The Care Quality Commission
  • Ambulance service

Archived: Rapid Response Secure Ambulance

Overall: Requires improvement read more about inspection ratings

Badger House, Oldmixon Crescent, Weston-super-mare, BS24 9AY 0345 350 3797

Provided and run by:
Rapid Response Personnel Ltd

Important: This service was previously registered at a different address - see old profile
Important: This service is now registered at a different address - see new profile

All Inspections

15 June 2021

During a routine inspection

We carried out a comprehensive inspection of Rapid Response Secure Ambulance Limited (the provider) on 15 June 2021 to follow up on their inspection in February 2020, when we issued a warning notice and rated the service inadequate. We undertook a focused inspection in April 2021 to follow up specifically on the warning notice and found the service had made improvements. We did not rate the service at that previous follow-up inspection as we only looked at the areas identified in the warning notice.

At this inspection we inspected our five key questions: safe, effective, caring, responsive and well led. Before the inspection we reviewed information we had about the provider, including information we received and intelligence available. The inspection was announced with one week's notice to ensure the registered manager and the team would be available.

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

  • Processes to assess patient risks were not as yet fully effective and medicines management did not provide sufficient assurance about safe medicines administration processes. There was no specific guidance, policies or procedures relating to children and young people. Although the ambulance vehicle was well maintained, the intercom system was not working and there was a lack of risk assessments to ensure a safe environment for patients being transported with mental health disorders.
  • The service monitors response times and had performed well with journey times. However there was no framework to judge staff’s competence, and limited training regarding caring for children and young people. Staff did not have enough awareness of consent processes relating to children and young people.
  • The service did not always consider the physical health needs of patients or the specific needs of children. Although the service was small at the time of our visit, the provider was not always able to obtain feedback from patients who used the service. It had also not asked organisations who used the service to obtain opinion on the quality of the service received.
  • Recruitment practices did not always obtain enough information about the new members of staff to makes sure they were safe to work with patients.

However:

  • Staff received mandatory training and regular refresher training, including adult safeguarding and child protection training. The ambulance vehicle was clean and there was enough staff to convey patients and keep them safe during the journey. Staff completed patient records and stored these securely. Staff reported incidents and there were processes to ensure learning from incidents were shared.
  • Staff had access to policies and procedures to obtain information to support their practice. There was a comprehensive training programme available to staff and they received regular supervision and appraisals. Food and drink were provided to patients if this was required during long journeys.
  • The provider planned its transport to meet the needs of local people with mental health conditions. Patients could access the service when they needed it and did not have to wait too long for transport.
  • Leaders ran the service using reliable information systems and supported staff to develop their skills. Staff understood the provider’s vision and values and felt respected, supported and valued. Staff were focused on the needs of patients receiving transport and were clear about their roles and accountabilities.

Following this inspection, we wrote to the provider as we had urgent concerns about the safety of transport arrangements for children, although just two had been transported up until the time of our inspection. For example, there was a lack of children’s adaptive seating in the ambulance and specific training for staff. The provider sent us an action plan to address the urgent concerns and set the minimum age of children they will transport at 13 years and above. We also raised urgent concerns about the management of a deteriorating patient. The provider’s action plan stated it planned to amend the deteriorating patient policy. They would provide training for staff on the use of a specific tool to help staff identify if a patient’s condition was deteriorating and they required additional medical support. We will continue to monitor the provider’s actions in meeting our concerns.

23 April 2021

During an inspection looking at part of the service

We conducted this focussed follow-up inspection on 23 April 2021. The inspection was announced with one week’s notice to ensure the registered manager and the team would be available. We did not inspect all key questions as defined within our methodology but focused on those areas highlighted in the warning notice as requiring significant improvement following the inspection on 25 February 2020.

The ratings were not reassessed as part of this inspection.

At this inspection we found:

The provider had achieved progress in addressing our concerns and we judged that the requirements of the warning notice had been met.

Staff had training in key skills and understood how to protect patients from abuse. The service had systems for infection, prevention and control. Staff assessed risks to patients, acted on them and kept records to monitor actions taken.

The registered manager monitored the effectiveness of the service and made sure staff were competent.

The registered manager was in the process of developing systems to make it easier for people to give feedback.

The manager had introduced reliable information and monitoring systems and supported staff to develop their skills. Staff were clear about their roles and accountabilities. The manager and the team were committed to improving services continually.

25 February 2020

During a routine inspection

Rapid Response Secure Ambulance is operated by Rapid Response Personnel Limited. Rapid Response Secure Ambulance provide a patient transport service for mental health patients.

We inspected this service using our comprehensive inspection methodology. We carried out the short-notice announced inspection on 25 February 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.

The main service provided by this service was patient transport services.

We rated this service as Inadequate overall.

  • The recruitment processes for agency staff were not enough. The service did not have clear expectations of required mandatory training for agency staff and did not complete thorough checks to make sure the agency staff were up to date with mandatory training. We were not assured agency staff were appropriately trained to provide a safe service to children of all ages. The service did not take account of the specialist needs of patients with dementia when selecting agency staff. There was no documented induction for agency staff.

  • There was no clear protocol for the use of mechanical restraint. We could not be assured the service only used mechanical restraint in a safe, proportionate and monitored way as part of a wider person-centred support plan. There were no clear protocols regarding use of restraint reduction plans and audits, no processes for ensuring appropriate staff training, no processes to monitor risk of harm to patients during use of mechanical restraints and no processes for effective record keeping around use of mechanical restraints.

  • The service did not have systems to control infection risk well. Staff did not follow best practice to protect patients, themselves and others from infection. The vehicle was visibly dirty.

  • The service did not ensure there were processes to make sure staff completed safety checks of the vehicle prior to each journey. The service did not ensure first aid equipment was checked or that loose items were secured in the vehicle. Equipment to manage clinical waste was not always available to agency staff.

  • The service did not consistently document risk assessments. Records did not contain risk management plans for patient journeys. We were not assured staff removed or minimised risks. There was no formal document to define the eligibility or exclusion criteria for patients referred to the service.

  • We were not assured the service provided care and treatment based on national guidance and evidence-based practice. Policies were not fit for purpose and contained information irrelevant to the scope of the service.

  • We were not assured the individual needs of patients with dementia, autism or a learning disability were being recognised by the service. We were not assured that information about patient’s specific needs gained during the bookings process was always communicated to agency staff prior to commencing the journey. There was no system or equipment available to meet the needs of patients with hearing impairment or speech difficulties. There was no written information available in the vehicle for patients. It was not easy for people to give feedback and raise concerns about care received. Complaints procedures were not accessible to patients.

  • There was no governance structure to ensure there was oversight of quality, safety and performance. The service did not use systems to manage performance effectively. The manager was not clear about accountability for the service. The manager was unable to give assurance the information systems were secure. The manager did not have all the skills and abilities to run the service well. There was no documented vision or strategy for the service. Leaders and staff did not actively and openly engage with patients, staff, equality groups, the public and local organisations to plan and manage services.

Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a warning notice that affected the Patient Transport Service. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South region), on behalf of the Chief Inspector of Hospitals