Twinwoods Ambulance Station is operated by Ambulance Response Services Ltd. The service provides a patient transport service. We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 10 July 2017 and 14 July 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?

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 had systems in place to monitor staff compliance with mandatory training.
• There was a service had a system in place for reporting incidents.
• There was a policy in place for the storage, transport and destruction of patients’ records.
• Staffing levels and skill mix was planned and reviewed to ensure that people were safe from avoidable harm and received safe care and treatment at all times.
• The service had a fire safety risk assessment for the premises and a policy that gave guidance for all staff in terms of managing fire safety on vehicles.
• There was a system in place to demonstrate that policies had been developed, reviewed, and updated to reflect current practice.
• The service was equipped to manage a variety of health-related complaints. The service primary function was the provision of first aid at events.
• The service did not formally monitor patient outcomes. There were no formal contractual or service level agreements in place at the time of the inspection.
• Systems were in place for staff to seek patient’s consent, and assess capacity to agree to treatment when required.
• Feedback messages from patients using the service were positive.
• The service planned to meet the needs of local people, and provided a service based on an external risk assessment for events.
• The patient booking process meant patients’ individual needs were able to be identified.
• Patients had access to timely care and treatment at events.
• There was guidance available on vehicles for patients to make a complaint or express their concerns.
• The service was led by the manager who was a trained pre-hospital emergency practitioner with significant experience of working in the independent ambulance industry.
• The manager and senior staff took immediate and effective actions to address the concerns we raised during the inspection.

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

• The service had systems in place to ensure the safety and cleanliness of vehicles and equipment and the safe storage and management of medicines. However, these had not always been followed, as we found vehicles and equipment that was not clean and some not fit for use. The manager explained the vehicles had been in use the day before and there had not had been an opportunity to clean them before the inspection. The manager took immediate action to address these concerns.
• The service had systems in place to safeguard adults and children. However, these had not always been followed, as the necessary staff checks and training had not always been provided. The manager took immediate action to address these concerns.
• The service had systems in place to manage effective staff recruitment processes; however, these were not always followed. The manager took immediate action to address these concerns to ensure staff with appropriate skills and of good character were working with patients.
• Due to the small size of the service, there was a limited governance framework to support the delivery of the strategy and high quality care.
• The risk register was limited and did not reflect some risks we found during the inspection.

Due to the nature and range of concerns that we raised during the first day of inspection, the registered manager undertook to not provide any regulated activity during the inspection period to ensure the actions required were duly provided. Immediate and significant actions were taken to address these concerns by the second day of the inspection so that the provider could resume provision of regulated activities. Following the 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 that affected the patient transport service. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals