The Elms

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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. Safeguarding arrangements were effective and well embedded. 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.

The service had clear safeguarding policies and procedures in place to support staff in identifying, reporting and responding to suspected abuse. These included defined safeguarding pathways tailored to the age and needs of patients. Staff demonstrated a good understanding of safeguarding processes and were able to describe the pathways for both children and adults.

All staff had completed safeguarding training appropriate to their role. Managers were trained to level 4, forensic nurse examiners and sexual offence examiners (FNEs/SOEs), and medical staff to level 3, and crisis workers to level 2. Comprehensive records of safeguarding training and activity were maintained to evidence ongoing competence. Managers had completed additional training to support the delivery of safeguarding supervision, which was embedded as a core element of the supervision arrangements available to staff.

We reviewed patient records and saw evidence of effective safeguarding practice. A comprehensive safeguarding assessment was completed for all patients as part of the forensic examination. This included consideration of risks such as female genital mutilation (FGM), human trafficking and honour-based violence.

Referrals for children aged 12 years and under to the service were made by the police or social services, and these children were required to be accompanied by an appropriate professional. A forensic doctor or strategy coordinator attended all strategy meetings for this age group to agree actions required to safeguard the child’s welfare. Following attendance at the service, safeguarding summaries were completed and shared with relevant partner agencies.

Safeguarding was routinely discussed as part of daily case reviews. Referrals were actively followed up to ensure that appropriate action had been taken by external agencies.

The service had Freedom to Speak Up Champions in place, providing staff with support to raise concerns where necessary.

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

The police leased the premises from Hinchingbrooke Hospital and held overall responsibility for the management of the site, including health and safety. SARC staff undertook legionella management and fire safety checks. One staff member had been trained as a fire marshal, with further training planned for additional staff. Regular fire drills were carried out to ensure staff were familiar with emergency procedures.

CCTV was in operation outside the building to enhance the safety of patients and staff. Panic alarms were also installed in clinical rooms, enabling staff to call for assistance if required.

The premises had been designed to meet ISO and forensic science regulatory standards. Patient flow was managed in a single direction—from the pre-examination room to the forensic medical examination room and then to the aftercare room—to minimise the risk of cross-contamination. Forensic examination rooms were secured when not in use, and a log was maintained of all personnel accessing these areas.

A designated area was provided for staff to put on and remove personal protective equipment, including appropriate handwashing facilities. A separate storeroom was used exclusively for medical consumables to maintain forensic integrity and reduce the risk of contamination.

Bathroom doors could be opened from the outside in the event of a patient collapse, and furnishings were designed to be anti-ligature to mitigate risks to patients.

Staff were trained in adult basic life support (BLS), and one staff member had recently completed training as a BLS champion. While not all recommended emergency equipment and medicines were available on site, staff had prompt access to the co-located hospital and its emergency crash team, who could attend quickly if needed.

At the time of the inspection, the service employed 3 sexual offences examiners (SOEs), 6 crisis workers and 2 strategy coordinators. Staff told us that staffing levels were sufficient to deliver a responsive service to patients. Although there were occasions where staffing levels were stretched, vacant shifts were covered by the manager or staff from an alternative site. Staff reported that patient care and critical forensic timescales had never been compromised due to staffing shortages.

Recruitment processes were robust. We reviewed personnel files for 3 recently appointed staff members and found that appropriate pre-employment checks and vetting procedures had been completed to ensure their suitability for their roles. Disclosure and Barring Service (DBS) checks were undertaken every 3 years to monitor staff’s suitability.

The service had a structured induction and training programme for all new staff, which had received formal accreditation from the Faculty of Forensic and Legal Medicine (FFLM). Staff we spoke with provided positive feedback about their induction experience.

There was a comprehensive mandatory training programme in place covering a wide range of relevant topics, including information governance, PREVENT, basic life support, female genital mutilation, and infection prevention and control. All staff maintained a live training and competency portfolio to support their ongoing professional development. Records we reviewed showed that staff had completed all mandatory training relevant to their roles.

The service had clearly defined expectations regarding staff competency. Where staff had not undertaken a forensic procedure within a 3-month period, their competency was reassessed by the associate head of healthcare to ensure skills were maintained.

Training compliance was monitored through reporting at board level meetings.

All staff received regular supervision and appraisal. We reviewed evidence confirming that staff received 3 types of supervision: safeguarding, clinical, and managerial.

The provider had policies and procedures to support effective infection prevention and control (IPC). Records showed that staff were up to date with mandatory IPC training. Daily cleaning checks were completed, and the premises were subject to a monthly deep clean. Regular IPC audits were also undertaken to monitor standards. Environmental monitoring was undertaken each month to check that cleaning procedures had been effective in removing all traces of DNA in forensic areas.

All areas of the SARC were visibly clean and maintained to a good hygienic standard, including the waiting areas, toilets, storage areas and corridors. Examination rooms were fitted with sealed flooring and coved edges, along with smooth, non-porous work surfaces to support effective cleaning. Handwashing facilities in treatment rooms met required standards. Although not wall mounted, sharps bins were positioned safely and labelled correctly.

Cleaning equipment and materials were stored separately from forensic consumables and followed NHS colour-coding guidance. Single-use disposable mop heads were used to minimise the risk of cross-contamination. At the time of inspection, there was only one washing machine in use for laundering both staff scrubs and patients’ towels. However, the provider had plans to introduce a dedicated laundry facility with separate machines.

Following each patient examination, crisis workers carried out a thorough clean of the forensic examination room to maintain cleanliness and remove any potential DNA contamination. Staff were able to describe these cleaning processes, which were in line with national guidance.

Forensic rooms were appropriately tagged after cleaning, and records were maintained to confirm that cleaning had been completed.

The provider had systems and processes in place to support the safe management of medicines. Patient Group Directions (PGDs) were in place, enabling registered nurses to supply medicines to patients appropriately.

A limited formulary was held on site, including emergency contraception, Hepatitis B vaccine and post-exposure prophylaxis (PEP). Medicines were stored securely, and the temperature of the storage room and refrigerator was monitored daily. Regular stock checks were carried out, and records showed that stock levels were accurate. However, there was no system in place to monitor and manage the use of the prescription pad held within the medicines cupboard.

Staff recorded all medicines supplied to patients within their clinical records, including batch numbers. We reviewed case notes and saw evidence that this was completed consistently.

Case notes also demonstrated that assessments for the need for HIV PEP and emergency contraception were undertaken and medicines were supplied in line with national guidance.

Systems were in place to ensure that staff received and actioned national patient safety alerts, including those from the Medicines and Healthcare products Regulatory Agency (MHRA).