Broughton Park Ambulance Services Ltd provides emergency and urgent care services.

We inspected this service using our new phase inspection methodology. We carried out the announced part of the inspection on 4 September 2018.

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 said about the service and how the provider understood and complied with the Mental Capacity Act 2005.We found the following issues that the service provider needs to improve:

• Although the service assessed, and managed some risks accordingly, other risks were not always identified or responded to in the right way.
• Despite having access to national guidance, we had no assurance that care was always provided in line with it and documented clinical pathways outlining these processes were not in place at the time of our inspection. In the days following our inspection documentation was produced but this was not sufficiently aligned with national guidance.
• Although the service had managers in place to run the service, we were not assured that they had sufficient understanding of regulation relating to fit and proper persons and governance at the time of our inspection.
• Some formal governance processes to support the delivery of clinical care had not been identified as necessary or implemented by managers.
• The service generally gave, recorded and stored medicines well. However, not all medicines were stored and administered correctly.

We also found the following areas of good practice:

• The service had a system for reporting, reviewing and investigating incidents.
• Staff received training as part of their role and the majority were up to date.
• The service had safeguarding systems and processes in place to help staff identify safeguarding concerns and protect people from abuse.
• The maintenance and use of facilities and equipment kept people safe.
• The service had enough staff with the right skills and training to keep people safe and to provide care and treatment. The service made sure staffs were competent in their roles as responders. They received appropriate training and understood their roles and responsibilities under the Mental Health Act 1983 and Mental Capacity Act 2005.
• The service kept appropriate records of patients’ care and treatment and had access to appropriate levels of pain relief.
• The service monitored response times to help make sure they reached people as quickly as practicable. They monitored some outcomes and used findings to improve care for patients.
• Staff cared for patients with compassion, providing emotional support to patients to minimise their distress. Patient feedback confirmed they were treated well and with kindness. They involved patients and those close to them in decisions about their care and treatment.
• The service provided care that reflected the needs of the local population and took account of people’s individual needs. People could access the service when they needed it. Response times were monitored so that the service could ensure care was provided in a timely way.
• The service treated concerns and complaints seriously and had a policy in place for investigating and learning lessons from the results.
• The service promoted a positive culture that supported and valued its staff. Staff held extreme pride for being members of the service.
• The service had a vision for what it wanted to achieve and plans to turn it into action, with a systematic approach to continually improving the quality of its services.
• The service engaged well with patients and staff to plan and manage services effectively.

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 emergency and urgent care services. Details are at the end of the report.

Ellen Armistead

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