The Blue Sky Centre - Nuneaton 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 6 quality statements under this key question. Safeguarding was firmly embedded within the SARC and care was provided in a way that kept patients safe from avoidable harm. 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.

We found there were effective systems in place to manage safety. Patients were fully assessed for risk factors such as domestic abuse, non-fatal strangulation and alcohol use so that any concerns could be identified and support offered. Staff told us they had recently worked with partner protection agencies to develop a specific protocol to support patients who attended the service frequently, so that they received a coordinated multi-agency response to their needs.

The SARC’s risk register had identified potential ligature points in the bathroom, issues with the storage of confidential patient information and problems accessing the building. These had been fully assessed, with action taken to mitigate the risks clearly documented and reviewed.

The SARC had clear referral pathways in place to support patients’ holistic needs and records we reviewed showed that appropriate onward referrals to other agencies such as mental health teams, GPs, counselling services and genitourinary medicine clinics had been made. All patient referrals were then actively followed up by staff to ensure they had been received. Patients were also provided with comprehensive information about local support agencies that could be contacted following their visit to promote continuity of their care.

Staff actively engaged with local partners such Coventry City Council, Coventry University and a sex worker charity to promote a wider understanding and knowledge of the services provided at the SARC. At the time of our visit, staff were working with local prison services to develop safe referral pathways for prisoners.

Staff told us they felt confident they could report safety incidents and that these would be investigated by managers. Regional meetings were held every Wednesday for managers to review any incidents that had occurred. The provider then produced regular bulletins, where learning to prevent their recurrence was shared across all SARC locations..

There were comprehensive policies and procedures to provide staff with information about identifying, reporting and dealing with suspected abuse, and staff had completed the appropriate level of safeguarding training for their role.

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. Where concerns were identified, they were recorded by staff, along with any action taken. Staff told us they always submitted safeguarding referrals even if they were aware other agencies had already done so. Referrals were routinely made for any 16- or 17-year-old attending the service, and for under 18s where female genital mutilation had been identified.

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 protection agencies. Self-harm risk assessments were also completed for patients to identify support needs when they left the service.

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 SARC was located in a dedicated and secure building, with access that was separate and not open to the public. All patient areas were sited on the ground floor and were accessible for wheelchair users, although there was no portable hearing loop to assist patients with hearing impairments.

As the provider did not own the building, it was reliant on other agencies to provide key safety checks and some equipment maintenance. Fire alarm and portable appliance testing was undertaken by police services and legionella risk was managed by the nearby hospital. However, the SARC manager had good oversight of when checks were due and kept a log of when equipment needed to be serviced.

Product safety data sheets were available for all hazardous cleaning products in use on the premises.

Some aspects of the premises failed to meet standards as set out by Forensic Science Regulator guidance. For example, there was no separate donning or doffing area for staff to use before entering the examination room. The hand wash basin in the examination room had an overflow and did not have elbow-operated or non-touch taps to reduce the risk of contamination. There was no system to monitor air quality and flow, and patient bathroom fittings were not designed to prevent ligature risk.

Staff undertook training in basic life support, and equipment and medicines were available to respond to any medical emergencies on site. The bathroom could be opened from the outside by staff in case of patient collapse.

At the time of our inspection 8 sexual offences examiners and 5 crisis workers were employed and the SARC was fully staffed. Staff told us there were enough of them for the smooth running of the service and the rota was managed well. Rotas for the previous few months to our inspection showed that the SARC was staffed consistently with a sexual offences’ examiner and crisis worker available at each shift.

Personnel files we reviewed for 2 recently recruited staff members demonstrated that appropriate pre-employment and vetting checks had been completed to ensure they were suitable for their role. All staff underwent a comprehensive induction, and the provider had recently received formal accreditation from the Faculty of Forensic Legal Medicine 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. Training records we viewed showed that staff had completed all essential training for their role.

All staff received regular supervision and appraisal to identify any training needs and ensure their practice met professional standards. Staff told us that their appraisals were useful, and they valued the feedback they received from managers.

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. Quarterly environmental monitoring was in place to test the efficacy of the SARC’s cleaning procedures and DNA management.

We noted that all areas of the SARC, were visibly clean and hygienic, including the waiting areas, toilet, and corridor. We checked an examination room and surfaces including walls, floors and cupboard doors were free from dust and visible dirt. The room had sealed flooring and modern sealed work surfaces so they could be cleaned easily.

Cleaning equipment was colour coded, and mop heads were single use to minimise the risk of cross contamination. Staff scrubs were laundered on site. A bin was available for the disposal of sharps, although this was not wall mounted to minimise risks to staff and patients.

There was controlled access to the forensic examination room to minimise the risk of DNA contamination and a detailed log was kept recording its use. All staff entering the forensic medical examination room wore appropriate PPE, including face mask, inner and outer gloves, mob cap and disposable barrier clothing.

After each patient was seen, the crisis worker undertook a full clean of the forensic examination room both to clean it and ensure any residual patient DNA was removed.

A small number of medicines were held on site 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 care record, along with the corresponding batch numbers.

Medicines were stored securely and the temperature of the room in which they were held was monitored. Staff undertook daily checks to ensure that stock levels were adequate, and the medicines had not passed their expiry date. Hepatitis B vaccines were kept in the fridge as required, however we found discrepancies in the fridge temperature checks which indicated they were not being stored within the recommended range. Staff took action during our visit to rectify this.

The need for HIV prophylaxis medication was fully assessed before being prescribed to patients to ensure nationally recommended guidance was followed. We found appropriate referrals had been made by staff to local GUM services for follow up HIV testing and support.

National patient safety and medicines alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA) were sent by the provider’s pharmacist to all SARC centres.