Yormed Ambulance Station

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Managers encouraged staff to raise concerns when things went wrong. Staff provided continuity of safe care and treatment to patients of all ages. Staff fulfilled and understood safeguarding requirements appropriate for their role and responsibilities. Staff managed and involved patients in discussions around risks, including clinical, to review and assess them. The service had staffing levels to meet the needs of their patients. The premises and equipment were appropriate for the service being delivered. All service areas were clean, monitored and audited for cleanliness. All staff were appropriately trained in medical gases administration.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All staff had achieved the service’s statutory and mandatory training (SMT) target of 100% during CQC’s assessment. SMT consisted of basic life support, data security awareness, handling information, infection prevention and control, information governance and data protection, resuscitation for adults, paediatric and newborn patients. Staff complied with the service’s mandatory training development policy. CQC reviewed all staff’s SMT certificates. SMT was audited monthly; CQC saw this had been done for every month in 2024. Managers gained report permissions to log in, access and check staff’s SMT compliance. Staff also completed and refreshed all their care certificate training (CCT) standards every three years and were reminded before any expired. Managers monitored mandatory training and alerted staff when they needed to update their training. Managers ensured staff completed any outstanding training. The service’s recruitment policy outlined expectations around staff’s SMT completion. Staff had to complete this within four weeks during their induction as part of the core skills training framework (CSTF). The CSTF detailed staff’s training requirements and how often each certificate had to be renewed. Managers identified any relevant training needs their staff had; such as the Oliver McGowan LD and autism module. The service’s governance & compliance lead worked as a contractor with other NHS and IH ambulance providers to share wider learning from incidents and complaints. Examples include always having drinks onboard as patients could often be dehydrated (waiting long periods in a discharge lounge). The service’s head of compliance and governance was employed through their consultancy firm entity. They worked in governance on behalf of several other sector wide IH ambulance services. They highlighted sector wide learning examples to managers. Managers planned to record more of these examples in their operational and governance reports to evidence learning.

On CQC’s last inspection in July 2019, the service did not investigate patient safety incidents in a way that supported learning. On this inspection CQC found this had improved. Incidents were investigated, learning was shared and actions taken where necessary. The service had an incident reporting policy. The policy outlined incident reporting procedures, levels and timescales of investigation. There was a risk assessment matrix staff followed which determined risk score grades of low, moderate, high or extreme for each incident. An external governance provider and the registered manager investigated any incidents scored as 8 or above. The service only had one EUC incident in the 12 months since CQC’s last inspection in November 2023. This involved a cardiac arrest in February 2024. CQC saw staff reported this promptly using the service’s call sign from third party providers in attendance. Staff were included in multi-organisational briefings and safeguarded by managers who completed welfare checks. The service took prompt action and held meetings in response to incidents. A former manager had debriefed with crew staff and shared update details with other staff in response to a cardiac arrest incident in January 2024. The debrief included conversations about staff’s reflective practice, such as could they have done anything differently or better after administering cardio-pulmonary resuscitation (CPR). Managers shared learning with external and contracted partner organisations. All staff could complete incident report forms. Wider learning was shared with the service’s contracted NHS ambulance services and foundation trust. The RM ensured staff’s welfare, offered them downtime and psychological support. The service had a duty of candour policy Staff understood the duty of candour. They were familiar with the policy and had signed read receipts. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

Managers and office staff monitored all drivers through a road safety app. This displayed various dashboard metrics such as harsh braking, and a 10% threshold for speeding (as speedometers were not calibrated). The app recorded any idling time over three minutes. This helped drivers be more fuel efficient, as fuel was the service’s second biggest expense. Managers tracked all vehicles using a telemetric system based on virtual desk infrastructure (VDI) from the road safety manager app. This was a camera-based tool which scored staff’s driving. The app listed all vehicle-specific metrics including consumables in date. The app worked by geofencing so would not allow crew staff to progress to the next pre-shift checks until they had physically moved around the vehicle. Drivers could photograph any vehicle defects. Managers could replay all video events to determine the cause of any accident or incident. They explained the app helped improve road-related safety and reduce any incidents. Driver staff received their dashboard driving summary upon logging into their smartcam. Managers received monthly driving performance reports, with top ten scoreboards based on yesterday, last week and last month. This helped managers address driving non-compliance immediately.

On CQC’s last inspection in July 2019, patient record forms were not consistently completed to an acceptable standard. On this inspection CQC found staff kept patient records secure and up to date. They used transfer report forms (TRFs) for contracted EUC transfer jobs.

Designated safeguarding leads had received the correct level of training. The external governance lead and freedom to speak up guardian (FTSUG) were both trained to level 5. The senior administrator was also trained to safeguarding level 4. The governance and FTSU leads had set up separate private companies for investigating safeguarding reports. Staff could directly access these individuals, and their contractor safeguarding leads or contacts for support and advice on any safeguarding matters. All other staff were level 2 trained in safeguarding adults and children as part of their induction statutory and mandatory training (SMT).

The service had well established partner working and contacts around safeguarding with their contractors and local authorities. Most of their safeguarding cases were passed onto the relevant teams of their contracted NHS ambulance trusts. This meant staff did not report to the LA directly.

The service’s office contained information to advise staff who to contact with safeguarding concerns. Staff followed a safeguarding flowchart for action regarding children and vulnerable adults if they had concerns about their welfare. This included relevant local authority contacts, including out of hours. For out of area safeguarding concerns, staff referred to the NHS safeguarding app available on their devices. Staff had protected time to complete safeguarding referral information.

CQC reviewed a positive feedback letter from the mother of a young patient with highly complex needs sent in June 2024. The service had transported this patient long-term and the mother requested named staff to transport her child. She praised the ‘sensitivity, organisation and training of all involved’. CQC also saw positive feedback about EUC crew showing ‘great presence of mind and flexibility’ when helping ED staff manage a patient having a non-electrical seizure. Managers told us a regional foundation trust had provided positive feedback about the service. This was for EUC work under a critical care contract.

The service did not transport any high-risk patients at the time of CQC’s assessment. Staff used a dynamic risk assessment for any patients with specialist needs. For example, in the past staff had transported patients with mental health needs, dementia, autism and learning disabilities. They ensured at least one parent, carer or chaperone accompanied the patient during transfer. Staff had the knowledge and skills to safely and supportively meet the needs of patients. In the past they had transported a young patient with highly complex needs who required specialist equipment and emergency medication. Staff facilitated their relative administering a suction unit onboard. CQC were assured staff could manage risk and emergencies. They could recognise and respond to patients at risk of deterioration during transit. Staff could accommodate bariatric patients under the maximum limit of their heavily weighted stretcher. They could assign an extra crew member, or a second crew to these jobs if needed. The service had also previously transferred some end-of-life care (EOLC) paediatric patients from a regional acute trust’s children’s hospital to hospice or home. CQC spoke to the trust’s procurement team who confirmed the service’s contract ended in May 2024.

On CQC’s last inspection in July 2019 staff did not consistently identify and act in response to patients at risk of deterioration. On this inspection CQC found this had improved. Staff completed basic life support and resuscitation for adults, paediatric and newborn patient’s modules as part of their statutory and mandatory training (SMT). Drivers used a road safety app during shifts to ensure full vehicle compliance. They used an employee time tracking app for clocking in and out of shifts. Transfer report forms (TRFs) were initially completed by office staff over the phone. They gained as much information as possible to risk assess patients. Staff always included the date and time the booking was made on the TRF and considered medicines under ‘other information’. This information was then passed to the RM who completed the form as ambulance crew. Staff followed the service’s health and safety policy which outlined the risk assessment process, including for manual handling. Office staff would call wards on longer distance jobs to confirm medications were ready for the patient upon the vehicle’s arrival. Staff added all relevant information to TRFs to ensure patients were promptly returned to their place of care. For example, they noted patient’s ward number and two contact numbers for the clinical site or bed managers post transfer.

Managers confirmed they had separated the offending cylinders and flammable materials the day after CQC’s last inspection. Managers had completed numerous moving and handling training courses. They only used certified and accredited external trainers to ensure their competence. Staff covered the correct use of all specialist equipment as part of their induction with a senior staff trainer. On induction staff’s carry chair training involved demonstrations and staff being carried on the chair to experience from the patient’s perspective. Staff also carried out daily, weekly and monthly environmental checks in accordance with their amount of regulated activity. This ensured the service adhered to regulation 15 requirements. CQC reviewed the latest check from 14 October 2024 and found all areas were compliant.

On CQC’s last inspection in July 2019 defects of vehicles and equipment were not always attended to promptly. Vehicle and equipment maintenance logs were not available for inspection. CQC served a requirement notice under regulation 15 premises and equipment. On this inspection CQC found no environmental breaches or concerns. All medical gases on the premises such as oxygen cylinders were stored correctly, upright and in cages with no flammable or electrical equipment nearby. All oxygen and fire extinguishers onboard vehicles were securely fastened, checked and well within expiry date. All full and used empty oxygen cylinders were stored safely upright and chained in separate locked cages with hazard signs. All types of fire extinguishers were securely tagged and annually checked. The control of substances hazardous to health (COSHH) cabinet was clearly labelled and locked. CQC inspected two ambulance vehicles managers had purchased after their last PTS inspection (see other report). Both vehicles were up to specifications with all suitable equipment onboard. No faults or issues were found. Staff maintained asset registers for each vehicle’s specialist equipment and when it was next due for service. Ambulance and specialist bariatric stretchers were serviced, suitable and available for use. CQC saw positive feedback about EUC crew demonstrating excellent manual handling techniques whilst transporting a patient in a great deal of pain and discomfort. During CQC’s assessment, the registered manager was the only staff member carrying out moving and manual handling training. All confidential waste was shredded as per data protection requirements. The service had a contractor for confidential waste collection. Staff could request disposal if bins were full before the due collection date.

All consumables were in the two vehicles. Staff were incentivised to dispose of any expired stock towards charity appeals in Pakistan and more recently Ukraine. Clinical engineering services completed annual vehicle checks. The main dealers of ambulance vehicle manufacturers completed vehicle health checks. The service monitored these checks on an asset register. Contractors for any spare vehicle work like handbrake checks and oxygen lines were completed bi-monthly onsite. Wherever possible the service reverted to the original car dealer or equipment manufacturer for routine annual servicing. For example, defibrillators and stretchers were returned to their manufacturer for periodic checks. This was more costly but ensured the service covered everything.

The service was undertaking no emergency and urgent care (EUC) during CQC’s assessment. After their EUC contracts ended, the service had seconded out these staff to a regional NHS ambulance service, their emergency operations centre (EOC) and other IH ambulance providers. This ensured EUC staff retained their emergency care clinical competencies. Managers planned to reemploy and upskill the relevant staff again should the service resume or gain new EUC contracts. Managers had not recruited any EUC staff since CQC’s last PTS inspection in November 2023. Managers had scaled down the EUC service to have no permenant staff, due to no contractual work. One staff member did not trust managers to safely recruit appropriate future EUC staff. They wanted to accompany managers at interview and shortlisting to ensure potential recruits could carry out transfers for higher acuity patients. The service encouraged staff to pursue continuing professional development (CPD) opportunities. For example, two paramedics had qualified from the service’s apprenticeship scheme under an external clinical training provider (FREC3 and above).

The service had systems in place to properly and safely recruit staff. For example, managers had implemented a recruitment policy staff followed. Managers gave all new staff a full induction tailored to their role. This consisted of completing the relevant NHS E-learning for healthcare portal training modules of all statutory and mandatory training (SMT) within four weeks. Staff had to complete the care certificate within 12 months. This was a mandatory requirement when recruiting staff. The care certificate covered mental capacity act (MCA) and deprivation of liberty safeguards (DoLS) modules. Managers recognised completion was time-consuming, so they encouraged staff to progress at the right pace for them, and complete piecemeal in smaller sections. New recruits were shadowed over the year including on ride-along journeys, audits, spot checks and record keeping. Office staff kept a personnel file of all training the new staff recruit had completed. Managers reviewed this annually. The service’s training and development policy covered their induction process. Managers could deliver this as a group intake or on a one-to-one individual basis. Their five week classroom-based apprenticeship scheme was very tailored. Emergency care assistant (ECA) inductions were paramedic-led.

The service had utilised a deep cleaning company since February 2022. The company carried out pre and post swabbing at the registered location. They shared their deep cleaning reports with service managers after all scheduled deep cleans. The CQC saw their report from March 2024. Managers monitored their deep clean swabbing start and finish times. They found after their shift emergency and urgent care (EUC) drivers were not wiping down the gear shift. CQC saw on deep clean reports this vehicle area had the highest swabbing score. As a result, managers ensured staff cleaned all areas properly. Deep cleans were quarterly as vehicles were rarely used during CQC’s assessment. The service’s next deep clean was due in early November 2024. Staff also completed stock checks and cleaned down after every shift at a contractor location. Staff then also used cleaning wipes when arriving back at their ambulance station.

CQC assessed the two vehicles in service and found both were very clean, well maintained and free from clutter. Hand sanitiser and personal protective equipment (PPE) such as gloves in all sizes were stocked for staff to use. Managers ensured suitable PPE was provided to all staff needed for protection, as per their health and safety policy. They notified staff of any potential risks which required PPE for special duties or specific tasks. Clinical waste bins were secure and used appropriately. Staff placed clinical waste in yellow bags as per the service’s health and safety policy. Waste was collected at least every eight weeks.

The service had systems in place to monitor infection prevention and control. Managers had implemented monthly hand hygiene audits and infection prevention control (IPC) spot checks to ensure compliance. They also had oversight of their vehicle deep cleaning from monthly reports. All the service’s IPC audits were kept in a large file in their office. Staff completed infection prevention and control training.

The service only used oxygen onboard vehicles. All staff were appropriately trained and had completed medical gas administration training as part of their first response emergency care level three (FREC3) course qualification. Leads had sent a copy of the FREC3 syllabus to CQC the day after CQC’s last inspection. The service had an oxygen policy which staff followed when administering emergency oxygen.

The service carried out monthly medicines management audits on medical gas stock levels. These were correct as of February 2024. The service’s latest medicines management policy incorporated oxygen for use, as per the British Oxygen Company (BOC) guidance. CQC reviewed this policy which included the hazards of using oxygen, causes of oxygen fires and explosions, correct or optimal storage, and non-compatible materials. The policy described the RM’s responsibility to report any adverse reactions to the patient’s own medications to the medicines and healthcare products regulatory agency (MHRA).