Unit 1 is operated by Mr. David Ogden . The service provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 9 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.

We inspected the urgent and emergency care service we did not inspect the patient transport service .

We found the following issues that the service provider needs to improve:

• Policies in relation to clinical adverse incidents, non-clinical adverse incidents and adverse incidents with a third-party provider were out of date at the time of the inspection.

• The duty of candour policy was not dated and there was not a date when the policy became live and there was no review date.

• There was no evidence the service carried out any infection prevention control audits (IPC) audits.

• The service did not formally monitor and record adherence to infection control policies and procedures.

• There was no evidence of any vehicle cleaning audits and daily vehicle cleaning and deep cleans were not recorded.

• Five automatic external defibrillators (AEDs) were checked during inspection, three had no evidence of having been portable appliance tested (PAT) tested and one of the AED`s did not have a date when the machine was operational.

• There was no risk assessment for the storage of gas cylinders.

• There was no standard moving and handling equipment on board the urgent and emergency care ambulance such as a slide sheet, transfer board or slings for stretcher/chair transfers.

• During the inspection ten patient record forms (PRF`s) were reviewed. All the records were on headed paper that was in a previous company name. All the PRF`s had omissions including times, dates, signatures and professional designations, seven records omitted a pain score, nine records omitted allergy status, there was no evidence of deteriorating patient pathways, there was no evidence of national early score (NEWS) or modified early warning score (MEWS) and there was no evidence of any pathways being utilised. Six of the ten PRF`s had no hospital handover information recorded.

• There was no system for tracking the movements of medicines obtained by the service.

• There were no recorded audits of stock management or expiry checks, no evidence of daily controlled drugs checks and there was not a record of general stock rotation or expiry checks.

• Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to ensure staff received an annual appraisal and recorded these. During this inspection there was no evidence the service had a staff appraisal system.

• Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to develop clear guidance for staff on the transfer of children not accompanied by a responsible adult. During this inspection we found no evidence the service had developed the guidance.

• The service did not have an induction procedure for new staff.

• There was no evidence the service held regular governance meetings which had a set agenda, with minutes and actions.

• Following the last inspection in December 2017 the service was given a must do action to improve the service which was, to develop a system for identifying, reducing and controlling risk. During this inspection we saw no evidence the service had a risk register and there was not a system for identifying, reducing and controlling risk.

• Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to develop some clinical quality indicators related to the safety of the service and monitor performance against these. During this inspection we saw no evidence the service had developed clinical quality indicators.

However, we found the following areas of good practice:

• All staff mandatory training and safeguarding training was recorded on a spreadsheet which highlighted which courses staff had attended and when the date of the refresher was.

• All the services` vehicles were on the ministry of transport (MOT) reminder service from the Gov.uk online system which sent out an alert e mail a month then two weeks before the vehicle service was due.

• The premises including the store rooms and medicine storage were visibly clean, tidy and well laid out.

• The medicines were stored securely within a locked store room. Separate medicine stores were further secured behind a locked cupboard.

• Following the last inspection in December 2017 the service was given a should do action to improve the service which was, to ensure staff completed training updates in basic life support and the use of automated electronic defibrillators. During this inspection we saw evidence staff had received this training.

• Following the last inspection in December 2017 the service was given an action it should take to improve the service which was, to ensure staff were provided with communication aids and a translation service to aid communication with patients who have difficulty in understanding English or have communication needs. During this inspection there was evidence of a multilingual phrase book available for patient’s on board both ambulances we inspected.

• The ambulance we inspected had a supply of patient information/feedback forms, which briefly detailed how to make a complaint and provide feedback regarding the service received.

• Staff had to provide their driving licence details which were checked using the government internet licence check system.

Following this inspection, we told the provider that it must take 20 actions to comply with the regulations and that it should make 15 improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two enforcement notices that affected urgent and emergency care. Details are at the end of the report.

Name of signatory

Sarah Dronsfield

Head of Hospitals Inspections North East, on behalf of the Chief Inspector of Hospitals

Mr David Ogden - Skipton is operated by Mr David Ogden. The service provides emergency and urgent care services.

We carried out an announced inspection of this service using our comprehensive inspection methodology on 5 December 2017. The focus of this announced inspection was in relation to the emergency care provided during the transport of patients to an accident and emergency department (A&E).

During 2017 the service transported a total of 17 patients to hospital.

The provider`s main service is to provide first aid and medical cover at public and private events. We did not inspect this part of their service at the inspection as it is not regulated by the CQC. This element is regulated by the Health and Safety Executive.

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:

• Vehicles were well maintained, cleaned and equipped with the necessary equipment to provide safe care.

• The service had processes for the safe management and administration of medicines. Our observations during the inspection, our discussions with staff and patient records indicated these were followed.

• Staff had access to national best practice guidance and the service’s policies and procedures reflected national guidance.

• Staff completed a full assessment of each patient prior to transfer to hospital and liaised with NHS emergency services to ensure the most appropriate method of transfer was agreed and that the correct emergency pathways were followed.

• Feedback from patients and their relatives indicated staff showed compassion and thoughtfulness in their interactions. They said they felt supported and reassured by staff.

• Staff had an awareness of the importance of maintaining patients’ privacy and dignity.

• The service had a formal policy for involving patients and stated this was integral to treating people with dignity and respect.

• The service received no complaints during 2016 or 2017. A complaints procedure provided details of the process for the investigation of complaints and timescales for responding.

• Staff showed an awareness of the needs of patients with complex needs and the need to tailor their service to meet patients’ individual needs.

• The service had documented their values and these were evident in the way the service was managed and in examples given by staff. Staff were engaged and loyal to the service.

• The service had policies and procedures in place which were individualised to the requirements of the service, were comprehensive in their content and clear.

• The managing director was visible and involved in the day to day provision of the service.

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

• The service did not ensure staff working directly with children received level 3 safeguarding training. In addition, the identified safeguarding lead had not completed level 4 training for children and they did not have arrangements in place via a service level agreement for supervision and appraisal of staff by a level 4 trained professional. This does not comply with the Intercollegiate Guidance (2014). However, staff were aware of the signs of abuse and gave us examples of safeguarding referrals they had made.

• Although staff were able to explain the action they would take if a patient’s condition deteriorated on the journey to hospital, the service did not have a standard operating procedure or protocol to provide guidance for staff.

• The service did not measure any clinical quality indicators related to the safety of the service.

• The service did not consistently maintain records of training completed by staff to maintain their competence. Records of training updates in basic life support and the use of automated electronic defibrillators indicated 65% of staff completed this training from November 2016 to November 2017.

• Staff did not receive formal annual appraisals.

• A governance framework had not been developed. There were no documented management or governance meetings and no risk register. The management team were able to identify some of the risks but there was no evidence that all risks and been systematically identified and assessed

• There was a recruitment policy in place but staff personnel files were disorganised and important documentation was missing.

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 two requirement notices. Details are at the end of the report.

Ellen Armistead

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