14 November 2023
During a routine inspection
We rated this location as requires improvement because:
- Staff records were not always easy to find or review because of the multiple systems that were in use. The service had high turnover and sickness rates.
- The service did not submit any required safeguarding notifications to us.
- There was no staff infection, prevention control audits in place.
- Staff did not always complete and update risk assessments for each patient.
- The service did not have an in date home office licence for controlled drugs at the time of our inspection.
- The service also did not provide any training for staff in restraint. The service did not mandate that staff completed training in recognising or responding to patients with mental health needs.
- Clinical audits were not always completed consistently. Staff did not consistently record patients pain scores.
- Work was not always allocated in a timely way by the ambulance trust.
- There had been a recent period of instability in leaders in the service. Not all staff felt respected, supported, and valued. At the time of our inspection the service did not have a business continuity policy that reflected current service provision.
However:
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
- The design, maintenance and use of facilities, premises, vehicles, and equipment kept people safe. Staff managed clinical waste well.
- The service managed patient safety incidents well.
- The service provided care and treatment based on national guidance and evidence-based practice. The service monitored and met agreed response times so that they could facilitate good outcomes for patients.
- The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. All those responsible for delivering care worked together as a team to benefit patients.
- 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.
- Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
- The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.