Phoenix Private Ambulance Service is operated by Castle brand Limited and provides a patient transport service. This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC regulates the patient transport service and treatment of disease, disorder and injury service provided by Phoenix Private Ambulance Service, which makes up over 50% of the business. The other services provided are not regulated by CQC as they do not fall into the CQC scope of regulation. The areas of Phoenix Private Ambulance service that we do not regulate are transporting of children to a place of education.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 18 December 2018 and then with a follow up inspection on the 4 January 2019.

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.

The main service provided by this service was patient transport.

We found the following areas of good practice:

• Staff know their responsibilities for reporting incidents.
• Staff were up-to-date on mandatory training and there were systems in place to monitor staff compliance with mandatory training.
• The service mostly had systems in place to maintain cleanliness of vehicles and equipment.
• All staff cited that patient care was the most important part of the job.
• A full verbal handover for all patients was given before any transport was undertaken and this was thoroughly checked as correct.
• We witnessed very good care and excellent communication and manual handling skills by one crew on a transfer.
• Premises and equipment were appropriate and well maintained.
• Systems were in place to ensure ambulances were well maintained with equipment to meet the needs of patients.
• The service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• Leadership was visible, responsive and staff could access them when required.

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

• Governance systems were not established or effective. The service did not have an effective system in place to demonstrate risks had been identified and actions taken to mitigate risks, there was no formal process in place to report and record incidents, audits were not undertaken and some policies required updating.
• Although staff were aware of how and when to report incidents, the service did not have a policy on incident reporting on the first day of inspection. When we returned on the 4 January 2019 a policy was being implemented and staff had been informed of the process, although this was not yet embedded.
• Systems and processes were not in place to implement lone working procedures, although these were reviewed and added to the handbook immediately after the first day of inspection and were in place when we returned on the 4 January 2019.Staff were able to demonstrate their knowledge of the policy.
• There was no clear written guidance on the patient criteria for transport, and although staff stated that they would not transfer an unstable patient, there was no written process in place to follow. This was duly reviewed and we viewed the written criteria on our return visit. However, this was not the final revision of the criteria, as there remained some criteria to be reviewed. Therefore, the new criteria policy was to be implemented by the end of January 2019.
• There was no written criteria and process in place for the deteriorating patient. This was in the process of being added to the staff handbook and training at the time of the inspection in January 2019, but had not been fully embedded with staff.
• The safeguarding training was found to be inadequate for the level required for the transport of adult patients.The management had implemented a training programme for all staff to have completed by the 15t January 2019.
• 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 a requirement notice(s) that affected the transport service provided by them. Details are at the end of the report.

Amanda Stanford

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