KFA Medical is an independent ambulance service based in Keighley, West Yorkshire.

We carried out an announced focused follow up inspection of this service using our comprehensive inspection methodology on 25 April 2018. All five domains were not inspected because this was a follow up inspection.

This service had been inspected on 8 November 2017. Following that inspection of the service several breaches of regulations were identified, in addition, 27 areas where the service must improve and nine areas where the service should improve were identified. In December 2017 the service voluntarily suspended carrying out regulated activity for three months to enable them to make the required improvements. The service was subject to a CQC desk top review of progress in February 2018 in relation to the breaches of regulations, the areas where the service must improve and should improve. The improvements were not completed and the service requested and we agreed to an extension of its voluntarily suspension for a further two months which concluded on 30th April.

The focus of this announced follow up inspection was in relation to the five legal requirements, 27 areas where the service must improve and nine areas where the service should improve. Following this inspection, the provider was found to be compliant in relation to the breaches identified in the previous inspection and had taken action in relation to the 27 areas where the service must improve and nine areas where the service should improve were identified.

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 services need to improve and take regulatory action as necessary.

We also found the following areas of good practice:

• There was clear management structure with defined areas of responsibility.
• There was evidence of staff disclosure and barring service (DBS) checks.
• There were records kept of when the Patient Transport Service ambulance had been cleaned which included a deep clean every 28 days.
• There was evidence of formal internal driver training assessment carried out by the service by an independent person who was blue light trained.
• There was evidence that administrative staff checked the driving licences of staff that drove KFA Medical vehicles via the Driver and Vehicle Licensing Agency.

We found the following issues that the service needed to improve:

• There was a bin for clinical waste in the PTS ambulance but the lid could not be secured.
• There was not a system to collect data which identified which patients had been transported to their own residence.
• There was a business continuity plan but it had not been tested practically or through an exercise to ascertain if it was viable.

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

Ellen Armistead

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

KFA Medical is an independent ambulance service based in Keighley, West Yorkshire.

We carried out an announced inspection of this service using our comprehensive inspection methodology on 8 November 2017. The focus of this announced inspection was in relation to the transport of patients including patients with mental ill health.

The service provided transport services for patients transferring from hospitals to other hospitals, to care homes and to patients` places of residence which included patients with mental ill health. The provider`s main service was medical cover at public and private events. We did not inspect this part of their service at this inspection.

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? For this inspection we inspected the safe, effective, caring, responsive and well-led domains of the service.

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 issues that the service provider needs to improve:

• There was no formal incident reporting procedure.

• There was no system to share wider learning or lessons learned from complaints or incidents with staff.

• There was no evidence to show that staff had received sufficient safeguarding training or systems in place to ensure safeguarding issues could be promptly identified or referred to the appropriate authority.

• The provider did not have systems and processes that ensured the safety of their premises and the equipment within it

• There was no understanding of the Duty of candour principles and how these would be applied.

• Staff had not completed any training in dementia, learning disabilities or caring for people with mental health needs, the Mental Capacity Act of Deprivation of Liberty safeguards. .

• There were no accurate records kept of staff training attendance.

• There was no evidence of appropriate support, training, professional development and supervision.

• There were no staff appraisals

• Staff were not recording their risk assessments when the patients were transferred into their care.

• KFA. Medical did not maintain an accurate or complete record of the patients in their care. There was an over reliance upon the information from the provider that contracted the service.

• There was a lack of a recorded risk assessment which meant that timely care planning did not take place which therefore did not ensure the health, safety and welfare of the service users.

• There was no monitoring of the frequency of use of physical intervention or types of intervention used. Therefore, no themes or trends had been identified or potential for lessons learnt identified.

• There was no evidence of there being a system in place to monitor safety and use of outcomes following patient transports.

• Staff did not have access to any communication aids to facilitate communication with patients with a learning disability or for whom English was not their first language.

• There were no systems in place to identify, manage and mitigate risks. The service did not have a risk register.

• There were no systems in place to monitor the quality of services or to monitor staff compliance with policies and relevant national guidelines. There were no audits taking place.

• There was no business continuity plan.

• The company policies were generic and not specific to the service provided by KFA. Medical.

• There was no evidence that there was a clear company vision with a set of values with quality and safety as the top priority.

• There were no formal governance meetings which were relevant to the planning and delivery of care and treatment. There were no meetings to discuss policies and procedures, service and maintenance records, audits and reviews, purchasing and action plans in response to risk and incidents which had minutes and actions.

• The Management team did not have identified areas of responsibility and accountability.

However, we also found the following areas of good practice:

• There was evidence of staff disclosure and barring service (DBS) checks.

• There were records kept of when the Patient Transport Service vehicle had been cleaned including a deep clean every 28 days.

• Control of Substances Hazardous to Health (COSHH) were stored in locked cupboards and staff responsible for cleaning of the vehicles had completed COSHH training.

• There was evidence that administrative staff checked the driving licences of staff that drove KFA Medical vehicles via the Driver and Vehicle Licensing Agency.

• Staff responsible for the cleaning and overseeing the maintenance of the vehicles had received appropriate training.

• Staff were aware of how to maintain patient privacy and dignity.

• The provider had a Respect Charter relating to the dignity, privacy and independence of patients.

• Complaints received in the last 12 months had been investigated internally. The complainants had been kept informed of the outcome which they were satisfied with.

We found areas for improvement including four breaches of legal requirements that the provider must put right. We found 27 things the provider must improve and nine things they should improve to comply with a minor breach of regulations that did not justify regulatory action, to prevent breaching a legal requirement, or to improve service quality. Details are at the end of the report.

Following the inspection, the provider voluntarily suspended registration of the following regulated activities until 30th April 2018 to allow them to address  the issues identified at the inspection:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder or injury.

This meant the provider could not continue to carry out these regulated activities until after 30th April  2018.

Ellen Armistead

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

We found that the internal environment of the ambulance used at events was not adequately cleaned and the storage of healthcare equipment was not organised. We also found that there were no formal processes for regularly assessing the cleanliness of the ambulance or the infection control standards expected of people working for the provider.

We found that some equipment on the ambulance had not been effectively maintained and there were no accurate processes for ensuring equipment was well maintained and fit-for-purpose. We found the mountain bikes used at events were serviced regularly and the medical kit on the mountain bikes was fit-for-purpose.

We found some deficits in training and supervision. There were no formal processes in place to continually monitor / appraise the skills of volunteer staff. The majority of training provided was in-house which meant training was easily accessible. However, the suitability of the in-house training had not been externally verified so it was unclear if the course content fully met people’s training needs. We found in the staff records reviewed, people had received the necessary first aid training to perform their role but, overall, the training and support provided to volunteers was not effectively managed.