Location Medical Services - Shepperton Studios Medical Centre is operated by Location Medical Services Limited. The service provides emergency and urgent care and conveys patients from event sites to hospital emergency departments where clinically necessary.

We inspected this service using our comprehensive inspection methodology. We carried out this announced inspection on 1 November 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 issues that the service provider needs to improve:

• We found two out-of-date oxygen cylinders on one of the ambulances we inspected, and a further expired cylinder in the medical gas store. We informed the provider, who immediately removed the expired cylinders. The provider also sent written confirmation that an external contractor had audited all oxygen cylinders and removed any others that had expired or were close to expiry. The provider also introduced a daily check of oxygen cylinder dates as part of their daily vehicle checks to prevent this from happening again.

• The provider did not have assurances all staff carrying out regulated activity had appropriate, up-to-date mandatory training in key areas. These included infection prevention and control and safeguarding children level three training for staff that treated children and young people under the age of 18.

• The provider did not have assurances all staff carrying out regulated activity had a meaningful annual appraisal to provide ongoing assurances of their performance and competencies. Following our feedback, the provider began writing to NHS ambulance trusts where staff held substantive posts to establish a pathway to share evidence of mandatory training and appraisal.

• Five out of seven patient records we reviewed showed gaps in documentation, including missing observations. This meant the provider had not maintained accurate, complete and contemporaneous records for all patients. Following our feedback on this issue, the provider updated their clinical documentation policy and circulated to all staff. The members of staff who had completed the records we raised concerns about also reflected on their performance and produced a reflective statement.

• The provider had not taken sufficient action to mitigate identified clinical risks to the service. Other than client satisfaction questionnaires, there were no systems in use to assess, monitor and improve the quality and safety of the services provided at the time of our inspection.

• We raised concerns with the provider about the cleanliness of one of the three vehicles we inspected, as well as two pieces of equipment. The provider took immediate action to remove the equipment and vehicle in question from service, as well as producing audit tools to monitor cleanliness going forwards.

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

• Staff spoke positively about the culture of the service. The leadership team told us they made themselves accessible to staff at all times and encouraged a culture of openness and transparency. Staff told us they felt they could approach the leadership team at any time if they wanted to raise a concern or needed support.

• The provider had systems to ensure they maintained vehicles to keep them roadworthy. We saw evidence all ambulances the service used to carry out regulated activity complied with MOT testing, and had valid insurance and vehicle tax.

• We saw evidence that all medical equipment underwent annual testing and servicing by an engineer. The provider’s equipment servicing log provided assurances all equipment had passed the engineer’s inspection and testing within the last year.

• We saw evidence of effective pre-employment checks to assess the suitability of new staff. These included Disclosure and Barring Service (DBS) and reference checks, and evidence of professional registration.

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 that affected the Emergency and urgent care service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief Inspector of Hospitals

We spoke with two people who used the service. They told us they were extremely happy with the service. One person said; "I find them flexible, professional and very accommodating." Another person said; "I am very happy to continue working with them, they are a very professional service. Communication is excellent within the organisation." And; "I am very happy with the service from Location Medical Services."

We spoke with four members of staff who told us they felt well trained and supported and were very happy in their role. One said; "Brilliant organisation, the best I have worked for." Another said "I love this job." And "Managers are always available to ask advice, if I need it." Another said; "It's an open-door policy, managers are always available 24/7." "Communication is excellent." And, "We usually get our briefing instructions for the job in good time to allow us to plan."

We found that people were involved in their care and their needs were assessed and met.

The provider had taken appropriate steps to ensure people were safe from abuse. All staff received training in safeguarding. The provider had a safeguarding policy that clearly gave staff guidance on what to do if they suspected abuse was happening.

We found that staff received appropriate professional development. Staff members commented there were opportunities for progression within the service to take on a more senior role.

The provider monitored the quality of service. Vehicle checks were conducted, accidents and incidents managed and people's opinions were sought and acted upon.

We did not speak with any people as part of this inspection because there were no services taking place at the time of our visit.