Updated 11 February 2021
Background
Horizon SARC Walsall is located on a residential street in an adapted end of terrace house just outside of Walsall town centre. There is a secure side entrance for privacy which is monitored with CCTV, and a small car park. The SARC is accessible 24 hours a day seven days a week and is accessible for patients with limited mobility.
G4S Health Services (UK) Limited (G4S) are commissioned to deliver the adult SARC service (16 and 17 year olds could choose to be seen in the adult service if they wished to). Mountain Healthcare Limited (MHL) and G4S are co-commissioned to deliver the paediatric pathway which is provided as an in-reach service to the G4S premises in Walsall. This inspection report relates to the adult SARC service only which G4S provide as a nurse-led service with forensic medical examiners available to support with complex cases and rota cover. G4S provide crisis workers for all patients, including children, and offers onward referrals to external agencies for counselling support.
Horizon SARC has been managed by G4S since 2013, with the forensic element of the service also transferring to G4S in April 2018. G4S has a second location, Castle Vale SARC, which is registered and has been inspected separately by CQC, however the two sites operate with the same management and staffing team. The team includes a SARC manager, a deputy SARC manager, two full-time forensic nurse examiners (FNEs), five flexible forensic medical examiners (FMEs), and fourteen crisis workers. The lead doctor supporting the Horizon SARC Walsall is a member of the Faculty of Forensic and Legal Medicine (FFLM).
As a result of the COVID-19 pandemic, G4S made the decision to separate staff working for the adult and paediatric pathways so that staff could operate in two bubbles. As a result of this, adult staff worked and saw adult patients at the nearby Castle Vale SARC, whilst the paediatric pathway continued to be delivered from the Horizon SARC Walsall.
During the inspection we visited the Horizon SARC Walsall premises, and spoke with four staff members, however we did not speak with any patients. We looked at policies and procedures and other records about how the service is managed. We reviewed the records for 8 patients seen at the Horizon SARC Walsall prior to the COVID-19 pandemic.
Horizon SARC Walsall has two forensic examination suites on the ground floor, each with a pre/post examination room. There is a storage cupboard and a hallway with two separate entrances to the building. Upstairs there is a kitchen with laundry facilities, a staff toilet and two staff offices.
As a condition of registration, and as the provider of the service, G4S must have a person registered with the Care Quality Commission as the registered manager. 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 Horizon SARC Walsall was the service manager and organisational SARC lead for G4S.
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:
- The service had systems to effectively manage risk.
- Safeguarding processes were appropriate and staff knew their responsibilities for safeguarding adults and children.
- The service had thorough staff recruitment procedures.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment/referral system met patient’s needs.
- The service had effective leadership and a culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- Staff and patients were asked for feedback about the services they provided.
- The staff had infection control procedures which reflected published guidance.
There were areas where the provider could make improvements. They should:
- Ensure that all staff record safeguarding concerns and actions in line with policies and procedures.
- Ensure that all staff receive safeguarding level 3 training and complete training in the use of the new incident management system.
- Ensure that all staff have a completed competency assessment appropriate to their role.