British Red Cross Paddock Wood

Updated 10 May 2018

British Red Cross Paddock Wood is operated by British Red Cross Society. The service registered at this location in April 2017. The service previously operated out of a registered location in Canterbury between 2014 and 2017. Before this, the service operated out of a registered location in Worthing after it first registered with the Care Quality Commission in 2013. It is an independent ambulance service in Paddock Wood, Kent. The service primarily serves the communities of Kent, Surrey and Sussex.

The service has a registered manager, Claire Hewett, who had been in post since April 2017.

We carried out an announced inspection on 22 February 2018. This was the service’s first inspection since it moved to the registered location in Paddock Wood in April 2017.

Twenty-six members of staff worked at the service. There were 20 crew members consisting of emergency care support workers and technicians, three crew team leaders, two coordinators and a service delivery manager.

The service used 12 ambulances to carry out the regulated activities from the registered location in Paddock Wood and two satellite sites in Redhill and Canterbury. The ambulance station at Paddock Wood operated 24 hours a day, seven days a week. Eighteen members of staff were contracted to work from Paddock Wood, and seven vehicles were based there.

The ambulance station at Redhill operated seven days a week, with three vehicles allocated to this base, responding to patients in the Redhill and Crawley areas. Eight members of staff were based at Redhill. The ambulance station at Canterbury operated between the hours of 7am and 10pm as needed according to the commissioning NHS trust’s need for cover in this area. The remaining two ambulances were based in Canterbury.

Updated 10 May 2018

British Red Cross Paddock Wood is operated by British Red Cross Society. This location provides emergency and urgent care only. British Red Cross Paddock Wood has two satellite sites based at Redhill and Canterbury.

We inspected this service using our comprehensive inspection methodology. We carried out this announced inspection on 22 February 2018.

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:

• Staff prided themselves on giving compassionate care and treating patients in an empathetic way, with a strong ethos of humanism. We observed staff providing compassionate care in all interactions with patients. Patient feedback we reviewed demonstrated a high level of patient satisfaction.

• The service took action to meet patients’ individual needs. This included patients that did not speak English, refugees and patients with learning disabilities.

• All staff had undertaken a comprehensive induction programme and mandatory training in key areas to provide them with the knowledge and skills they needed to do their jobs safely.

• All crew members completed regular continuing professional development to refresh their clinical skills and allow them to develop new ones. A crew member had developed a preceptorship programme for emergency care support workers, which the provider was considering rolling out to all locations.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. All vehicles we inspected were visibly clean, and we saw evidence of deep-cleaning every eight weeks or sooner if needed. Staff demonstrated clear understanding of their daily duties in relation to cleanliness and infection prevention and control, which was in line with the provider’s infection prevention and control policy. Vehicle and premises audits provided monthly assurances around cleanliness.

• Staff understood how to protect patients from abuse and the service worked well with the subcontracting NHS ambulance trust to do so. All staff had training on how to recognise and report abuse and gave examples of times they had raised safeguarding concerns.

• Staff completed clear and thorough records of patients’ care and treatment. The service stored records securely to protect confidentiality. Monthly records audits provided ongoing assurances around clinical practices and standards of record keeping.

• We saw evidence the service had clear processes to keep vehicles and equipment safe and to meet the legal requirements relating to vehicles. This included evidence of annual MOTs, and regular servicing and maintenance.

• The culture of the service encouraged openness and candour. Staff demonstrated a willingness to report incidents and raise concerns. Staff received feedback and any relevant additional training to ensure the service learned from incidents to improve patient safety.

• All staff spoke highly of the local leadership and culture. The service took concerns seriously and took action to address them.

• Managers demonstrated an understanding of risks related to the service. We reviewed the risk register and regional management meetings minutes, which demonstrated ongoing oversight of quality and governance issues such as policies, risk management and human resources.

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

• The British Red Cross pocketbooks staff used for clinical guidance did not reflect up-to-date national guidance in one area by not specifying that ibuprofen was contraindicated for patients with suspected chicken pox. However, the service delivery manager told us, and we saw on the provider’s risk register, that the provider was in the process of reviewing all clinical guidance to ensure it met the most up-to-date national guidance and best practice.

• The trolley harness had visible signs of wear and fraying on one ambulance we inspected. In another ambulance, we saw the excess ends of the trolley harness were also beginning to show signs of wear. However, we raised this issue with the registered manager, who immediately ordered replacement trolley straps.

• In 10% of “vehicle and equipment check sheet and cleaning logs” we reviewed, there were some gaps where staff had not documented every check. This meant the service did not have assurances all staff completed every daily vehicle check on every shift in line with the target of 100%. However, the remaining 90% of check sheets were fully completed.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Amanda Stanford

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

Updated 10 May 2018

The only core service provided was urgent and emergency services. The service had a contract with an NHS ambulance trust, and 100% of the service’s activity was subcontracted from the commissioning trust.The commissioning NHS ambulance trust triaged 999 calls and allocated appropriate jobs to British Red Cross Paddock Wood crews as part of a subcontracting agreement. Between January and December 2017, British Red Cross Paddock Wood carried out 10, 053 ambulance responses.

We found many areas of good practice, including highly compassionate care, meeting patients’ individual needs and a culture that encouraged openness and candour. Staff demonstrated a willingness to raise concerns, report incidents and learn from them. The service took concerns seriously and took action to address them. All staff we met spoke positively of the local leadership and culture.

Where we identified areas the service should improve, such as two trolley harnesses showing signs of wear and tear, we saw the service took immediate action to rectify these issues following our feedback.