Updated 17 November 2021
Summary Findings
We carried out this announced inspection on 5 and 6 October 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 and a second inspector and was 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.
Background
Juniper Lodge is a sexual assault referral centre (SARC), which is commissioned by NHS England and the Police and Crime Commissioner. The SARC service is available 24 hours a day, seven days a week, including public holidays, to provide advice to police and patients, deliver acute forensic examination, provide support following recent and non-recent sexual assault and sexual violence. It also offers referrals to Independent Sexual Violence Advisors (ISVA) and counselling to people over 18 in the Leicester, Leicestershire and Rutland areas.
Leicestershire police commission the forensic medical examinations which are undertaken by Forensic Practitioners (FPs), who are nurses employed by Mitie Care and Custody (the provider). For the purpose of this inspection we inspected Mitie Care and Custody’s provision of FPs to perform the forensic medical examinations. At the time of inspection there were three FPs providing forensic medical examinations.
The service is approached via a discreet side road. There was ample parking outside for patients. The building is on one level and accessible for wheelchair users. There were three forensic pods which included a forensic changing area, forensic toilet and shower and the forensic examination room. One of the pods was slightly larger with adaptations to accommodate wheelchair users. At the time of inspection only one pod was in use. The building also included tastefully decorated meeting/interview suites which created a pleasant environment for patients, a staff shower, toilet and changing rooms, staff kitchen, offices and storerooms. In addition, there were facilities for patients to appear in court via video link.
During the inspection we spoke with the registered manager, two FPs (one of which was the lead nurse), the contract manager, the SARC manager, the medical director for Mitie care and custody and two crisis support workers. We also looked at policies and procedures, reports and nine patient records to learn about how the service was managed.
We left comment cards at the location the week prior to our visit and received three feedback cards. We also spoke to commissioners of the service.
Mitie care and custody provide the forensic medical service and as a condition of registration 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 Juniper Lodge was the lead sexual assault nurse examiner (FP) for the provider.
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 provider had systems to help them manage risks presented to the service.
- The FPs had suitable safeguarding processes and knew their responsibilities for safeguarding adults and children.
- Case records evidenced a holistic approach to assessing patient’s needs.
- There were effective working relationships with the co-located police colleagues.
- The provider had thorough staff recruitment procedures.
- FPs knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The FPs provided patients’ care and treatment in line with current guidelines.
- FPs treated patients with dignity, respect and kindness and took care to protect their privacy and personal information.
- The service had effective leadership and we saw a culture of continuous improvement.
- FPs felt involved and supported and worked well as a team.
- Patient feedback was positive about the support they received from the FPs and there had been no complaints.
- The service had suitable information governance arrangements.
- The environment was clean and welcoming.
- The provider had infection control procedures which reflected published guidance and had adapted to Covid-19 guidance to ensure services remained available to patients throughout the pandemic.
There was one area where the provider should make improvements:
- Patient leaflets should be readily available in other languages and easy read formats for patients with English as a second language and learning difficulties.