Archived: Devon Sexual Health - Exeter

We carried out this announced inspection on 18 March 2021 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 in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• 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

NHS England commission Northern Devon Healthcare NHS Trust to deliver a dedicated paediatric service based at Exeter Sexual Assault Referral Centre (SARC) for children and young people up to their 18th birthday. This service provides forensic medical assessments for children and young people from across Devon, Cornwall and the Isles of Scilly following recent sexual assault. The Exeter SARC also provides non-recent medical assessments of children and young people from Devon, Torbay, Plymouth and Cornwall following non-recent sexual assault.

The SARC is situated on a business park outside of Exeter town centre with a staff office in a separate building, but close by, to the patient environment. The SARC is spread over the ground floor of the premises with disabled access, a discreet entrance to the rear of the building and car parking outside. The SARC is available for forensic medical assessments between 9am and 5pm Monday to Friday, and between 10am and 2pm Saturday and Sunday. A 24 hour telephone advice line is staffed by clinicians and available to professionals 365 days a year.

The SARC facilities, situated within a building leased by police with police offices adjoining, include two examination rooms, one for non-recent and one for recent examinations. There are two waiting rooms; one forensic and one non-forensic, as well as an aftercare room, storage room and small kitchen area. Bathroom facilities including showers are available within the forensic suites, and a visitors bathroom is accessible in adjoining police offices. The staff office, leased by the provider, consists of a large open plan staff office with kitchen and bathroom facilities, a disabled toilet, meeting room and two smaller therapy rooms.

The SARC team are overseen by a specialist services manager, with a SARC general manager and SARC service manager, and a specialist nurse carrying out the crisis worker role for all children and young people attending the SARC. The paediatric clinical lead is a consultant paediatrician supporting four forensic medical examiners (one of whom is currently on maternity leave). Three clinical staff are members/licensee of the Faculty of Forensic and Legal Medicine.

On the day of inspection we spoke with four staff members and reviewed eight patient records. We reviewed policies and procedures and other records about how the service is managed. We also spoke with three staff members via virtual meetings in advance of the site visit.

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 understood their responsibilities for safeguarding adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There were good working relationships with police colleagues.
• There was a culture of continuous improvement.
• Staff showed care and passion for their work and felt well supported in their roles.
• Patient feedback was positive about the support received from the SARC, and there had been no complaints.
• The environment was clean and included age appropriate rooms and equipment with toys and visual distractions for children.
• The provider had infection control procedures which reflected published guidance and had adapted quickly to COVID-19 guidelines to ensure services remained available to patients throughout the pandemic.

We identified regulations the provider was not meeting. They must:

• Ensure that patient records are complete and contemporaneous, and evidence the discussions with patients and/or their responsible adult to explain the clinicians decision making and the rationale for care and treatment provided.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Ensure that assessment proformas evidence how a clinician has determined capacity to consent.
• Include the Gillick Competence assessment for staff to complete with under 16’s if applicable.
• Evidence the voice of the child in assessments.