YorMed Ambulance Station is operated by YorMed Limited. We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the service on 3 to 5 July 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.
The service provided mainly patient transport services at the time of inspection. The service was also engaging with commissioners to obtain emergency and urgent care contracts. Where our findings about patient transport services, for example, management arrangements, also apply to other services, we do not repeat the information but cross-refer to the patient transport core service.
Our rating of this service is requires improvement. The service was not previously rated.
We found the following areas that the service provider needed to improve:
Patient deterioration was not always recognised, escalated and managed safely. The service did not investigate patient safety incidents in a way that supported learning. Patient record forms were not consistently completed to an acceptable standard.
Some contracts for the delivery of services were under review as assurance of the safety of services was sought by commissioners.
Governance processes were not fully effective and the service did not use systems effectively to manage risks and performance.
The registered manager was unaware of his responsibility as safeguarding lead to ensure statutory notifications were submitted by the service.
The service did not have a formal process to monitor performance and make improvements. No performance or quality monitoring reports were prepared.
Defects of vehicles and equipment were not always attended to promptly and vehicle and equipment maintenance logs were not available for inspection.
Few staff had undergone a formal appraisal of their work performance.
Leadership did not provide sufficient assurance high quality services would be delivered. The strategy to turn the vision for the service into action required development with relevant stakeholders.
However:
Staff understood how to protect patients from abuse and staff had training on how to recognise and report abuse.
Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean.
Staffing levels and skill mix were planned flexibly to meet workload requirements. The service provided mandatory training in key skills to all staff.
The service supported staff competence for their roles with induction and training and ambulance staff had undergone emergency driver training.
The service took account of patients’ individual needs and preferences and made reasonable adjustments to help patients access services. Staff received training to support patients with dementia needs or other needs caused by reduced capacity.
The service had a mainly open culture although not all staff felt they could raise concerns.
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 10 requirement notices that affected patient transport services. Details are at the end of the report.
Ann Ford
Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals