Cartello Ambulance is operated by Cartello Adams Limited and provides a patient transport service. The service was registered on 4 September 2014 and provides a service for both adults and children.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 17 January 2017.

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.

Cartello provided regular services such as taking and picking up children with complex medical needs from school or day centres, supplying ambulances to another private ambulance on a sub-contractor basis and transporting NHS patients discharged from hospital or attending outpatient appointments. The service was based in Hednesford, Staffordshire. There was an office and a garage, which housed the seven ambulance vehicles

We found the following areas of good practice:

• The service employed staff who were knowledgeable about how to carry out their role.

• We saw that vehicles and equipment were clean and well maintained.

• Staff worked effectively with other providers in order to provide the transport service.

• Staff were caring, helpful and respectful.

• Staff within the service had completed training to assist with meeting the needs of individuals including patients living with dementia and learning disabilities.

• There was a positive culture within the organisation with approachable leaders.

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

• A culture of incident reporting was not embedded in the service. Staff reported incidents verbally but there was no formal recording of incidents or their severity or how learning from incidents had been shared.

• We saw that patient records were not always available or complete and did not specify patients’ needs or actions to be undertaken in an emergency.

• Staff and managers were not aware of the duty of candour regulations or actions that the service was required to undertake under these regulations.

• There were no practical checks of driver competence at the time of our inspection although this was planned.

• Staff had never had an appraisal or a formal review of their performance.

• The safeguarding policy included both safeguarding vulnerable adults and children but did not fully detail the legislation to safeguard both vulnerable groups.

• The organisation did not have any policies or procedures that referred to obtaining consent from patients or considerations, which should be made with regard to the Mental Capacity Act 2005.

• There was no formal recorded vision and strategy for the service.

• Governance arrangements needed to be strengthened to ensure the service was able to develop systems to minimise the risk to patients and staff.

• There was no registered manager or responsible individual for the organisation.

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 four requirement notices, details of which are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals