The Care Quality Commission
  • Ambulance service

Starcross Trading Ltd T/A Bears

Overall: Good read more about inspection ratings

C/O Cannons Park Motors, 229 Whitchurch Lane, Edgware, Middlesex, HA8 6QU

Provided and run by:
Starcross Trading Limited

All Inspections

24 September 2021

During an inspection looking at part of the service

This was a focused follow up inspection to investigate whether concerns from our previous inspection on 11 and 12 February 2020 had been resolved. We did not rate this service at this inspection. The previous overall rating of good remains.

At this inspection we found:

  • The provider has complied with the Requirement Notice issued in March 2020. The provider had made improvements to their recruitment processes and had completed retrospective reference checks for all staff to ensure fitness to work. The provider had also implemented a new system to ensure employee files were consistently being fully completed including documentation such as interview notes and reference checks.

11 and 12 February 2020

During a routine inspection

Starcross Trading Ltd T/A BEARS is operated by Starcross Trading Limited. The service provides emergency and urgent care and a patient transport service.

British Emergency Ambulance Response Service (BEARS) was founded in 2009 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency patients, patients receiving Extracorporeal Membrane Oxygenation (ECMO), non-emergency transfers secure/mental health patient transfers and a paramedic service. ECMO stands for Extracorporeal Membrane Oxygenation and is a form of life support that provides both cardiac and respiratory support to persons who heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. The service provides transport for both adults and children and young people. Journeys are made to various locations within London and longer journeys occur on a regular basis. The service has vehicles operated by emergency care assistants, emergency medical technicians and paramedics.

The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals.

The provider is registered for the regulated activities:

  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder and injury

The service performs contracted work with two London NHS Trusts and ad-hoc work for various other hospitals within London. The service also does ad-hoc work for other independent ambulance providers based on agreed set rates. The service also subcontracts some work out to smaller independent ambulance services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 and 12 February 2020.

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 last inspected this service in May 2018 but at the time we did not have the legal duty to rate independent ambulance services. However, following this inspection we rated the service good overall for both core services.

The main service provided by this service was PTS. Where our findings on PTS – for example, management arrangements – also apply to EUC, we do not repeat the information but cross-refer to the PTS core service.

We rated it as Good overall because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The provider had systems, processes, and practices to keep people safe and safeguard them from abuse. Staff were aware of and knowledgeable about these processes. The safeguarding lead was now trained to the recommended level.
  • The service had improved their use of Patient Group Directives (PGDs) since the last inspection. These were now only in place for appropriate staff.
  • The service had introduced training around information governance since the last inspection. Patient records were completed to a good standard and audited to ensure good compliance.
  • The secure services division had improved the completion of patient record forms for patients who required restraint during transport. There was now evidence of risk assessment and decision making in patient notes. This included an incident report form being completed.
  • The service had improved the way they recognised deteriorating patients.
  • The service encouraged staff to report incidents and staff investigated incidents and took actions to improve services.
  • The service’s had reviewed its policies and these were now in date. This had improved since the last inspection.
  • The service had improved their service level agreements with subcontractors and procedures were in place for auditing services to ensure quality of care.
  • We observed effective multidisciplinary working between BEARS staff and staff at the various hospitals they worked with.
  • The service performed well against their key performance indicators and discussed these on a regular basis with hospital staff
  • Staff treated patients and relatives with compassion, kindness, dignity and respect. We observed staff acting in a professional and courteous manner at all times. Patient feedback was positive.
  • Staff reported a positive working culture within the service and found leadership supportive and caring.
  • The provider had improved their processes for Disclosure and Barring Services (DBS) checks to ensure it was safe for staff to work with patients.
  • The service had further developed its in-house electronic information system to include staff rota, audits and equipment checks. This allowed management to have good oversight of the services performance.

However;

  • The safeguarding policy was not up to date with the most recent national guidance. The service updated the policy following our inspection.
  • Incidents around restraints during secure service transfers were not included in the main incident report log. The service took immediate action to ensure this took place going forward.
  • We found two occasions where sedated patients were transported without a registered professional. The service updated their booking process during our inspection to ensure this was completed going forward.
  • We found staff records did not always show evidence of interview notes and reference checks were not always completed.
  • Whilst we found good risk management within the service we found no evidence in the board minutes this was discussed at an executive level.

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, to help the service improve. We also issued the provider with one requirement notices. Details are at the end of the report.

Nigel Acheson

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

1st May 2018

During an inspection looking at part of the service

British Emergency Ambulance Response Service (BEARS) was founded in 2009 and is an independent ambulance service providing a range of patient transport services across London. This includes the transfer of high dependency and critical care patients, bariatric patient and paediatric patients. It also includes secure transfers of mental health patients.

The service has contracted work with three NHS trusts in London and also provides ad-hoc work for other NHS and independent hospitals. Journeys are made to various locations within London and longer journeys occurred on a regular basis. The service has vehicles operated by paramedics, ambulance and emergency care assistants and emergency medical technicians.

We previously inspected this service in October 2017 and identified some concerns regarding the use of restraint. We asked the service to make some improvements, which included:

  • The secure services division was occasionally using mechanical restraint without appropriate consideration of the mental health act code of practice.

  • Ensure they consider the Mental Health Act (1983) Code of Practice in their policies and procedures around secure patient transfers.

  • Not use mechanical restraints on patients in a way that deprives their liberty.

  • Ensure use of mechanical restraints is appropriately risk assessed and the least restrictive option.

  • Ensure patient record forms include all key information around the secure services patient transfer. This should include detailed information of the decision to restrain patients including any risk assessments.

  • Ensure patients who are sedated are accompanied by a qualified mental health profession.

Our key findings from this inspection were as follows:

  • The service ensured they considered the mental health act code of practice within the secure services division.

  • In the records we reviewed the service was not using restraint in a way that deprived patients of their liberty.

  • The service conducted risk assessments for patients where any form of restraint might be used, including the Cat B secure cell in the vehicle (this is a secure cell within the back of the vehicle). The service also recorded details of professionals who were involved in these decisions.

  • Patient record forms included all key information around secure service patients’ transfers. This included detailed information about the patients’ behaviour and mood, any risks and de-escalation methods used.

  • The service recorded whether patients were sedated and accompanied by mental health professionals.

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.

Professor Sir Mike Richards

Chief Inspector of Hospitals

24 and 25 October 2017

During a routine inspection

British Emergency Ambulance Response Service (BEARS) was founded in 2009 and is an independent ambulance service providing a range of patient transport services across London. This includes the transfer of high dependency and critical care patients, bariatric patient and paediatric patients. It also includes secure transfers of mental health patients.The service has contracted work with two NHS trusts in London and also provides ad-hoc work for other NHS and independent hospitals. In addition, the service are providing a step in arrangement for a trust in North West London. Journeys are made to various locations within London and longer journeys occurred on a regular basis. The service has vehicles operated by paramedics, ambulance and emergency care assistants and emergency medical technicians.

We carried out this inspection in response to some concerns we received in September 2017. We responded to these concerns by carrying out an unannounced inspection on the 24 and 25 October 2017. The inspection we carried out was a comprehensive inspection covering all five domains.

We had not previously inspected this service under the current methodology. However, the service had previously been inspected in December 2012.

At the time of the inspection the registered manager was Claire Olohan-Bramley.

Summary of the information triggering the responsive inspection:

In September 2017, we identified some concerns about aspects of care one of the patient transport services was providing. BEARS subcontracted work out to the service. We also received some enquiries regarding BEARS. These concerns were about:

  • Staff recruitment including reference and disclosure barring services (DBS) checks.

  • Staff blue light training.

  • Subcontracts in place and audits of subcontracted work.

  • Subcontracted services registration.

  • Allocation of jobs to other patient transport service.

Inspection findings

We identified areas of poor practice where the service needs to make improvements:

  • The safeguarding lead was not trained to the recommended level of safeguarding training.

  • Patient group directions (PGDs) were not being appropriately used.

  • Information governance training was not part of mandatory training as per national guidance.

  • The secure services division was occasionally using mechanical restraint without appropriate consideration of the mental health act code of practice.

  • Subcontracts with other patient transport services were not signed off at the time of the inspection. However, audits of the services had begun.

  • A number of policies were currently under review.

  • Staff had not had appraisals at the time of the inspection.

However, there were also areas of good practice including:

  • The service had an incident log and learning from incidents was shared with staff.

  • Staff adhered to good Infection prevention and control practice.

  • Vehicles were maintained to a high level of cleanliness.

  • There were good systems in place for checking controlled drugs and drugs on ambulances.

  • We saw staff treating and caring for patients with compassion and respect.

  • The service had good performance against Key performance Indicators (KPIs) and regular communication with providers.

  • Staff felt valued and enjoyed working for the service.

  • The new management team was taking steps to improve the service and changes were apparent during the inspection. This included ensuring all staff had DBS checks.

  • The service had developed a mobile phone application which promoted good information sharing with staff.

Importantly the provider must:

  • Ensure they consider the Mental Health Act (1983) Code of Practice in their policies and procedures around secure patient transfers.

  • Not use mechanical restraints on patients in a way that deprives their liberty.

  • Ensure use of mechanical restraints must be appropriately risk assessed and the least restrictive option.

  • Ensure patient record forms include all key information around the secure services patient transfer. This should include detailed information of the decision to restrain patients including any risk assessments.

  • Ensure patients who are sedated are accompanied by a qualified mental health profession.

  • Not use patient group directions for care assistants and technicians.

  • Ensure all staff must receive information governance training.

  • Ensure all staff must receive training on duty of candour and understand their role with regards to the regulation. The duty of candour policy should be up to date and incorporated into the serious incident policy.

In addition, the provider should:

  • Train the safeguarding lead to the appropriate level of safeguarding training.

  • Make sure staff are competent and appropriately qualified.

  • Improve completion of mental capacity and mental health training to support staff when they are making mental health transfers.

  • Have service level agreement in place with all services BEARS subcontracts work too. The service should audit these services to ensure they are safe and providing good care and treatment.

  • Continue to update all out of date policies and procedures.

The above list is not exhaustive and the service should examine the report in detail to identify all opportunities for improvement and determining its improvement plan.

Amanda Stanford

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