We carried out this announced inspection on 5 and 6 February 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 carried out by four CQC inspectors who were supported by 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.

Our findings were:

Are services safe?

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

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

In West Mercia, services for support and examination of people who have experienced sexual assault are commissioned by NHS England and West Mercia Police. The Glade provides these services in the counties of Herefordshire, Worcestershire and Shropshire. The centre is located in Bransford, Worcestershire in a building owned by West Mercia Constabulary. The Glade provides services to adults, with an option that young people aged 16 and 17 years old can choose to access this service instead of regional paediatric services if appropriate. A different provider holds the regional paediatric contract for sexual assault referral services in West Mercia, this service uses the Glade once every week to offer child appointments.

The centre is out of town in a rural location, all signage is for the Glade and discreet. It is adjoined to a confidential police interview suite and car parking is available outside the centre with level access for people who use wheelchairs. The entrance is welcoming, and covered by CCTV. The door is secure which protects patients accessing the centre. A clear record is maintained of all visitors.

The staff team consists a mix of permanent full-time staff and flexi staff that provide cover both day and night. Permanent staff include a centre manager and coordinator (also a crisis worker) along with two nurses and a midwife who are forensic medical examiners. Most examiners are nurses, though there is also some doctor cover within the rota. Flexi staff who are examiners and crisis workers work an on-call rota, to cover daytime, nights and weekends. The service has two medical suites.

The service is provided by G4S Health Services (UK) Limited (G4S). The centre is staffed Monday to Friday 9am until 5pm, with out of hours cover provided via rota cover. All requests and referrals to the centre by phone are through a call centre run by G4S, who liaise with examiners and crisis workers to ensure appointments meet the needs of patients and forensic examination timescales.

During the inspection we spoke with the centre manager who is the registered manager with CQC, a G4S regional manager, the centre coordinator, one forensic medical examiner and two crisis workers.

We looked at policies and procedures and other records about how the service is managed and reviewed patient case notes.

Our key findings were:

• The provider had systems to manage risk, and recognised where improvements could be made.
• Safeguarding processes had recently been improved and were being embedded.
• 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 referral and appointment systems met patients’ needs.
• The service had effective leadership. There was a culture of continuous improvement.
• The service worked in partnership with many local organisations to raise the awareness of the SARC services but also promote healthy consensual sex and raise awareness of sexual assault and rape amongst vulnerable people.
• Staff felt involved and supported and worked well as a team.
• The centre was clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and emergency equipment were available.
• Staff and patients were asked for feedback about the service to inform continual development.

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

• Ensure that new patient risk assessment and safeguarding processes are fully embedded, and all safeguarding risk assessments are fully completed.
• Ensure the premises is appropriately risk assessed to reduce potential risks to patients who might be at risk of self-harm.
• Ensure that patient records contain relevant information about medicines which have been administered.

Clinical waste management arrangements should ensure all sharps containers are replaced to conform with infection prevention and control guidance.