ION Pinewood

Updated 7 February 2022

iON Pinewood is operated by iON Ambulance Care Limited. It is an independent ambulance service based in Slough, Berkshire. iON Pinewood provides patient transport services (PTS) across the Southeast of England region and urgent and emergency care services under contract with a local NHS Ambulance Trust. iON Pinewood also provides ambulances and staff to support the local NHS ambulance services with their patients’ transfer needs. It is registered with the Care Quality Commission (CQC) for the regulated activities of transport services, triage and medical advice provided remotely and the treatment of disease, disorder or injury.

The main service operated by the provider is patient transport. iON Pinewood includes a fleet of 18 ambulances, with four high dependency (HDU) vehicles and one bariatric support vehicle. The service employs 60 permanent staff members to support patients who require transport to attend hospital appointments. They also provide a service for patients who are discharged from hospital to alternative living accommodation such as care homes, nursing homes or other hospital accommodation. In addition, the service provides ambulances to assist patients who require minimal medical intervention or support during their transfers. These are staffed by ambulance technicians and ambulance care assistants. For patients who may require medical support during their journey, iON Pinewood provides a high dependency service with qualified paramedics and ambulance technicians. They also provide mental health secure transfers using a special vehicle.

The registered manager has been in post since 2017 and covers several sites.

We last inspected iON Pinewood on 14 and 29 August 2019 as part of our routine comprehensive inspection schedule. We rated the service as good for safe, effective, caring and responsive, and requires improvement for well led. On 13 October 2021, we carried out an unannounced comprehensive inspection as part of our new approach inspection methodology, followed by an announced visit focused on mental health secure transfers on 24 November 2021.

Updated 7 February 2022

Our rating of this location went down. We rated it as requires improvement because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and assessed patients’ food and drink requirements. The service met agreed response times. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service took account of patients’ individual needs and made it easy for people to give feedback. People accessed the service when they needed it and did not have to wait too long for treatment.
• It was easy for people to give feedback and raise concerns about care received.

However:

• The service did not always use systems and processes to safely administer and store medicines.
• The service did not always manage the risk of infection well. There was no processes to screen patients for some infectious diseases and staff did not always have access to or training on the correct level of personal protective equipment.
• Leaders did not operate effective governance processes, throughout the service.
• Systems for monitoring the effectiveness of care and treatment were not fully embedded.
• The service had a mission statement for what it wanted to achieve but no coordinated strategy or vision.
• Managers did not review competency of staff.
• Leaders and teams did not always use systems to manage performance effectively or identify and escalate relevant risks and issues to reduce their impact.
• Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up to date or detailed enough to ensure good care.

Updated 7 February 2022

Urgent and emergency care is a small proportion of service activity. The main service was patient transport services (PTS). Where arrangements were the same, we have reported findings in the appropriate sections of the report.

Our rating of this service stayed the same. We rated it as good.

See overall summary for more information.

Areas for improvement

Action the service MUST take is necessary to comply with its legal obligations. Action a service SHOULD take is because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall, to prevent it failing to comply with legal requirements in future, or to improve services.

Action the service MUST take to improve:

• The service must ensure staff who may be exposed to aerosol generating procedures at any time during their work must have the correct level of personal protective equipment and are trained to use it in line with Department of Health guidelines (Regulation 12(1)).
• The service must develop an overarching governance strategy for managing risk, performance and driving improvement (Regulation 17 – Good Governance).

Action the service SHOULD take to improve:

• The service should ensure it formally records medicines audits into a central register (Regulation 12).
• The service should ensure it continues to develop its staff personnel records process (Regulation 17).
• The service should ensure it carries out its own safety and quality checks and assurances via its own governance framework for any NHS ambulance trust bookings provided (Regulation 17).
• The service should ensure the infection status of all patients is recorded (Regulation 12).
• The service should ensure records are maintained for all patients including essential information such as pain score and clinical observations (Regulation 12).
• The service should ensure there are systems to review staff competency (Regulation 17).
• The service should ensure all records and action plans are accurate and available for safe patient transfers; such as booking forms and risk assessments to support safe transfer (Regulation 12).
• The service should ensure fire extinguishers are not cable tied to the vehicles (Regulation 12).
• The service should ensure that the consumables room does not contain any out-of-date items and ensure staff do not have access to out of date supplies (Regulation 12).
• The service should ensure it reviews the quality of what was recorded by the crew completing the transfers and the handovers from the hospital staff (Regulation 12).
• The service should ensure it holds the equipment to carry out randomised alcohol tests in line with the staff handbook (Regulation 17).
• The service should ensure it documents on the forms the patients’ preferences regarding the gender of the crew carrying out the transport for dignity, privacy or sexual safety (Regulation 12).
• The service should consider including the details of visual observations completed during transfers in the patient record forms.
• The service should consider reviewing the booking form and patient record forms to ensure they meet the needs of patients receiving high dependency transfers.
• The service should consider drafting and implementing a patient search policy for mental health secure transfers.
• The service should consider carrying out regular safety and maintenance checks of the rigid handcuffs kept on board the mental health secure transfer vehicle.
• The service should consider providing restraint procedure training to all staff carrying out mental health secure transfers once these resume.
• The service should consider appointing a controlled drugs officer to oversee transport and administration of controlled drugs during transfers.

Updated 7 February 2022

Areas for improvement

Action the service MUST take is necessary to comply with its legal obligations. Action a trust SHOULD take is because it was not doing something required by a regulation but it would be disproportionate to find a breach of the regulation overall, to prevent it failing to comply with legal requirements in future, or to improve services.

Action the service MUST take to improve:

Urgent and Emergency Care

• The service must ensure systems and processes are embedded to identify and manage risk throughout the service (Regulation 17 (1)).
• The service must ensure staff who may be exposed to aerosol generating procedures at any time during their work must have the correct level of personal protective equipment and are trained to use it in line with Department of Health guidelines (Regulation 12(1)).

Action the service SHOULD take to improve:

Urgent and Emergency Care

• The service should ensure the infection status of all patients is recorded (Regulation 12 (1)).
• The service should ensure it formally records medicines audits into a central register (Regulation 12 (1)).
• The service should ensure records are maintained for all patients including essential information such as pain score and clinical observations (Regulation 12 (1)).
• The service should consider reviewing the booking form and patient record form to ensure they meet the needs of patients receiving high dependency transfers (Regulation 12 (1)).
• The service should ensure there are systems to review staff competency (Regulation 17 (1)).

Our rating of this service went down. We rated it as requires improvement because:

• Although we found the service largely performed well, it did not meet legal requirements relating to infection control and governance, meaning we could not give it a rating higher than requires improvement.
• The service did not always manage the risk of infection well. There was no processes to screen patients for some infectious diseases and staff did not always have access to or training on the correct level of personal protective equipment.
• Leaders did not operate effective governance processes, throughout the service.
• Leaders and teams did not always use systems to manage performance effectively or identify and escalate relevant risks and issues to reduce their impact.
• Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up to date or detailed enough to ensure safe care.
• Systems for monitoring the effectiveness of care and treatment were not fully embedded.
• Managers did not review competency of staff.

However:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service managed incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment. The service met agreed response times. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served.
• People could access the service when they needed it and received the right care in a timely way.
• It was easy for people to give feedback and raise concerns about care received.

Urgent and emergency care is a small proportion of this service’s activity. The main service was patient transport services. Where arrangements were the same, we have reported findings in the patient transport section.

We rated this service as requires improvement because safety and leadership require improvement, although the service was effective, caring and responsive.