Due to the transient nature of this service we were not able to speak with people who used the service. We contacted the NHS trust that commissions the service. Feedback from the NHS Trust was positive. They confirmed Tascor provided them with a responsive and flexible service.

We spoke with the registered manager and twelve members of staff. A member of staff said “I treat everyone like they were my parent or friend as if the situation was reversed that is how I would like to be treated should I ever require this service”. Another member of staff told us “we work with people who are usually extremely ill and are being detained for their own safety. It is not their fault and due to their illness may not have no control or no recollection of that period of time”.

Journeys were planned taking into account the needs and safety of the person.

There were effective systems in place to reduce the risk and spread of infection.

Staff had received appropriate training to enable them to fulfil their roles and support the people who were using the service. A robust recruitment process was in place.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Vehicles were fit for purpose, systems were in place to ensure that they were maintained and appropriately equipped.

Keynsham Vehicle Base is run by Tascor services Ltd and is located on a trading estate in Keynsham in the south west of England. It is part of Capita Plc. The service provides non-emergency ambulance transport for people with mental health conditions, most of whom are detained under the Mental Health Act 1983. The service also provides transport for non detained patients, for example patients living with dementia who attend day centre groups.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 7 and 8 August 2017, and returned unannounced on 22 August 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.

We found the following areas of good practice:

• The service performed well on safety. Staff we spoke with understood their responsibilities to raise concerns, to record safety incidents, and to report them.
• Vehicle cleanliness and hygiene was maintained with daily cleaning.
• Patients’ records were kept secure during patient transport.
• Systems, processes and practices were in place, which were essential to keep people safe such as incident reporting and training and these were communicated to staff.
• Staff received annual training in first aid, control and restraint and the prevention and management of violence and aggression and received regular driving assessments.
• Risks to people who used services were assessed, and their safety was monitored and maintained. Potential risks to the service were anticipated and planned for in advance.
• There were enough staff to deliver the service they were running.
• There were plans in place for a range of issues that could affect business continuity.
• Assessments were carried out to inform what care and support was needed during transport and staff followed evidence-based practice in relation to control and restraint and detention of patients under the Mental Health Act 1983.
• Staff and other services worked well together to deliver effective care and treatment. Other providers were very complimentary about how the provider worked with them, which sometimes reduced the need for patient restraint.
• The provider monitored response times and quality measures which were reported to the commissioner of the service every six to eight weeks.
• Staff had annual performance appraisals.
• Patients and those close to them were treated with kindness, respect and compassion while they received care and support.
• Staff ensured patients’ dignity was maintained in public places and during transportation.
• Staff communicated with patients so that they were involved in and understood their care.
• Staff understood the impact that a person’s care, treatment or condition would have on wellbeing and on those close to them, both emotionally and socially.
• Staff did what they could to help patients who used services maximise their independence.
• Patients accessed care and treatment in a timely way. Services ran on time, and people were kept informed about any delays. The service was over performing on out of area journeys with a planned pick up occurring within 24 hours. The provider had never fallen below the performance indicator of 95% of all patients being picked up within two and three hours for urban and rural journeys respectively.
• Transport services were planned, delivered and coordinated to take account of people with complex needs, including those detained under the Mental Health Act 1983 and people living with dementia.
• The provider operated 24 hours a day and seven days a week.
• Complaints were used to improve the service.
• Leadership and culture at all levels, encouraged openness and transparency. The registered manager was visible and approachable for staff. Staff told us they felt respected and valued, and were very proud of the work they did.
• The board had oversight of the quality standards through monthly board reports from the registered manager.

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

• There was a limited understanding of the formal definition and the legal implications of the Duty of Candour.
• Most complaints were managed through other organisations or trusts the provider worked with. Tascor was unable to provide information about the total number and type of complaints that may have been made about them to other providers. This meant the service may have been missing opportunities to improve the service.
• Patients we spoke with did not know how to make a direct complaint about the transport service.
• Some patient identifiable information was not kept securely at base location.
• Not all staff understood all their responsibilities to adhere to safeguarding policies and procedures but reported safeguarding issues.
• There was no comprehensive, regular safeguarding or Mental Capacity Act 2005 training.
• Not all policies were up to date or had been regularly reviewed.
• There was no vision for the service.
• The governance framework did not always ensure that responsibilities were clear. At Tascor board level it was not clear who was responsible for CQC updates, Duty of Candour, training or equality and diversity, safeguarding or for the Mental Health Act 1983 and Mental Capacity Act 2005.
• There was no local risk register and the board risk register did not reflect issues we identified during inspection.
• There was no up to date statement of purpose
• There was no patient feedback or engagement and the staff survey was not representative.

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 three requirement notice(s) that affected Keynsham Vehicle Base. Details are at the end of the report.

Name of signatory

Deputy Chief Inspector of Hospitals (area of responsibility), on behalf of the Chief Inspector of Hospitals

Professor Edward Baker