We spoke with four patients about their medicines. Everyone we spoke with was positive about their stay. One patient we spoke with about medication handling told us, “they’re really, really good, they explained how everything worked”. Documents for assessing and supporting patients to self-administer medication were available and in use. Patients choosing to do so were; where possible, supported to look after their own medicines. Patients told us that they had enough information about the medicines they were taking and about any changes to their medicines.

During our visit we were able to speak with a number of patients and in some cases, their relatives. People that we spoke with were very complimentary about the care and treatment they had received at the hospital and spoke highly of staff providing their care.

Comments from patients included;

‘’We have such a laugh with them (the staff), it passes the time away.’’

‘’So far, everyone I have had looking after me has been great.’’

‘’They can’t do enough for you – whatever you ask for they will try to sort out.’’

One patient commented, ‘’They are so very kind and attentive. I will be sad to be going home.’’

Visiting relatives also expressed satisfaction with the care their loved ones were receiving and told us that they had felt fully involved at all times. One relative said, ‘’You can tell they really care about the patients here. They always seem to have time for people.’’

Other relatives’ comments included;

‘’The staff here are so good. I come in every day and see everything going on and I can tell you this is a good place.’’

‘’They are great and they make you feel so comfortable.’’

No person that we spoke with during our visit expressed concerns about any aspect of the care they or their loved one had received. People told us that staff took time to understand their individual needs and that their requests for assistance were always answered promptly.

The majority of people we spoke with were very complimentary about the care they were receiving and spoke highly of staff. Comments included;

‘’I feel lucky to be here, they are absolutely brilliant with me.’’

‘’I felt scared when I came but they soon put my mind at rest.’’

‘’We are treated very well, if the younger generation are treated as well as us then this is a very good place.’’

Most people felt that their care needs were met well and that they were cared for in a way that they wanted.

People told us that they felt their dignity and privacy was respected and everyone we spoke with told us that they had never been made to feel embarrassed during their stay.

Whilst people were generally very positive about their care, some did express concerns. Some people commented that, at times, they had to wait a long time to get assistance and generally felt that this was due to staffing levels sometimes being low.

We received generally positive feedback about the quality and variety of meals available. People told us that they thought there was a good choice of food made available. However, several people told us that they didn’t always get the meals they had ordered.

People said that they were confident that staff understood their nutritional needs. One patient told us that she had been very underweight on her admission but had managed to achieve a steady weight gain throughout her stay.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

We carried out this announced inspection on 4, 5 and 28 December 2018 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 carried out by two CQC inspectors and a team leader 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.

Our findings were:

Are services safe?

We found that this service was providing safe services in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

In Lancashire, services for support and examination of people who have experienced sexual assault are commissioned by NHS England and Lancashire Constabulary. The SAFE Centre provides these services. The centre is based at the Royal Preston Hospital, Preston and provides services to adults and children from all over Lancashire.

The centre is a separate building within the hospital grounds and car parking is available outside the centre with level access for people who use wheelchairs and those with pushchairs. Most appointments are pre-booked at times to meet the needs of each patient. The entrance door is secure to safeguard staff and patients and a clear record is kept of all visitors to the centre.

The team consists a mix of permanent full-time staff and bank staff to provide a service day and night. Permanent staff include a centre manager and receptionist, one adult and one child independent sexual violence advisor and a part time clinical director. A new child and young person support worker commenced in post the week of our inspection. Doctors and crisis workers work an on-call rota, to cover daytime, nights and weekends. The service has two medical suites.

The service is provided by Lancashire Teaching Hospitals NHS Foundation Trust (LTH). The centre is included as part of the main services registered at the Royal Preston Hospital. The service is open from 8.30am until 4.30pm, with on call staff available outside of these hours.

During inspection we spoke with the centre manager, director, trust managers for governance and human resources, two independent sexual violence advisors, a crisis worker, the receptionist, and a doctor.

We looked at policies and procedures and other records about how the service is managed. We sampled 15 patients' records.

Our key findings were:

• The clinical staff provided patient care and treatment which was in line with current guidelines.
• Staff treated patients with dignity and respect.
• Not all risks to patients had been identified but managers were developing systems to help identify and manage risk.
• The service appeared clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and emergency equipment were available.
• The appointment/referral system met patients’ needs.
• The service had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The service asked staff and patients for feedback.

We identified an area of good practice. The manager and clinical director had agreed that all bank staff would be treated as permanent staff for the purposes of training, appraisal and supervision due to the nature of the work they carried out at the centre. In addition, the centre had developed an accredited two-day sexual assault referral centre training course for staff. This ensured staff were appropriately trained and supported in providing the best possible patient care for patients attending the centre and their families.

There are also areas where the provider SHOULD make improvements. They should:

• Ensure that governance arrangements are fully embedded into the service including risk assessment, incident reporting and learning, record keeping and audit procedures.

• Ensure referral arrangements to and from partner health services are formalised.