Bridge House SARC

We carried out this announced inspection on 26 and 27 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 two 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.

During our inspection, we found a number of concerns in the safety of the service. The Care Quality Commission served an urgent Notice of Decision on 29 November 2019 under section 31 of the Social Care Act 2008, to impose conditions the registered provider must not provide regulated activities without the prior written agreement of the Care Quality Commission and until fire safety systems and processes had been implemented in the building. A further inspection was carried out to review this on 23 December 2019.

Background

Bridge House SARC is a sexual assault referral centre (SARC). Mountain Healthcare Limited provides health services and forensic medical examinations to patients aged from 16 years old upwards in North Yorkshire who have experienced sexual violence or sexual abuse. The SARC premises are owned and maintained by the police. Mountain Healthcare Limited use the top floor of the building, which comprises of a small staff office and one forensic suite. Communal areas on the ground floor include a waiting room, kitchen and toilet which are shared with the police. The police are situated on site and use the rooms on the ground floor to carry out video recording interviews.

The service is jointly commissioned by NHS England and the Police and Crime Commissioner. The SARC does not offer a walk-in service and appointments can be made by telephone. Staff were on site during core working hours and staff attended the service during the on-call period, from 5pm to 8am. Mountain Healthcare operates a call centre that provides a 24 hours-a-day and seven days-a-week advice service for patients. For non-urgent enquiries patients could make contact by email; this was not monitored out of hours. The staff team consisted of a centre manager, forensic nurse examiners (FNEs) and crisis workers. Staff are deployed to work between Bridge House SARC and Casa Suite SARC in Hull.

The service is provided by a limited company and, as a condition of registration, the company 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 the Bridge House SARC was also the medical director for Mountain Healthcare Limited who is a member of the Faculty of Forensic and Legal Medicine. We have used the terms ‘registered manager’ and ‘centre manager’ to differentiate between the two roles. The registered manager and the centre manager were not available at the time of the inspection.

Comment cards were sent to the service prior to our visit and we did not receive any responses from patients who accessed the service. Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC.

During our inspection we toured the premises and reviewed the care and health records of 15 patients who had used the service and the records for the management of medicines. We spoke with the director of nursing, the associate head of healthcare, two FNEs and two crisis workers. We checked six staff recruitment files, minutes of meetings, audits, and information relating to the management of the service.

Our key findings were:

• The service did not have effective systems in place to help them manage risk. Fire safety systems were not in place to ensure that patients were not exposed to the risk of harm.
• The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults, however safeguarding processes were not always being followed for children.
• There were gaps in the staff recruitment procedures.
• Appropriate medicines were available.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff did not always treat patients with dignity and respect.
• Staff took care to protect patient’s personal information.
• The appointment/referral system met clients’ needs.
• The service did not always have effective leadership.
• There was a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The service asked staff and clients for feedback about the services they provided.
• The service staff dealt with complaints positively and efficiently.
• The staff had suitable information governance arrangements.
• The service appeared clean.
• The staff had infection control procedures which reflected published guidance.

We found a number of concerns in the safety of the service. We took urgent action to impose a condition that the registered provider must not provide regulated activities at this location to ensure that people were not exposed to the risk of fire in the building. A further inspection was carried out to review this on 23 December 2019. Further details of this can be found in our report in December 2019.

We identified one breach in relation to good governance. We also found that a screen was not provided for patients in the forensic examination room, however this was rectified soon after our inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We identified regulations the provider was not meeting. They must:

• Ensure the premises being used to care for and treat service users are safe for use.
• Ensured the privacy and dignity of patients.
• Ensure risk assessments of equipment and furniture in the forensic examination room are carried out.
• Ensure systems or processes are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others who may be at risk.
• Send CQC a written report setting out what governance arrangements are in place and any plans to make improvements.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Establish whether patients require a male practitioner prior to them entering the service, so that one can be provided as necessary.
• Carry out a lone worker risk assessment specific to the SARC.
• Follow the correct safeguarding processes to make certain safeguarding referrals are sent for all children under the age of 18 years old.

We carried out this announced inspection of Bridge House SARC on 23 December 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection took place to check whether the registered provider had met the requirements of an urgent Notice of Decision (NoD) we served; to impose a condition on the registered provider after the initial inspection on 26 and 27 November 2019.

The inspection on 23 December was carried out by a CQC inspector and focussed on the question of whether the location was Safe, one of the five key questions in the CQC’s regulatory framework.

Background

Bridge House SARC is a sexual assault referral centre (SARC). The SARC provides health services and forensic medical examinations to patients aged 16 and over in North Yorkshire who have experienced sexual violence or sexual abuse.

The SARC occupies part of a two-storey building owned by North Yorkshire Police, which is used for other purposes as well as the SARC. The centre is located on the first floor of the premises and there is a single entrance to the building. There is a small staff office and one forensic examination suite. Further details on the layout of the building can be found in the report of the previous inspection in November 2019.

Bridge House SARC is jointly commissioned by NHS England and the Police and Crime Commissioner. Staff were on site during core working hours and attended the SARC during the on-call period, from 5pm to 8am. Mountain Healthcare operates a call centre that provides a 24 hours-a-day and seven days-a-week advice service for patients.

At the time of this inspection the staff team included a centre manager, Forensic Nurse Examiners (FNEs) and crisis workers who also took on administrative duties.

The service is provided by a limited company, Mountain Healthcare Limited. As a condition of their registration the company must have a person registered with the Care Quality Commission as a registered manager. Registered managers have legal responsibility for meeting the requirements on the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager at Bridge House SARC was also the medical director for Mountain Healthcare Limited.

During our previous inspection of 26 and 27 November 2019, we found a number of concerns in the safety of the service. The Care Quality Commission served an urgent Notice of Decision on 29 November 2019 under section 31 of the Social Care Act 2008, to impose conditions the registered provider must not provide regulated activities without the prior written agreement of the Care Quality Commission and until fire safety systems and processes had been implemented in the building.

The provider subsequently submitted an action plan outlining the areas and actions they would take to address the concerns, along with supporting documents and photographs. We reviewed these in advance of our visit on 23 December 2019.

During our visit on 23 December 2019 we spoke with the registered manager, the forensic nurse examiner and the chief executive officer. We also reviewed additional documents whilst on site and carried out observations of the physical environment.

We found sufficient evidence to show that the requirements of the NoD had been met. We removed the urgent conditions on the providers’ registration as a service provider in respect of a regulated activities.