Grange Park SARC

We carried out this announced inspection on 29 and 30 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a second CQC inspector.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

Grange Park Sexual Assault Referral Centre (SARC) is in Cobridge, Stoke on Trent and provides forensic and therapeutic support to adults who have experienced rape or sexual assault recently or in the past. The service, provided by G4S Health Services (UK) Limited, (referred to throughout the report as G4S) is commissioned by NHS England to deliver adult sexual assault cases only from the age of 18 years upwards. Young people aged between 16 to 18 years can request to be seen at this service for the physical examination, however all aftercare is provided by the local paediatric sexual assault services. The local paediatric SARC service is not part of this inspection.

The service is provided by G4S and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager at Grange Park SARC is the SARC manager.

This SARC is a nurse led unit with the back-up of a Forensic Medical Examiner (FME) for complex cases and rota coverage. At the time of our inspection the core team consisted of the SARC manager, SARC coordinator, one crisis worker and two forensic examiner nurses known as Sexual Offence Examiners (SOE) who worked on a 4 day on 4 day off basis. A third flexi nurse had been recruited and was undergoing an induction and training period. The nights were covered by flexi contract SOE nurses and crisis workers. The SARC manager and SARC coordinator were also both trained Crisis Workers.

The service is available 24/7 to help people that have been affected by sexual abuse and sexual violence. Patients can be referred through the police or directly self refer using the self-referral 24 hour phone line.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the centre.

The SARC has two adult forensic examination suites.

On the day of inspection we spoke with the registered manager, the West Midlands regional SARC manager, two sexual offences examiners and a crisis worker.

We looked at 14 patient records, policies and procedures and other records about how the service is managed.

Patients spoke positively about the service and the quality of care that was provided. Inspectors read comments that told the team how patients had felt respected and one person described how the attitude of staff had helped them to stay engaged through the process and not walk away.

Our key findings were:

• The provider did not have suitable safeguarding processes and staff did not demonstrate an understanding of all their responsibilities for safeguarding adults and children.
• Risk assessments were not carried out on potential ligature points.
• Governance arrangements did not always identify issues and quality assurance systems did not always prevent non-compliance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The service had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment/referral system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The service asked staff and patients for feedback about the services they provided.
• The staff had suitable information governance arrangements.
• The environment appeared clean and well maintained.
• The staff had infection control procedures which reflected published guidance.
• Systems were in place to support multi-agency working.

We found that this service was not protecting service users from abuse and improper treatment and we are taking enforcement action.

The provider must:

• Ensure that systems and processes to prevent the abuse of patients are operated effectively.
• Ensure effective safeguarding processes are in place.
• Ensure staff are trained in safeguarding adults and children according to the required national guidelines.
• Staff must review records to ensure any safeguarding risks are considered.
• Ensure that governance arrangements are established and fully embedded into the service including risk assessment, record keeping and audit procedures.

We undertook an announced inspection of Grange Park SARC on 11 June 2019. This inspection was focussed on the improvements required following a warning notice issued to the SARC after the initial inspection on 29 January 2019.

The Care Quality Commission issued a warning notice on 18 February 2019 in relation to Regulation 13, (1) (3), Safeguarding service users from abuse and improper treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The warning notice set out the following areas of concern, where significant improvement was required:

• The provider did not have suitable safeguarding systems and processes.

• Staff did not know their responsibilities for safeguarding adults and children.

• Staff were not trained in accordance with national safeguarding training guidance.

• Safeguarding records showed risks were not fully considered and actioned.

The warning notice gave the provider a timescale of three months in which to comply. Following the issuing of the warning notice, the provider sent us an action plan, outlining the areas and actions they would take to address the concerns.

In this follow up inspection, on 11 June 2019, we found immediate improvements had been made, but change was ongoing and new systems were not yet fully embedded. The requirements of the warning notice had been met but further work was needed to continue the improvements.

We looked at specific key lines of enquiry, under the key question of safe. During this inspection, we found improvements had been made which included:

• A review and update of the safeguarding policies and procedures

• Staff receiving safeguarding training at the appropriate level with multiagency input

• The SARC taking appropriate action to follow up safeguarding risks on the cases identified at the previous inspection.

We found sufficient evidence to show that the requirements of the warning notice had been met.