Royal Preston Hospital

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 5 quality statements under this key question.

Safeguarding arrangements were well embedded throughout the service and supported by effective clinical leadership. Care was delivered in a way that protected patients from avoidable harm, and staff worked collaboratively with health services, support organisations, and criminal justice partners to achieve positive outcomes for patients. The premises were clean, well maintained, and supported by robust infection prevention and control measures. Medicines were prescribed, stored, and managed safely. Access to hospital emergency support, helped to promote the safety of both patients and staff.

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 trust had comprehensive safeguarding policies and procedures which provided information to staff about how to identify, and report suspected abuse. All staff had completed safeguarding training appropriate to their role and demonstrated a good understanding of their safeguarding responsibilities. Staff reported effective relationships with the trust’s safeguarding team; who provided specialist advice, support and contributed to multi-disciplinary working. Sexual offence examiners (SOE) completed initial safeguarding and risk assessment at the first point of contact for all patients prior to them attending the SARC, which identified risks and vulnerabilities; including self-harm. Arrangements were in place with the immediate response mental health team to support patients with acute concerns regarding mental health or suicidal thoughts.

We reviewed patient records and found evidence of effective safeguarding practice. Clinical documentation was detailed, and clearly identified risks of harm, vulnerabilities and safeguarding actions required to protect children, young people and adults. Child protection reports were completed in line with Royal College of Paediatrics and Child Health (RCPCH) standards. Reports were routinely shared with relevant professionals, including investigating police officers, social workers, general practitioners and other healthcare professionals, to support effective multi-agency safeguarding arrangements.

Staff attendance at strategy meetings was inconsistent and largely dependent on the availability and professional background of the on-call SOE. The service had identified this as an area for development and was working collaboratively with the Integrated Care Board and local authority to improve partnership working and promote greater attendance at strategy meetings.

Case summaries were routinely completed by the clinical director as a safeguard to ensure that the end-to-end process for all cases was complete; including safeguarding referrals, welfare calls and communication with other professionals. Leaders acknowledged that there could be some short delay in completing this, as this task was completed only by the clinical director. This was a risk, as they only worked one day each week at the SARC, meaning any omissions or required actions might not be identified quickly or acted upon.

Staff had access to supervision to support them in their roles, both through one-to-one sessions and team meetings. The lead crisis worker was in the process of implementing more formal supervision arrangements for crisis workers. Quarterly face-to-face peer supervision sessions were provided for all SOEs. Staff also told us they regularly sought informal support and supervision from colleagues following cases seen at the centre. Team meeting minutes routinely documented safeguarding discussions, demonstrating a culture of reflective practice, shared learning, and continuous improvement.

The trust also had Freedom to Speak Up Champions who provided staff with an independent route to raise concerns, seek advice and speak up about issues affecting patient safety and quality of care.

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 on the Royal Preston Hospital site and benefited from the trust’s established estates and facilities management arrangements. Essential health and safety checks, including fire safety inspections and portable appliance testing were undertaken routinely by the hospital estates team, helping to ensure the environment remained safe and fit for purpose. Annual servicing arrangements of specialist equipment, such as the colposcope (a specialised magnifying instrument used to examine the vagina), were effectively managed by the SARC team. SARC staff also completed regular flushing of water outlets to reduce the risk of legionella contamination.

At the time of the inspection, the SARC was working towards UKAS ISO accreditation for forensic services. Regular governance meetings to review progress within the SARC and involving the trust’s governance team ensured continued oversight of the ISO requirements.

The SAFE Centre had 2 forensic examination rooms, complemented by a pre‑assessment room, bathroom, and post‑examination room. The pre-examination room was functional, with appropriate seating and a table to accommodate the initial assessment process. A bathroom, with shower and toilet facilities was available for patients to use.

Contained within a secure forensic corridor, there was a clear, one-way flow for patients through pre-examination, forensic examination and post examination areas to minimise the risk of cross contamination. Forensic examination rooms were secured when not in use, with written logs and sealing systems in place to maintain integrity and the service maintained an audit trail of staff access to the area.

Appropriate safety measures had been implemented throughout patient areas. For example, solid plastic sheaths had been fitted to all cord-operated light fittings to reduce ligature risks. The service had completed a ligature risk assessment and had measures in place to manage identified risks; however, further review was required to ensure that mitigations for the highest-rated risks were sufficiently robust and effective.

Staff had access to dedicated facilities for donning and removing personal protective equipment (PPE). A shower facility was available to enable staff to decontaminate between cases where there was a risk of cross-contamination, including cases involving linked individuals.

Medical consumables were stored in a dedicated secure storeroom used exclusively for clinical supplies to maintain forensic standards and reduced the risk of contamination.

The service had suitable arrangements in place to respond to medical emergencies. Staff were trained in adult and paediatric basic life support. Emergency equipment, including an automated external defibrillator (AED) and a ligature rescue knife, were readily available and subject to regular checks. Staff also had immediate access to the co-located hospital's emergency response and resuscitation teams. This meant additional clinical support could be obtained quickly in the event of a medical emergency.

Access to the unit was appropriately controlled, with measures in place to prevent unauthorised entry. CCTV was installed externally around the SARC building and centrally monitored by the trust’s security team, the internal SARC environment was not covered by CCTV. Portable safety alarms were installed in the SARC, and staff would respond to these when required.

Patients’ care records were paper based; they were appropriately located behind a fire door and stored in fire proof cabinets. Care records were scanned into a secure electronic system for each individual patient, this ensured any fire risk to the integrity of records was mitigated, as electronic copies of care records were retained.

The service had adequate numbers of appropriately qualified, skilled and experienced staff to meet the needs of children, young people and adults accessing the SARC.

At the time of our inspection, the service operated a flexible workforce model. The trust employed a core team of substantive staff at the SARC, including a centre manager, centre co-ordinator, lead crisis worker, quality manager and administrator. However, all SOEs and crisis workers were employed on bank contracts, meaning the service relied heavily on staff availability to maintain rota cover. The trust had successfully recruited additional SOEs and crisis workers to strengthen resilience within the bank workforce; however, some staffing gaps on the rota remained. If crisis workers were not available, SOEs would provide telephone assessment and onward referral to an alternative SARC if required. Staff reported that patient care and critical forensic examination timescales had not been compromised because of staffing shortages.

At the time of the inspection, the centre manager post was being recruited to, and the quality manager had assumed some additional responsibilities to provide interim cover. However, the work required to achieve and maintain compliance with UKAS ISO accreditation placed further demands on the quality manager's capacity. This increased the fragility of the service's staffing arrangements and created a potential single point of failure. To help mitigate this risk, the matron with oversight of the SARC provided additional leadership and support and worked directly within the service one day each week.

The service was staffed by a skilled and experienced clinical workforce. SOEs included GPs, a forensic physician, emergency department consultant, nurses and midwives. All SOEs were registered with their respective professional regulatory bodies. In addition, the SAFE Centre was accredited by the Faculty of Forensic and Legal Medicine to deliver a short training programme for SOEs, which was completed by all SOEs between January and March 2026. All SOEs had also received training in statement writing and court skills to support their involvement in criminal justice processes.

Recruitment processes were robust. We reviewed the personnel files of 2 recently appointed staff members and found that appropriate pre-employment checks, including identity verification, references and Disclosure and Barring Service (DBS) checks, had been completed before staff commenced employment.

The service had a structured induction programme for all new staff, which included both role-specific training and the trust’s’ mandatory training requirements. Staff shadowed colleagues as part of the SARC induction until assessed as competent to undertake their role. Crisis workers completed a competency training portfolio booklet to record their activities during and following their induction and clinicians completed an end-to-end assessment before they worked independently. These comprehensive assessments were also repeated annually for all staff. Staff also had access to additional training to maintain competence in areas of practice that they might not routinely experience, for example, skills sessions were used for hair and nail clippings toxicology testing. Staff received regular supervision and annual appraisals of their performance.

The provider had comprehensive infection prevention and control (IPC) policies and procedures in place to support the safe delivery of care and the maintenance of forensic integrity. Records demonstrated that staff were up to date with mandatory IPC training and understood their responsibilities for maintaining a clean and safe environment.

There were established cleaning and monitoring processes in place. Routine cleaning tasks were completed regularly, and the premises underwent a monthly deep clean. Trust-led infection prevention and control (IPC) audits were undertaken to provide assurance that required standards were being maintained. In addition, SARC-specific audits were completed to meet the requirements of UKAS ISO accreditation. These had led to the introduction of enhanced cleaning schedules and the implementation of pre-cleaning procedures for forensic examination rooms.

To support forensic standards, environmental DNA monitoring was carried out on a quarterly basis and this provided assurance that cleaning processes were effective in removing residual DNA and minimising the risk of contamination within the forensic examination area.

We observed that all areas of the SARC, including the waiting area, bathroom, and interview room, were visibly clean and hygienic. In the clinical examination rooms, surfaces, walls, floors, and cupboard doors were free from dust and visible dirt. The examination rooms had sealed flooring to support effective cleaning. However, the flooring was not continuously coved, and gaps were present, which presented an IPC risk. In addition, a radiator in one forensic examination room was not wall-mounted, preventing it from being cleaned effectively, and rust was visible at its base. Handwashing facilities within the examination room met required standards, although some limescale was observed on taps in both the forensic examination room and the doctor’s room. Cleaning equipment and materials were stored separately from forensic consumables, reducing the risk of cross-contamination.

Medicines’ management arrangements were safe and well organised.

The provider had medicines’ management procedures for the safe handling and administration of medicines and patient group directions were in place to allow the registered nurses and midwives to supply medicines to patients.

Doctors prescribed medicines individually to patients which included emergency contraception, and HIV post exposure prophylaxis (PEP) treatment. Records showed that the need for PEP and emergency contraception was fully assessed and dispensed according to nationally recommended guidance.

Medicines were stored securely and staff routinely monitored the fridge temperature to provide assurance that medicines were within the required temperature range and safe for use. Pharmacy staff completed quarterly audits of medicines. Outcomes were discussed at operational meetings and shared with staff during team meetings.

Staff maintained accurate records of all medicines supplied to patients. Clinical records included details of medicines administered, together with batch numbers, enabling full traceability. We reviewed patient records and found this documentation was completed consistently. Records also demonstrated that clinicians routinely assessed the need for HIV PEP and emergency contraception and administered these medicines in line with local and national guidance.

Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts and other relevant notices were disseminated through the trust’s governance team, ensuring staff were informed of any actions required to maintain patient safety.