The Sussex Beacon

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm. We assessed all quality statements in this key question.

The service worked with people and partners to establish and maintain safe systems of care and ensured continuity of care when people moved between different services.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

However, staff did not always receive the correct level of training and policies did not reference current guidance.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them in line with the incident reporting policy. Although the incident reporting policy was out of date and under review at the time of our assessment, all staff had access to the incident reporting system and continued to follow the process.

The service reported a steady increase in incidents: 16 in 2022, 28 in 2023 and 61 in 2024. Managers told us this demonstrated an improvement in reporting culture at the organisation. Staff told us that they were encouraged to be inquisitive and were empowered to challenge.

Medication errors made up 50% of all incidents and were the most frequently reported incident. Incidents related to the environment or equipment were the second most frequent.

Leaders reviewed incidents as a standing agenda item at monthly quality and governance committee meetings.

Leaders told us they actively encouraged staff to consider human factors when reviewing incidents. They held regular team meetings and used incidents as opportunities for reflection and learning.

However, leaders and staff acknowledged that whilst there had been recent improvements, shared learning from incidents within the inpatient unit had not always been effective in the past and identified this as an area to continue improving going forwards.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.This included the local NHS hospital, community teams and charities.

The service participated in a weekly multidisciplinary team (MDT) meeting with the local NHS hospital HIV service. This meant that every patient admitted to the inpatient unit was discussed by a multidisciplinary team. Admission assessments were tailored to individual’s needs and wishes.

Referrals came from healthcare professionals within the community or hospital settings. Staff completed a pre admission assessment for all patients before admission to the inpatient unit. This could be completed by telephone or in person depending on risk factors and preference. These assessments covered holistic care needs, mental health, social circumstances, and any additional support required for substance misuse. Staff discussed and documented agreed admission aims and goals.

The service completed ‘pre clerking’ by communicating with a patient’s doctor to prescribe necessary medicines in advance of admission. For example, medicines to help with alcohol cessation if that was the reason for the admission.

The inpatient unit and community services shared a single database, allowing staff to view the entire patient pathway.

Staff also provided ‘in-reach’ support to the local NHS hospital, aiding patients admitted there who were living with HIV. ‘In-reach’ refers to specialist staff visiting another healthcare setting such as a hospital ward to provide expertise, advice, and direct support for patients who may benefit from their service.

The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. Staff did not always receive the correct level of training and policies did not reference current guidance.

Training records showed the CEO had completed level 3 safeguarding adults training but not the required level 4 training for a designated safeguarding lead. Following the inspection the service told us that this was due to mandatory training records not being available for a previous role. Information provided by the service showed that all registered nurses (RNs), client support workers, co-ordinators and women and families leads were required to complete safeguarding adults and children training. Training records shared with us following the assessment for inpatient unit staff showed 80% had up to date level 3 safeguarding for adult as well as a significant improvement of safeguarding children training compliance.

The safeguarding policies for adults and children did not reflect the most recent guidance. The policies did not specify the training levels required for staff, refer to protected characteristics, or outline how to escalate concerns if they were not acted upon. A separate document stated that all registered nurses (RNs), client support workers, co-ordinators and women and families leads were required to complete safeguarding adults training. However, training records for inpatient unit staff showed only 50% had up to date level 3 safeguarding for adults and only 60% had level 2 safeguarding children.

Staff knew how to identify abuse and were able to describe the process for raising safeguarding concerns. Staff described raising the concerns on the patient’s electronic record, which automatically notified the CEO as safeguarding lead and the registered manager. This meant that there could be a delay in safeguarding referrals being made to the local authority. Staff told us if urgent referrals were needed or immediate concerns about violence or aggression; they would contact the police directly.Following the inspection, leaders told us that the escalating of safeguarding concerns was completed in conjunction with line managers and the designated safeguarding leads (DSL), and that the DSLs met monthly to review themes, trends and concerns.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service involved patients in managing risks, and risk assessments were person-centred, proportionate and reviewed regularly. Patients felt safe, listened to, and supported.

Staff undertook pre admission assessments to ensure patients being admitted to the inpatient unit would be safe and well cared for. They shared examples where the level of risk to patients was considered too high to be safely managed within the inpatient unit, and these referrals were not accepted. For example, patients with suicidal ideation could not be admitted to the unit.

As part of the inpatient unit’s patient satisfaction questionnaire, patients were asked whether they felt the service helped patients to be in control of their care and that their care was planned with support from staff. Of the 41 responses, 68% of patients rated the support as excellent, 19% as good, and 5% said they would prefer not to comment or felt the level of support was poor.

Records reviewed showed that risks to patients’ health and wellbeing had been considered and assessed. These included risks relating to medicine allergies, food allergies and falls.

Staff ensured that Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) forms were completed for patients where appropriate. ReSPECT forms provide a summary of personalised recommendations for a person’s clinical care in the event of a future emergency where they are unable to make decisions or express their wishes. Forms that we reviewed had been completed appropriately and were available for staff to refer to when required.

The service reviewed care plans at the formal weekly multidisciplinary team (MDT) meeting. Staff were kept informed of people's risk management plans at shift handover meetings. These included signs of deteriorating health, medical emergencies or behaviours that may challenge. We reviewed care plans and saw that they were structured using drop down options to show actions to be taken for each patient.

However, we reviewed the care plan for a patient living with dementia and found no specific actions addressing falls risk for this patient. We discussed this with the senior team, who acknowledged that while staff had the capability to individualise care plans, this was not consistently applied in practice.

The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

At the time of our assessment, access to some of the balconies adjoining each bedroom was restricted due to needing essential safety repairs. Staff told us that when the balconies were in use this provided patients with private outdoor space, along with access to the communal garden space. They told us that they assessed patients’ mental wellbeing as part of their pre admission and ongoing risk assessments, before allocating rooms. The service did not accept patient who were experiencing an acute mental health episode.

The lift which was needed by patients who could not use the stairs was out of service pending repairs. We also saw a sink in the room adjacent to the kitchen area on the floor below the inpatient unit that was out of use with no fixed date for repairs. Leaders told us this was due to waiting for funds to make the repairs.

We reviewed incident reports and found 3 incidents in 2024 relating to the lift being out of use. These included a patient’s admission being cancelled because the patient was a wheelchair user.

We found several items of electrical equipment overdue for electrical safety testing and 1 item without an electrical safety testing sticker. This meant these items may not be safe for use and could pose a risk to staff, visitors or patients. Staff told us that electrical safety testing was completed by a third-party contractor.

The service provided a list of estate priorities for repair, which included the lift but did not include the balconies or kitchen sink.

We viewed the bedrooms which varied in size, we found 1 smaller room to be cramped. Staff told us that to provide nursing care they could move the bed away from the wall, however that this could be difficult, especially if a patient had additional moving and handling needs or required specialist equipment. We saw damage to the wall protector at the end of the room which demonstrated the challenges of working in a small space. However, larger rooms could accommodate people with mobility needs such as wheelchair users.

The service was located in a purpose-built two-storey building in a peaceful setting with access to gardens and outdoor space. The premises provided ample car parking for staff and visitors and included a smoking area for patients. There was a mix of private and shared spaces for patients to use.

The ground floor contained the main reception, meeting rooms, offices and group work spaces. The first floor comprised the inpatient unit, which consisted of 10 single en-suite rooms.

The inpatient unit included communal areas such as a kitchen and living room. Patients could use these areas freely, and furnishings were comfortable.

The premises were secure, and visitors signed in on entry to ensure that only authorised people accessed the building. Volunteers staffed the reception area during the day, and nursing staff controlled entry after hours when doors were locked.

The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. Staff did not always make sure staff received effective support, supervision and development.

The service provided mandatory training for staff, which included, infection prevention and control, moving and handling and information governance. However, compliance was poor for several areas. Fewer than 20% of staff had completed Prevent duty training, fire marshal training and basic life support. No staff had completed training on learning disability and autism, deteriorating patient, sepsis, anaphylaxis and opiate overdose and dementia awareness. Following the assessment, we were provided with updated mandatory training which showed significant improvements in compliance.

Not all staff received supervision and appraisals. At the time of our assessment, mangers told us they were not routinely completing appraisals due to uncertainty about the future of the service. One to one meetings had only recently been reintroduced following the appointment of the CEO and were scheduled every 6 weeks. We reviewed staff records and saw examples of these meetings which followed a standard proforma that checked the staff member’s welfare and identified any support required.

None of the 3 staff recruitment files we reviewed contained proof of eligibility to work in the UK. However, the service had procedures to ensure staff were suitable to work with vulnerable people, including checks for proof of identity, 2 written references and Disclosure and Barring Service clearance.

Senior managers checked the staff rota to ensure suitable cover. Managers told us they could flex the rotas depending on patient need and that they had never fallen below the staffing template. The inpatient unit was staffed with 2 registered nurses during the day, and 1 registered nurse and 1 clinical support worker overnight. The service relied heavily on a small bank of registered nurses to cover gaps in the rota.

Senior managers checked the staff rota to ensure suitable cover. Managers told us they could flex the rotas depending on patient need and that they had never fallen below the staffing template. The inpatient unit was staffed with 2 registered nurses during the day, and 1 registered nurse and 1 clinical support worker overnight. The service relied on a core group of highly skilled and qualified bank staff, a small number of trusted agency nurses to cover gaps in the rota, alongside substantive staff who would be paid overtime rates for any additional hours they could complete.

The service did not employ consultants and medical cover was provided by research fellows and GP trainees undertaking HIV and GUM rotations, supported by direct access to the specialist HIV consultant team at the local NHS hospital. Overnight the service was supported by the on-call HIV consultant on call at the local NHS hospital overnight, ensuring continuity of specialist expertise at all times. Medical emergencies were always escalated to the emergency ambulance service.

The evidence showed a good standard. The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected as much as possible from the risk of infection. The inpatient unit was visibly clean and had suitable furnishings which were easy to clean and well maintained.Staff had access to disposable aprons and gloves and used them when delivering care and treatment to patients to reduce the risk of cross-infection.

Staff adhered to the 'bare below the elbows' policy when providing care and treatment. The service completed monthly hand hygiene audits and we saw that there was generally good compliance. When issues were identified, actions were taken and recorded to ensure improvements in hand hygiene were implemented and sustained.

As part of the inpatient unit’s patient satisfaction questionnaire, patients were asked whether they felt their rooms were cleaned satisfactorily during their stay. Of the 41 responses, 95% said yes.

We reviewed housekeeping records for September 2024 and found daily schedules for the cleaning of patient rooms, the communal day room, nurses’ station, sluice room, reception and hallways. Patient rooms were cleaned daily, and when cleaning did not occur staff recorded reasons such as the patient being asleep, refusing or having a visitor. However, there were some gaps in cleaning of the sluice room and nursing station but no explanation was provided for this.

Staff completed infection prevention and control training. However, records showed that only 60% of staff from the inpatient unit had completed this.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff reviewed patient’s medicines regularly and provided specific advice to patients and carers about their medicines. All medication other than controlled medicines was dispensed using a self administration of medicines (SAM) approach. The use of the SAM approach helps to promote independence with patients and helps to prepare patients for discharge, facilitating smoother transition to home care.

The service carried out a self administration of medicines (SAM) quality audit over a 3 month period in 2024. After the first month they recognised that the audit tool required amendment to incorporate electronic records. Performance improved across the 3 months, with improved documentation of consent to participate in the SAM process and all patients audited had a SAM assessment completed on admission.

Pharmacists specialising in HIV medicines attended the service twice a week and were available by telephone at other times.

The service provided medication safety training, we saw that 80% of inpatient unit staff had completed this.