The Saturn Centre SARC

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 assessed 5 quality statements under this key question. There were effective systems in place to identify and report safeguarding issues. Staff worked collaboratively with the wider healthcare services, support systems and criminal justice agencies to improve outcomes for patients.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

There were policies and procedures to provide staff with information about identifying, reporting and dealing with suspected abuse, with specific safeguarding pathways in place depending upon the age of the patient. However, we noted that the policy in relation to children and young people required updating to reflect current guidelines and terminology.

All staff had completed the appropriate level of safeguarding training for their role and attended dedicated safeguarding supervision sessions. Staff had the opportunity to discuss recent cases and ensure they had been managed in line with guidance. Supervisors had undertaken specific training for this role and had completed a certified course provided by the NSPCC.

Staff were able to describe to us in detail the safeguarding pathways for both children and adult patients. Referrals for children aged 13 years and under were made by police or social services, and children had to be accompanied to the SARC by a professional such as a social worker or police officer. A forensic physician attended all strategy meetings for this age group.

Children over 14 years old could self-refer to the service, although were encouraged to bring a responsible adult or someone with parental responsibility with them.

A full safeguarding assessment was completed for all patients as part of their forensic examination and covered vulnerabilities including human trafficking and honour-based violence. Safeguarding management was considered as part of each daily case review, and any referrals were actively followed up to ensure they had been received by relevant agencies.Summary records following a child's attendance were shared with the GP, while full medical reports were shared with Social Care and local designated doctors for safeguarding purposes.

Staff attended the quarterly Pan Sussex Safeguarding partnership meetings which involved colleagues from the police, social and health services to ensure a multi-agency approach to safeguarding concerns. Monthly meetings with social services had recently been introduced to improve collaborative working.

Freedom to Speak Up Champions were available if staff wanted to raise any concerns.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

As the SARC was based at Crawley hospital safety checks for fire, portable appliance testing, emergency lighting, legionella management and equipment maintenance were completed regularly by NHS Property Services. Staff told us they used an on-line system to report any equipment failures or to submit repair requests which were responded to quickly, ensuring a safe environment. Three of the SARC’s staff had been trained as fire marshals and full drills were undertaken every 6 months to ensure staff knew what to do in the event of an emergency.

The premises had been purposely designed to meet all ISO and forensic science regulatory requirements. For example, patients moved through the premises in one direction from the pre-examination room to the forensic medical examination room, to the post examination room to prevent cross contamination. Forensic examination rooms were locked when not in use and a log was kept of all persons entering them. There was a dedicated area for staff to put on and remove personal protective equipment and a shower was available so that staff could wash between concurrent cases that might be linked.

There was a specific storeroom only for medical consumables with restricted access to ensure their forensic integrity and minimise cross contamination. Air movement between the rooms was managed and the temperature of the premises could be regulated to ensure staff and patient comfort.

The bathroom doors could be opened from the outside in case of patient collapse, and all furnishings, apart from automatic fire door closures, had been designed to be anti-ligature to reduce risks to patients.

Safety data sheets were available for all hazardous products in use on the premises. Spill kits were held to ensure bodily fluids could be cleaned up safely.

Staff undertook training in basic life support, and some basic equipment and medicines were available on site. There was a defibrillator, but staff struggled to find the paediatric pads to use with it. This was rectified during our visit. There was no paediatric pulse oximeter or pocket mask available. No medicines were kept to respond to common medical emergencies such as seizures and asthma attacks.

Staff did not routinely undertake medical emergency simulations to keep their knowledge and skills up to date and ensure a rapid response to any emergency.

At the time of our inspection 7 sexual offences examiners (SOE) and 9 crisis workers were employed at the service. Staff told us there were enough of them to offer a responsive service and neither patient care nor critical forensic timescales had ever been missed due to shortages. Staff expressed high levels of satisfaction in their work and told us they felt valued and supported by managers.

Personnel files we reviewed for 2 recently recruited staff members demonstrated that most pre-employment and vetting checks had been completed to ensure they were suitable for their role. However, we were not provided with evidence to show that gaps in staff’s employment history and reasons for leaving previous employment had been adequately explored and documented where relevant.

All staff underwent a comprehensive induction, and the provider had recently received formal accreditation from the Faculty of Forensic Legal Medicine (FFLM) for its 5-day staff induction course. We spoke with one crisis worker who told us they had received a thorough induction which gave them the basic skills for their new role.

The provider had arrangements to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. Training records we viewed showed that SOEs had completed all essential training for their role such as statement writing and court room skills. In addition to this, staff had completed training in areas such as non-fatal strangulation, alcohol withdrawal and epilepsy. After a year of employment, forensic nurses were eligible to attend an accredited university course in forensic science.

Staff training figures were reported on at board meetings to ensure compliance with mandatory training requirements.

All staff received regular supervision evidence of which we viewed. However not all supervisors who supported the SOEs had completed the Licentiate of the FFLM is Sexual Offence Medicine as recommended.

The provider had appropriate policies in place in relation to infection prevention and control, and records showed that all staff were up to date with training. Daily cleaning checks were undertaken, as well as a monthly deep clean of the premises.

We noted that all areas of the SARC, were visibly clean and hygienic, including the waiting areas, toilets, storage rooms and corridors. Examination rooms had sealed, coved flooring edges and modern sealed work surfaces so they could be cleaned easily. Hand wash sinks met required standards. Medical consumables were stored in labelled wipeable containers and wall mounted bins were available for the safe disposal of sharps.

Cleaning equipment and materials were stored separately from forensic consumables and followed NHS colour coding requirements. There was a dedicated laundry room with separate washer dryers for patients’ towels and staff scrubs.

All staff entering the forensic medical examination room wore appropriate protective equipment, including face mask, inner and outer gloves, hair caps and disposable barrier clothing.

After each patient was seen, staff undertook a full clean of the forensic examination room both to clean it and ensure any residual patient DNA was removed. A crisis worker described to us the cleaning procedures undertaken following a patient examination and we noted it followed national guidance.

Environmental monitoring was undertaken quarterly and recent results showed that cleaning procedures had been effective in removing all traces of DNA in forensic areas.

The provider had comprehensive medicines management procedures for the safe handling and administration of medicines.

There was a limited formulary comprising of emergency contraception and post exposure prophylaxis drugs (PEP) and patient group directions were in place to allow the registered nurses to supply them to patients.

Staff maintained a record of all medicines issued to patients in their case record, along with the corresponding batch numbers, evidence of which we viewed in the case notes we checked.

Medicines were stored securely and the temperature of the cupboard in which they were held was monitored. Hepatitis B vaccines were stored appropriately in a fridge, with its temperature monitored, although both minimum and maximum temperatures reached were not recorded. Staff undertook weekly checks of the medicines, and we found stock level records were accurate.

Records we reviewed showed that the need for HIV and Hepatitis B post exposure prophylaxis and emergency contraception was assessed and dispensed according to nationally recommended guidance. Referrals had been made by staff to local genitourinary services for follow up testing and support if needed.