provide feedback regarding the service received.

  • Staff had to provide their driving licence details which were checked using the government internet licence check system.

Following this inspection, we told the provider that it must take 20 actions to comply with the regulations and that it should make 15 improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two enforcement notices that affected urgent and emergency care. Details are at the end of the report.

Name of signatory

Sarah Dronsfield

Head of Hospitals Inspections North East, on behalf of the Chief Inspector of Hospitals

5 December 2017

During a routine inspection

Mr David Ogden - Skipton is operated by Mr David Ogden. The service provides emergency and urgent care services.

We carried out an announced inspection of this service using our comprehensive inspection methodology on 5 December 2017. The focus of this announced inspection was in relation to the emergency care provided during the transport of patients to an accident and emergency department (A&E).

During 2017 the service transported a total of 17 patients to hospital.

The provider`s main service is to provide first aid and medical cover at public and private events. We did not inspect this part of their service at the inspection as it is not regulated by the CQC. This element is regulated by the Health and Safety Executive.

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:

  • Vehicles were well maintained, cleaned and equipped with the necessary equipment to provide safe care.

  • The service had processes for the safe management and administration of medicines. Our observations during the inspection, our discussions with staff and patient records indicated these were followed.

  • Staff had access to national best practice guidance and the service’s policies and procedures reflected national guidance.

  • Staff completed a full assessment of each patient prior to transfer to hospital and liaised with NHS emergency services to ensure the most appropriate method of transfer was agreed and that the correct emergency pathways were followed.

  • Feedback from patients and their relatives indicated staff showed compassion and thoughtfulness in their interactions. They said they felt supported and reassured by staff.

  • Staff had an awareness of the importance of maintaining patients’ privacy and dignity.

  • The service had a formal policy for involving patients and stated this was integral to treating people with dignity and respect.

  • The service received no complaints during 2016 or 2017. A complaints procedure provided details of the process for the investigation of complaints and timescales for responding.

  • Staff showed an awareness of the needs of patients with complex needs and the need to tailor their service to meet patients’ individual needs.

  • The service had documented their values and these were evident in the way the service was managed and in examples given by staff. Staff were engaged and loyal to the service.

  • The service had policies and procedures in place which were individualised to the requirements of the service, were comprehensive in their content and clear.

  • The managing director was visible and involved in the day to day provision of the service.

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

  • The service did not ensure staff working directly with children received level 3 safeguarding training. In addition, the identified safeguarding lead had not completed level 4 training for children and they did not have arrangements in place via a service level agreement for supervision and appraisal of staff by a level 4 trained professional. This does not comply with the Intercollegiate Guidance (2014). However, staff were aware of the signs of abuse and gave us examples of safeguarding referrals they had made.

  • Although staff were able to explain the action they would take if a patient’s condition deteriorated on the journey to hospital, the service did not have a standard operating procedure or protocol to provide guidance for staff.

  • The service did not measure any clinical quality indicators related to the safety of the service.

  • The service did not consistently maintain records of training completed by staff to maintain their competence. Records of training updates in basic life support and the use of automated electronic defibrillators indicated 65% of staff completed this training from November 2016 to November 2017.

  • Staff did not receive formal annual appraisals.

  • A governance framework had not been developed. There were no documented management or governance meetings and no risk register. The management team were able to identify some of the risks but there was no evidence that all risks and been systematically identified and assessed

  • There was a recruitment policy in place but staff personnel files were disorganised and important documentation was missing.

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. Details are at the end of the report.

Ellen Armistead

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