Updated 13 April 2020
We carried out this announced inspection of this sexual assault referral centre (SARC) over two days on 03 and 04 March 2020. 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
G4S Health Services (UK) Limited provide forensic and criminal justice services in different parts of the country, including a number of SARC services such as The Shores.
The Shores is situated in the centre of Bournemouth adjacent to the police station. The police station and the SARC occupy the same building although the SARC is accessible through a separate front door to the main road and through a dedicated entrance at the side. The centre is fully accessible to people using wheelchairs.
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 16 and over and the other is used mostly for children.
NHS England and the Dorset Police and Crime Commissioner jointly commission this SARC. This is the only SARC in Dorset. As such, the SARC provides forensic medical examinations and related health services to people living in Dorset who have been sexually assaulted. The SARC is also sometimes used by people who live just outside the county of Dorset for whom it is the closest service of this type. This is an ‘all-age’ service; that is, all adults aged 18 and over, children and young people aged 13 and above and children under the age of 13.
The SARC is available 24 hours each day with a one-hour call-out time outside office hours. Adult patients can be referred through the police or they can self-refer. Children’s are referred through children's social care. Children aged under 16 can self-refer subject to certain safeguards as set out in this report although all children under 13 must be referred through safeguarding processes.
The staff team includes a centre manager, crisis support workers (CSW), sexual offence examiners (SOE) and administrative support. The service is a ‘nurse-led’ service and so all SOEs, including the SARC manager, are registered nurses or midwives. The SOEs carry out examinations of all adult patients at the centre. Community paediatricians employed by the local hospital trust are separately commissioned to lead on the acute (within 72 hours of an incident) forensic examinations of children alongside the SOEs at the SARC. Children who do not require an acute forensic medical examination are seen as part of safeguarding medical examination procedures by the paediatricians at the local hospital, and this was not part of our inspection.
All patients are referred to a follow-up independent sexual violence adviser (ISVA) service provided by a local advocacy and advice organisation, which also provides a children’s ISVA (or ChISVA) service for children under 18. Although part of the ISVA service is subcontracted by G4S Health Services, the service itself is not provided by G4S so is not in scope for this inspection.
One of the forensic suites is made available for one day each week for use by the Dorset’s sexual health service as a bespoke sexual health clinic for people who are LGBTQ+. The provider of this service is also not in the scope of this inspection.
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 Shores is also the centre manager who is on-site during weekdays. We have used the term ‘manager’ below for simplicity.
During our inspection visit we spoke with the registered manager, two of the SOEs, two CSWs, and the SARC co-ordinator. We also spoke by telephone with a community paediatrician from the local hospital. We looked at the records of six patients. Two of these were children under 13, and four 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 keep patients safe.
- Appropriate medicines were available.
- The service had systems to help them manage risk.
- Staff were well trained.
- There were sufficient staff to meet patients’ needs.
- 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.
- There was sufficient information available to ensure patients were informed of the service.
- The single point of referral system met patients’ needs.
- The service had effective leadership and a 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.
There were no areas where we felt the provider should make improvements