Hope House

We carried out this announced inspection on 3 and 4 May 2023 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 three further CQC inspectors.

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 service is commissioned by NHS England to provide support services for people who have experienced both recent and non-recent sexual abuse or assault. The service is commissioned 24 hours a day, seven days a week, to see adults as well as children aged between 16 and 17-years-old. Children under the age of 16 are not seen at this service.

The service accepts self-referrals, referrals made by the police, other professionals and stakeholders.

Gloucester Health and Care NHS Foundation Trust 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 service is provided from two sites, Hope House in Gloucester, and Swindon and Wiltshire SARC in Swindon. While the Trust manage all aspects of the service at Hope House directly, another organisation has been subcontracted to manage most parts of the service that is provided at Swindon and Wiltshire SARC. This means that the employment of the management team and crisis support workers as well as managing the maintenanceand cleanliness of the environment is managed by the sub-contracted provider. There are also different policies and procedures used at both sites.

Referral pathways are in place to other important services which are provided externally to the Trust, such as independent sexual violence advisors, as well as mental health services and general practitioners.

Hope House and Swindon and Wiltshire SARC are both located in buildings that are accessible for wheelchair users. Each site has one examination suite which is used for both adults and children, and are accessed by discreet entrances.

Services at Hope House and Swindon and Wiltshire SARC are provided by a team of staff, including clinical and non-clinical managers, forensic nurse examiners, crisis support workers and administration staff.

The Trust employs a forensic medical examiner two days a week, who is a member of the Faculty of Forensic and Legal Medicine. They are also employed as the clinical lead for the service as well as being the clinical director for SARC services at the Trust.

During the inspection we spoke with staff, including leaders, forensic nurse examiners, crisis support workers and support staff.

We looked at policies and procedures as well as other records about how the service is managed.

Throughout this report we have used the term ‘patients’ to describe people who use the service, including children aged between 16 and 17, to reflect our inspection of the clinical aspects of the SARC.

Our key findings were:

• The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The service had thorough staff recruitment procedures.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• 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 clients’ needs.
• The service had 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 had a system in place to deal with complaints positively and efficiently.

However,

• Although the Trust had processes in place to manage risk, these had not always been followed.
• Systems to maintain oversight of services provided had sometimes been ineffective.
• Contemporaneous records of care and treatment provided had not always been kept.
• Although the Trust had started to strengthen joint working agreements with the provider who were subcontracted to manage non clinical services at Swindon and Wiltshire SARC, these needed to be developed further.

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

• Ensure that effective systems are operated to maintain oversight of the services provided. This includes, but is not limited to making sure that the forensic examination suite has been cleaned in line with trust policies, making sure that there are systems in place to make sure that portable appliance testing is completed when needed as well as making sure that all consumables that are available for staff to use is in date.
• Ensure that an effective system to identify, manage and mitigate risks is operated. This includes, but is not limited to making sure that formal risk assessments are completed for all risks that have been identified, such as important health and safety assessments.
• Ensure that all telephone consultations as well as patient risk assessments are fully documented and that there is an effective system in place to monitor compliance of this.
• Ensure that joint working agreements with the provider who are subcontracted to manage non clinical services at Swindon and Wiltshire SARC are strengthened further, making sure that policies and processes are aligned and that there is a clear understanding of roles and responsibilities.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Consider ways to make sure that all policies have been reviewed in a timely manner and contain references to the most up to date information.
• Continue to consider ways to make sure that there are sufficient numbers of staff available and that there are always arrangements in place for staff to access medical advice if needed.
• Consider ways for patients to be able to request to be seen by a male member of staff if this is their preferred option.
• Consider ways to make sure that all staff have completed and are up to date with all required mandatory training.
• Consider ways to make sure that staff have completed training in Female Genital Mutilation (FGM).
• Consider ways to make sure that training delivered by the provider who is subcontracted to manage non clinical services at Swindon and Wiltshire SARC is aligned with the minimum standard of training expected by the Trust.