The registered manager was not present on the day of our inspection but we spoke with the operations manager and nurse liaison manager. We checked the personal records of five staff and looked at information provided by the provider.

We spoke with the registered manager and eight members of staff.

A member of staff told us, “It is a good atmosphere here, management are visible and approachable”. Another member of staff told us, “We are definitely well led”.

We inspected the patient transport service element of B N Gibson Ltd. People who used the service were collected and transported to different locations. For example people could be collected from or taken to hospital for appointments or be brought home from hospital after a stay in hospital as an in-patient.

Arrangements in place for infection control were well managed so risks to people who used the service were minimised.

We found the premises were suitable and safe.The ambulances were clean, tidy and well maintained. Vehicles were regularly checked to ensure that they were clean, equipped and fit for purpose.We saw evidence of routine checks carried out on vehicles.These highlighted any defects or issues which were then addressed.

Equipment was available in sufficient quantities to meet patient’s safety and welfare needs.

We found that the staff recruitment procedures were effective as they ensured that people who used the services were safe and their health and welfare needs were met by staff who were fit and appropriately qualified.

Staff told us they were appropriately trained,however we found that suitable appraisal and supervision arrangements were not in place.

Overall summary

B.N.Gibson Ltd Ambulance Services provides a non-emergency ambulance service to hospitals, care homes, residential homes, nursing homes, schools and patients homes. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 and 31 January 2017 along with an unannounced visit to the hospital on 10 February 2017. This was an announced comprehensive inspection of the service’s patient transport services. We visited the service’s headquarters, workshop, and storage areas during the inspection. The overall fleet size is 73 vehicles and they have 4,400 journeys on average per month.

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?

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 understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
• Infection prevention and control processes were in place and equipment had been checked in line with the service policy.
• Staffing levels were planned, implemented and reviewed to ensure patients received safe care and treatment at all times.
• Equipment was readily available, maintained and serviced.
• Staff assessed and responded appropriately to potential risks to patients.
• Staff received training to provide them with the skills and knowledge required for their role.
• Medical record documentation met national standards.
• Policies for care and treatment reflected relevant research and guidance.
• Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.
• Staff, teams and services worked together effectively to deliver effective care and treatment.
• Response times were good and feedback from service users confirmed this.
• Staff treated patients with kindness, compassion, dignity and respect.
• Staff responded compassionately when patients needed help and supported patients emotionally. This was reflected in their care and treatment.
• Patients were able to provide feedback which was unanimously positive about the care and treatment they had received.
• Patients were involved and encouraged in making decisions about their care.
• The service reviewed patient feedback forms and staff job sheets which enabled them to identify areas for improvement to better meet the needs of patients.
• Staff took the needs of different patients/young people into account when providing transport services.
• There was shared understanding between staff that every patient had individual needs.
• Services were planned and delivered in a way which met the needs of the local population.
• Without exception, staff we spoke with were consistently positive about local leadership.
• The service encouraged feedback from patients and staff.
• Staff told us that managers were both visible and accessible and that they would have no concerns in raising any issues directly with them should the need occur.
• Staff we met were welcoming, friendly and helpful. They were proud of where they worked and said they were happy working for the service.

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

• There was no facilities available to support staff to communicate with non-English speaking patients.
• Whilst we saw complaints were investigated the service on one occasion had not followed the complaints policy fully.
• The service used their Care Quality Commission statement of purpose for the service strategy and vision. However not all staff could articulate the vision of the organisation.
• At the time of inspection the service did not have a robust governance process particularly in relation to documented and mitigated risks.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Name of signatory

Helen Vine

Inspection Manager Hospitals (central region)