Millfield House SARC

We carried out this announced inspection on 7 & 8 December 2021 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 two additional CQC inspectors 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

Millfield House is a Sexual Assault Referral Centre (SARC) for Derbyshire residents aged 18 years and over. The service is available 24 hours a day and seven days a week, including public holidays. Patients can self-refer although most referrals were received from the police. Calls were triaged by a crisis worker and patients who had been recently sexually abused were transferred to a Forensic Nurse Examiner (FNE) to complete an initial screening.

The SARC building is located on a busy road, however it is discreetly signed and with parking available for patients to use. There is level, ground floor access to the areas used by patients. There are three forensic suites available which included a forensic bathroom and examination area as well as a small room with seating used to carry out the initial assessment. One of the forensic suites was adapted for patients with additional accessibility needs. At the time of the inspection, all three suites were available for use, however only one patient would be seen at a time. There were also facilities for staff to shower and change, court video link interview rooms and a tastefully furnished family room.

The SARC services are commissioned jointly by NHS England, the Police and Crime Commissioner and local authority. Mountain Healthcare Limited (MHL) employ FNEs to deliver the forensic examinations at Millfield House. Crisis Support Workers (CSWs) are employed by SV2 (a local third-sector organisation). For the purpose of this inspection we inspected MHL’s provision of FNEs to perform the forensic medical examinations.

Patients who accessed the SARC were offered contraception, Hepatitis B vaccination and injury checks. Access to these services is available at Millfield House for patients who don’t wish to have forensic samples taken.

SV2 staff make onward referrals with the support of MHL staff and with patient consent, for ongoing support such as Independent Sexual Violence Advisors (ISVAs), counselling, mental health support and safeguarding. Safeguarding (urgent and routine) and any other urgent referrals needing action at the time of the examination were completed by the FNE. SV2 staff are also responsible for the forensic cleaning of the suites.

MHL employed one SARC manager and four FNEs at Millfield House. During this inspection we spoke with the SARC manager, two FNEs, MHL’s SARC director and safeguarding lead and SV2’s SARC Delivery Manager.

We left patient comment cards at the location the week prior to our visit and received four completed cards. We also looked at policies and procedures, reports and eight patient records to learn about how the service was managed. We also spoke with commissioners prior to the inspection.

The service is provided by a limited company and as a condition of registration they 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 Millfield House was the SARC manager for this and one other location, as well as covering shifts as an FNE.

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.

Our key findings were:

• The service had systems to help staff manage risks to patient safety, although we found that not all ligature risks had been identified.
• There were appropriate 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 and had received relevant training. Appropriate medicines and life-saving equipment were available and regularly checked.
• The FNEs provided care and treatment to patients in line with current guidelines. Patients were asked for their consent at various stages during the assessment and examination.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The service had effective leadership and a culture of continuous improvement. Staff felt supported and able to contribute to the development of the service.
• Staff felt they received the required training and were supported with continuous professional development.
• Staff and patients were encouraged to provide feedback about the quality of the service.
• There were effective governance processes in place and good joint working with partner agencies.
• The service appeared clean and well maintained.
• Infection control procedures reflected published guidance.

There was one area where the provider should make improvements:

• The ligature risk assessment should be further reviewed to ensure it accurately reflects risk levels at Millfield House.