Centre failed to inform regulator of senior staffing issues, says Mental Health Commission30 May 2022
We have reminded all approved inpatient mental health centres that they must, under law, notify the MHC immediately if or when there are any changes to senior healthcare management which could affect the subsequent care and treatment of patients and residents.
We are publishing a series of three reports, this morning on its findings from the Bloomfield mental health centre in Dublin. The MHC was so concerned about the findings of the October 2021 annual inspection, that it carried out two further focussed inspections to verify the ongoing safety of residents.
The second focused inspection was carried out in January 2022 to assess whether there was a clinical director at the centre and if residents were receiving appropriate care and treatment. The MHC was conscious that this was at a time when the service was experiencing an outbreak of COVID-19 and there was an acute need for clinical leadership and oversight. The MHC became aware that the clinical director at Bloomfield had left their post but had not been informed by the centre of a replacement, despite repeated requests to the centre to clarify matters.
The first focused inspection in November 2022 took place following a critical risk rating on premises at the annual inspection, which found that the centre was not clean and hygienic internally or externally, with several areas noted to be dirty including the dining room, bedrooms, bathrooms and toilets.
“Under the Mental Health Act 2001, approved mental health centres must notify the MHC when there is a new clinical director,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “In this instance, we had been made aware that the clinical director had vacated the post. However, it was not the centre who informed us of this fact, and this was a concern. Several letters were sent by the MHC to the centre regarding this and other staffing matters, but no response was received. We then became concerned about who was managing the centre and decided to conduct a second focused inspection in January of this year (2022).”
Highlighting the importance of governance, the Chief Executive of the Mental Health Commission, John Farrelly, stressed: “Good governance requires having well informed and expert clinical and corporate leaders in place, who understand how modern person centre mental health care should be delivered”
Addressing the issues around maintenance and cleanliness, Mr Farrelly, said: “No patient should have to live in a mental health centre where basic maintenance is not provided. If we find that a centre is not reaching the standards required under law, we will use our enforcement powers - as we did in this case. However, it is not acceptable that we have to inspect a facility on three occasions over a period of three months in order to drive change.”
As a result of the findings of the annual inspection and the subsequent focussed inspections, MHC initiated a targeted regulatory programme which involved a series of escalation, enforcement and monitoring activities aimed at ensuring that residents were safe and that they continued to receive appropriate care. This included three immediate action notices, two regulatory compliance meetings and a system of weekly reporting to the MHC on the care and welfare of residents.
The MHC also initiated enforcement steps under the 2001 Act to formally halt admissions to the centre. The centre voluntarily agreed to this step and no new admissions were accepted from 1 January 2022 to 4 April 2022. In response to the programme of regulatory activities, the registered proprietor has implemented a quality improvement programme which has resulted in a range of measures aimed at improving compliance.
A recruitment programme was implemented, and a range of premises and maintenance actions were put in place. Importantly, significant changes and improvements were made to the governance and leadership arrangements. A new clinical director was appointed on 17 January 2022, a new CEO was appointed on 21 February 2022 and improved internal audit and monitoring structures were implemented. MHC continues to closely monitor these actions.
Bloomfield Hospital is a 115-bed, voluntary hospital and is an independent non-profit organisation. It provides a national facility for the care of patients of Huntington’s disease. It has a neuropsychiatric unit, a specialist rehabilitation unit, a dementia unit, a high dependency unit and a unit for people with enduring mental illness. At the time of the inspection, 95 residents were in the centre for more than six months.
In the annual inspection in 2021, the hospital received a compliance rating of 91%, which was 6% lower than the rating it received in 2020. There was one condition attached to the registration - related to staffing - at the time of inspection. The centre was not in breach of the condition and was compliant with the associated regulation.
The inspection found three non-compliances. These consisted of a critical risk relating to the regulation on premises, a high-risk related to the regulation on risk management, and a moderate risk related to the regulation on privacy.
In relation to premises, the inspectors found during the annual inspection that the centre was not kept in a good state of repair either internally or externally and there was no programme of decorative maintenance. The centre was not clean and hygienic either internally or externally. Several areas were noted to be dirty including the dining room, bedrooms, bathrooms, toilets, and the pantries. Externally, both the courtyard and garden areas were littered throughout.
Following the annual inspection, a focused inspection was carried out in November 2021 to assess whether actions had been taken to clean and address the maintenance of the centre. There was an improvement in the cleanliness of the centre and deep cleaning was underway. However, a number of areas remained dirty. The pantries in three units were not clean; there were a number of maintenance issues which remained outstanding; there was rubbish and cigarette butts in one garden; the lino was heavily marked in one unit; there was a cracked window in a dining room; and toilets were found to be odorous and unflushed. In addition, a programme of routine maintenance, renewal and decoration had not been developed and implemented. The centre received a high-risk rating for the regulation on premises at the first focused inspection.
In January 2022, the MHC carried out a second focused inspection to assess whether there was a clinical director in place and if residents were receiving appropriate care and treatment. The focused inspection also assessed the governance arrangements and what actions had been taken to clean and address the maintenance of the centre. The focused inspection found six non-compliances, consisting of two critical, three high risk, and one moderate.
The inspectors found parts of the premises were still dirty and required further maintenance. There were inadequate arrangements for hot water over a prolonged period and a resolution had not been provided. Again, the centre received a high-risk non-compliance for the regulation on premises.
The centre received a critical-risk rating for non-compliance with the regulations on staffing. The centre was non-compliant with this regulation as the numbers of and skill mix of staff were not appropriate to the assessed needs of residents, the size and layout of the centre. There was insufficient staff and resources to operate the approved centre at the full capacity of 115 bed occupancy. It was agreed that all new admissions be deferred until a new clinical director commenced. At the time of the inspection, there was 101 residents in the centre with three residents in other healthcare facilities.
Both the annual and focused inspections noted that the roles, responsibilities, and job descriptions were unclear. The CEO post was vacant, and the Chairman of the Board of Directors had taken on the responsibilities of the CEO/Registered Proprietor until the post was filled. The MHC became aware that the clinical director had ceased working in the centre and they had not been notified of this. Several letters were sent by the MHC regarding these matters and no response was received. The MHC became concerned about who was managing the centre.
It was confirmed that a consultant psychiatrist had taken up the role of clinical director until a new appointed clinical director commenced.
The centre also received a critical-risk rating for noncompliance with the regulations on risk management procedures. The centre was non-compliant as clinical risks identified were not treated and the risk management policy was not implemented throughout the centre as not all health and safety risks had been identified, assessed, treated, and monitored.
The centre received a high-risk rating for non-compliance with the regulations on premises, food safety, and individual care planning.
You can read our full statement here.