Summary
We carried out this announced inspection of this sexual assault referral centre (SARC) over two days on 16 and 17 April 2019. We conducted this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements of the Health and Social Care Act 2008 and associated regulations. Two CQC inspectors, supported by a specialist professional adviser, carried out this inspection.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions about a service:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look at during the inspection.
Background
The Herts SARC is situated on a quiet side street close to the Hemel Hempstead town centre. The centre has sole use of the building. Patients can gain access through a dedicated entrance at the side, which also accommodates people using wheelchairs.
NHS England and the Hertfordshire Police and Crime Commissioner jointly commission this SARC. This is the only SARC in Hertfordshire, although the location shares some of its functions with the SARCs in the neighbouring local authority and police areas covering Bedfordshire and Cambridgeshire and some with SARCs in other areas in the south east. These include the clinical staff rotas and the single point of access known as the pathway support service.
The building is owned by the police and has two forensic examination rooms and associated waiting rooms. One room is used mostly for adults and young people aged 13 and over and the other is for children under the age of 13. As well as administrative facilities, there is a forensic interview (Achieving Best Evidence or ‘ABE’) suite which was not in the scope of our inspection.
The SARC provides forensic medical examinations and related health services to people living in Hertfordshire who have been sexually assaulted. This is an ‘all-age’ service; that is, adults aged 18 and over, children and young people aged 13 and above and, as from 01 April 2019, children under the age of 13. The service is accessible to male, female and transgender patients.
The SARC is available 24 hours each day with a one-hour call-out time outside office hours. Patients can be referred through the police (or through children's social care for younger patients). Patients aged 13 and over can self-refer subject to certain safeguards as set out below.
The staff team includes a centre manager, crisis workers, independent sexual violence advisers (ISVA) and sexual offence examiners (SOE). The provider sometimes refers to SOEs as forensic nurse examiners (FNE) and paediatric forensic medical examiners (FME). We have used the terms FNE and FME in this report to differentiate between the responsibilities of those roles. Crisis support workers provide business support during the day time whilst other crisis staff are on an on-call rota. Similarly, there are FNEs present during the day time whilst the remainder of the FNE staff are on an on-call rota shared with neighbouring SARCs. There are also four ISVAs on site during normal hours, two of whom specialise in supporting adults and two for young people aged 13 and over, although they also support children under that age.
The service is provided by a limited company and as a condition of registration they must have a manager registered with the Care Quality Commission. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager at the Herts SARC was the medical director for Mountain Healthcare Limited. We have used the terms ‘registered manager’ and ‘centre manager’ in this report to differentiate between each role.
During our inspection we spoke with the registered manager, the centre manager, a crisis worker, two ISVA workers, two FNEs and a paediatric FME. We looked at records of 10 patients. Three of these were children under 13, one was a young person under 18 and six were adults.
We left comment cards at the location in the two weeks prior to our visit but received no responses from people who had used the service in that period.
We also looked at the policies and procedures that were used at the location.
Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC.
Our key findings were:
- Staff knew how to deal with emergencies.
- Appropriate medicines and life-saving equipment were available.
- The service had systems to help them manage risk.
- The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The service was clean and well maintained.
- The staff had infection control procedures which reflected published guidance.
- The service had thorough, safe staff recruitment procedures.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- There were processes for monitoring the standard and quality of care.
- Staff treated patients with dignity, respect and compassion and took care to protect their privacy and personal information.
- The single point of access referral system met patients’ needs.
- The service had effective leadership and culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- The service asked staff and patients for feedback about the services they provided.
- The service dealt efficiently with positive, adverse and irregular events and learned lessons.
- The staff had suitable information governance arrangements.
We identified regulations the provider was not meeting. They must:
- Enable the centre manager to have access to central staff records so they are assured they have appropriate references and are properly professionally registered;
- Ensure that calibration certificates and guarantees for all medical devices are available to the centre manager;
- Ensure an up-to-date lone-working risk assessment is carried out and acted upon;
- Ensure there is an up-to-date business continuity plan specific for this location.
There were also areas where the provider should make improvements. The provider should:
- Ensure that staff make sufficient records to evidence professional curiosity about risks from domestic abuse;
- Ensure staff are effectively prompted to ask appropriate questions to help them consider a patient’s capacity;
- Ensure easy-read material is made available to enable patients with a learning disability to understand their care and treatment.
Full details of the regulation/s the provider was not meeting are at the end of this report.