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Inspection Summary


Overall summary & rating

Good

Updated 30 January 2020

We carried out this announced inspection on 5 & 6 November 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 health & justice inspector who was supported by a second health & justice inspector, and a specialist professional advisor.

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

The Bridge SARC is in Bristol and provides services to children, young people and adults. NHS England commission University Hospitals Bristol NHS Foundation Trust (UHB NHSFT) to deliver the paediatric pathway supporting children and young people up to the age of 18 years. A different provider was commissioned to deliver forensic medical examinations to over 18s. This inspection was of the paediatric pathway only delivered by UHB NHSFT.

The Bridge SARC provides services for children and young adults up to the age of 18 across a large geographical area. The SARC accepts referrals for children and young adults requiring a medical examination from the counties of Wiltshire, Gloucestershire, Avon & Somerset and Swindon.

The SARC is situated within the Central Health Clinic in the centre of Bristol with sexual health services delivered on the ground floor, and the SARC on the second floor. Access to the SARC is via a lift with secure entry to both the building and SARC on the second floor. The SARC offices are open between 9am and 6pm Monday to Friday, and between 10am and 4pm at weekends. Paediatric examinations may be carried out within these hours during the week, and between 12 noon and 4pm at weekends. A 24 hour telephone advice line is available for professionals 365 days a year.

The SARC facilities include two forensic medical examination suites with pre-examination, examination and bathroom facilities adjoining each other, and separate aftercare rooms. One suite is set up for adult patients and the second for children and young people. The provider has access to a loft space where forensic samples are stored, as well as a staff kitchen, staff shower and bathroom facilities and a disabled toilet. Staff work within a small office area and have access to a large meeting room which can be booked as required. Plans were in development to utilise a disused room on the same floor of the building as a shared staff comfort area.

The SARC team is led by a service manager and the paediatric pathway overseen and delivered by a consultant paediatrician. Three bank clinical sexual offence examiners are utilised to cover the rota with two substantive paediatricians due to join the team in January 2020. The provider’s staffing structure includes five full time equivalent crisis worker posts, of which one is currently vacant. Recruitment has taken place and the role is due to be offered imminently. 10 crisis workers from the trust bank cover out of hours provision on zero hour contracts.

During the inspection we spoke with three managers and four crisis workers. Throughout this report we have used the term children and young people to describe people who use the service to reflect our inspection of the paediatric patient service.

We looked at policies and procedures and other records about how the service is managed, and sampled care records for 15 children and young people.

Our key findings were:

  • The provider had systems to help them manage risk.
  • The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The clinical staff provided children and young people’s care and treatment in line with current guidelines.
  • Staff treated children and young people with dignity and respect and took care to protect their privacy and personal information.
  • The appointment/referral system met children and young people’s needs.
  • The service had effective leadership and a culture of continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and children/young people for feedback about the services they provided.
  • Staff followed appropriate information governance procedures.
  • The provider maintained a clean and welcoming environment for children, young people and visitors.
  • Infection control procedures reflected published guidance.

There were areas where the provider could make improvements. They should:

  • Implement a formal audit programme to align with the trust audit calendar and support the service’s culture of learning and development.
Inspection areas

Safe

Good

Updated 30 January 2020

We found that this service was providing safe care in accordance with the relevant regulations.

Effective

Insufficient evidence to rate

Updated 30 January 2020

We found that this service was providing effective care in accordance with the relevant regulations.

Caring

Good

Updated 30 January 2020

We found that this service was providing caring care in accordance with the relevant regulations.

Responsive

Good

Updated 30 January 2020

We found that this service was providing responsive care in accordance with the relevant regulations.

Well-led

Good

Updated 30 January 2020

We found that this service was well-led safe care in accordance with the relevant regulations.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 2 December 2014

Safeguarding procedures were in place and staff were knowledgeable regarding their responsibilities for safeguarding children and adults.

The department was clean and tidy and infection control policies and procedures were in place and followed to ensure the safety of people who visited the department and staff who worked there.

Care and treatment were provided in line with regional and national guidelines. 

Feedback from people who used the service was sought and the outcomes audited. Action had been taken in response to suggestions made by people who used the service. 

People’s privacy, dignity and confidentiality were respected at all times.

People who attended the service were positive in their comments about their care and treatment and all said that they would recommend the service to their friends.

Services were available to people over six days each week and clinics were led by trained and competent staff.

The department had a clear vision and strategy and staff were positive and proud regarding their work. 

Staff worked as part of an integrated multidisciplinary team, which had positive outcomes for patients.

Risk management systems were in operation and identified risks were escalated appropriately within the trust.