Herts SARC

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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 identify and report safeguarding issues. Staffing levels met patient need and infection control and medicines management was robust.

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 did not reflect current legislation, guidelines or terminology, and needed to be updated.

All staff had completed the appropriate level of safeguarding training for their role and attended dedicated safeguarding supervision sessions. Staff were able to describe to us in detail the safeguarding pathways for both children and adult patients and kept comprehensive logs of safeguarding training and activity to demonstrate their ongoing competence. Managers had undertaken level 4 training and additional training to provide specific safeguarding supervision to staff.

Effective safeguarding practice was well evidenced in patient records we reviewed. 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. Referrals for children aged 12 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 or strategy co-ordinator attended all strategy meetings for this age group.

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. Copies of all medical reports for children were shared with the local authority and police within a reasonable timeframe.

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

The premises were owned by the police who were responsible for fire safety, portable appliance testing, emergency lighting, legionella management and equipment maintenance. However, the SARC manager had effective oversight of when servicing and equipment maintenance was due. CCTV was in use outside the building to increase security, although there was no signage to inform patients of its use.

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 to protect their forensic integrity and minimise cross contamination.

The bathroom doors could be opened from the outside in case of patient collapse, and all furnishings had been designed to be anti-ligature to reduce risks to patients. However, we noted there was no heating in the patient shower room and the room was cold.

Staff undertook training in basic life support, and some basic medical emergency equipment was available. However, following a risk assessment, no medicines were kept to respond to common medical emergencies such as seizures and asthma attacks which did not meet recommended FFLM guidelines.

Four of the SARC’s staff had been trained as fire marshals and conducted weekly fire checks. Full fire drills were undertaken to ensure staff knew what to do in the event of an emergency.

At the time of our inspection 4 sexual offences examiners (SOEs) and 3 crisis workers and a strategy co-ordinator were employed at the service. 7 forensic medical examiners worked on a regional basis and were available on a rota system, to meet the needs of children under 12 years of age who required a forensic examination. 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. An additional 3-hour window was funded if staff had to work outside of their normal contracted hours to meet patient need, or to meet forensically critical timescales.

Personnel files we reviewed for 3 recently recruited staff members demonstrated that most pre-employment and vetting checks had been completed to ensure they were suitable for their role. However, not all files contained proof of the person’s ID, or 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 FFLM for its staff induction course. Staff maintained their competence through regular refresher training in key subjects and through peer review of their work. Staff we spoke with told us their competence to undertake a variety of forensic procedures was assessed regularly by managers who held specific qualifications from the FFLM.

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.

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

All staff received regular supervision and appraisal, evidence of which we viewed. Staff expressed high levels of satisfaction in their work and told us they felt valued and supported by 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.

We noted that all areas of the SARC, were visibly clean and hygienic, including the waiting area, toilet, 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 in treatment rooms; however, we noted a build-up of limescale on the taps and sink in the staff toilet which needed to be removed. 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. Single use disposable mop heads were in use.

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 monthly 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 the SARC had recently received additional funding to offer Hepatitis B vaccination to patients. Appropriate refrigerated storage had been put in place for this, along with a system to monitor its temperature. Patient group directions were in place to allow the registered nurses to supply medicines to patients legitimately.

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. Staff undertook regular checks of the medicines, and we found stock level records were accurate.

Records we reviewed showed that the need for HIV 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.

Systems were in place to ensure staff were notified of any national patient safety alerts.