The Glade Sexual Assault Referral Centre-Bransford

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• 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 safeguard patients and share information with appropriate agencies. Staff worked collaboratively with other health services to promote the best 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.

The provider had policies and procedures in place to provide staff with information on identification, reporting and management of safeguarding concerns. Staff we spoke with understood their responsibilities towards safeguarding their patients, and a pathway was in place to appropriately safeguard young people who had elected to be seen in the adult SARC.

All staff had completed the appropriate level of safeguarding training for their role and had the opportunity to attend quarterly safeguarding supervision sessions. This included peer review and reflective practice for recent cases which were scrutinised to ensure they had been managed in line with guidance.

Patient assessments included vulnerabilities such as child sexual exploitation, human trafficking and honour-based violence. Daily case reviews included an overview of safeguarding concerns identified and actions taken. This ensured the correct action had been taken following assessment. Safeguarding referrals submitted to the local authority were well documented and confirmation of receipt was requested. Referrals were followed up to ensure they had been received by the relevant agencies.

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.

The Glade was situated within a building owned and managed by the police. Police estate colleagues attended the building weekly to carry out the appropriate fire, emergency lighting and legionella testing. Equipment maintenance in the building and portable appliance testing was also carried out by police estates. The SARC manager had developed positive working relationships with the police estates team since taking up her role which ensured any concerns were addressed promptly to maintain a safe environment for staff and patients.

The premises had been recently refurbished to meet all ISO and forensic science regulatory requirements. For example, separate entrances for patients accessing the two forensic suites ensured patients did not meet while at the SARC, and the self-contained ‘pods’ created a flow for patients from pre to post examination to prevent any cross contamination. Forensic bathrooms within the pods had anti-ligature fixtures and fittings and doors could be unlocked from the outside to maintain patient safety.

Forensic examination rooms were sealed and tagged when cleaned and not in use, and records were completed to log any staff entering and the reasons for this. Cleaning logs were also maintained at the entrance to forensic pods. There was a dedicated area for staff to shower and put on/remove personal protective equipment, and washing facilities were on site to launder scrubs and towels.

A large room with restricted access was used to store medical consumables which helped maintain their forensic integrity and minimise cross contamination. Air flow management had been installed across the premises to manage the temperature and to refresh air flow within forensic areas in line with recommended guidelines.

Hazardous substances were correctly stored with safety data sheets for those held on the premises. Spill kits were available to ensure bodily fluids could be cleaned up safely.

Staff completed basic life support training, and emergency equipment and medicines including a defibrillator and oxygen were available on site. However, there were no medicines to respond to common medical emergencies such as seizures and asthma attacks.

Following a period of instability, staffing levels had improved and were now sufficient to meet demand for the service. 4 forensic examiners and 11 crisis/admin workers were employed at the time of the inspection with many joining the team in recent months, including the SARC manager. Staff we spoke with were positive about their induction, management and teamworking at the SARC and they told us they felt valued by managers.

Personnel files we reviewed for 2 recently recruited staff members had been completed appropriately. Pre-employment and vetting checks had been carried out to ensure they were suitable for their role including obtaining references, employment history and right to work in the UK.

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.

The provider had arrangements to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. Managers had oversight of outstanding actions through the online system which also prompted staff when a course was due to be refreshed or was out of date. We reviewed staff training records which evidenced that forensic examiners had received the essential training for their roles for example in safeguarding, Mental Health Act and statement writing. Staff training compliance was reported quarterly to commissioners at contract review meetings.

Staff were offered clinical and safeguarding supervision on a regular basis as well as the option to attend peer review and reflective practice sessions. Forensic examiners also took part in daily case reviews when on shift allowing an opportunity for reflection and learning on cases across the region.

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. Police estates contracted a cleaner to attend daily for general areas, however staff completed the forensic cleaning after cases. A monthly deep clean of the premises took place and the provider carried out routine environmental monitoring to check for any DNA in forensically cleaned areas. Records for this evidenced that appropriate action was taken following any positive results.

The SARC was clean during our inspection including communal areas, offices, kitchens, laundry and shower facilities and toilets. Forensic pods including pre-examination, examination and bathrooms were sealed and forensically cleaned. Forensic areas met infection prevention and control standards with compliant hand washing facilities, covered floor edging and wall mounted sharps bins. Medical consumables were stored in labelled wipeable containers.

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.

Staff could access a supply of appropriate personal protective equipment to wear in forensic areas which included face masks, inner and outer gloves, hair caps, and disposable barrier clothing.

The provider had robust medicines management procedures for the safe handling and administration of medicines. A range of Patient Group Directions (PGDs) were in place for registered nurses to supply emergency contraception, post exposure prophylaxis drugs (PEP) and hepatitis B vaccinations. Medicines administered were recorded in patient records including the brand, dose and expiry dates of the medicine.

Medicines were stored in a locked cupboard or fridge in a locked room where the room temperature was monitored daily. Records we reviewed showed that daily room and fridge temperature checks were up to date and had consistently been within recommended ranges. The nurse on shift carried out a daily and weekly check of medicines and stock levels corresponded to completed records during the inspection. A process was in place to re-order medicines and maintain adequate supply.

Nursing staff carried out comprehensive assessments of patients prior to their forensic medical examination to determine whether a patient was eligible for post exposure prophylaxis, a hepatitis B vaccination or emergency contraception. Details of treatment given were clearly recorded in patient records we sampled and we saw evidence that staff referred patients to local genito-urinary services for follow up testing and support if needed.