British Red Cross Paddock Wood

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