Updated 27 July 2022
Summary findings
We carried out this announced inspection on 17–18 May 2022 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 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
Oakwood Place is a Sexual Assault Referral Centre (SARC), which is commissioned by NHS England and NHS Improvement (NHSEI) and the Police and Crime commissioner. Although the SARC provides services to patients of all ages, for the purpose of this inspection we reviewed the care and treatment provided by Mountain Healthcare to children under 13 years old.
The under 13 year old service is available Monday to Friday 9-5pm. NHSEI commission Mountain Healthcare and two NHS Foundation trusts, to provide a paediatrician or Forensic Medical Examiner (FME) to undertake recent and non-recent alleged sexual assault examinations on different days. Mountain Healthcare provides an FME on a Friday only. They also provide paediatric crisis support workers (PCSWs) who work alongside the paediatricians and FME’s Monday to Friday 9-5pm. Mountain Healthcare take overall responsibility of the governance and administration of the service. However, they do not manage or oversee the activities provided by the NHS foundation trust paediatricians. NHSEI have commissioned Mountain Healthcare to provide a Sexually Transmitted Infections (STI) screening service for the under 13 year olds, although this was not part of this inspection.
Mountain Healthcare FMEs saw 13 children for recent and non-recent examinations over the period of April 2021 – April 2022. At the time of inspection there were three FMEs who were covering Oakwood Place SARC on a Friday and two PCSWs with a SARC manager overseeing both the adult and children’s services.
Oakwood place is a fully accessible building which is situated in the grounds of a community hospital with plenty of parking, including spaces for those with disabilities. The building is on one level and accessible for wheelchair users. There were two forensic examination suites, but one was used predominantly for children and was separate from the adult area. There was a child friendly non-forensic waiting room with lots of wipe clean toys and activities for a variety of ages. The forensic area had a separate waiting area with a working television and the examination room included a forensic shower room. The building also included a staff shower and changing area, an office with a kitchen area, storage rooms and interview rooms.
During the inspection we spoke with the registered manager who was also the regional contract director, the national SARC director, the medical director for Mountain Healthcare, the associate head of healthcare, the SARC manager, three FMEs and two PCSWs. We also looked at policies and procedures, various reports and five patient records to learn about how the service was managed.
We left comment cards at the location two weeks before our visit, but we did not receive any completed feedback cards. We also spoke with the commissioners of the service from NHS England.
Mountain Healthcare 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 Oakwood place was the regional contract director for Mountain Healthcare.
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 staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding children and adults.
- Case records evidenced a holistic approach to assessing patient’s needs.
- There were effective working relationships with the paediatricians from the external NHS trusts.
- Staff provided patients’ care and treatment in line with current guidelines.
- Patient feedback was positive about the support they received from staff. Staff dealt with complaints positively and efficiently.
- The service had effective leadership and we saw a culture of continuous improvement.
- 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.
- The provider had thorough staff recruitment procedures.
- Staff knew how to deal with emergencies. Appropriate life-saving equipment were available.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The service had suitable information governance arrangements.
- Staff felt involved and supported and worked well as a team.
- The environment was clean and welcoming.
There were areas where the provider could make improvements. They should:
- FMEs should improve the representation of the patients’ voice within the patient records to evidence the FME listened to the patient and understood and met their needs.
- Staff should be assured that all areas in the SARC have been appropriately risk assessed for ligature risks.
- Ensure that patients have a choice of gender of the doctor they are examined by.