Critical risk identified at Galway mental health centre29 September 2022
The Mental Health Commission has this morning published inspection reports for centres in Galway and Killarney which have identified one critical and six high-risk ratings for non-compliances on rules and regulations.
The critical risk was imposed on a centre in Galway as the inspection team found that monies that were supposedly being safeguarded by the centre were in fact being borrowed by the centre to fill a deficit in other residents’ monies without permission from the residents.
Under law, every centre has a duty to ensure that provision is made for the safe-keeping of all personal property and possessions, and to ensure that a record is maintained of each resident's personal property and possessions and is available to the resident in accordance with the approved centre’s written policy.
“In the case of this centre, some residents were unaware that their money was being used for other purposes and this is a clear and serious breach of the regulation on personal property and possessions,” said the Chief Executive of the Mental Health Commission, John Farrelly.
“It is unacceptable to take advantage of residents in this way; it is a clear denial of a basic human right. For this non-compliance, we had no choice but to impose a critical risk rating. Since the inspection, we have been assured by the centre that the money has been returned and improved arrangements are now in place to safeguard residents’ property. However, we will continue to require assurances from the centre in this regard.”
The Inspector of Mental Health Services, Dr Susan Finnerty, was also disappointed to note that both centres received a high-risk rating non-compliance on the regulation on individual care plans.
“As we have stated many, many times before, individual care planning is an integral part of the programme to help ensure that people accessing our mental health services are both involved in and understand their recommended pathway to recovery,” she said. “We will continue to remind centres and, if necessary, act to ensure that compliance with this critical regulation improves over the coming months and years.”
Woodview is a single storey mental health facility located on the campus of Merlin Park University hospital in Galway. Although it is registered for 16 residents, at the time of inspection the service had actively reduced bed capacity to 15 beds to allow for single bedroom occupancy. Woodview provides continuing mental health care to an ageing cohort, most of whom have been in the centre for a number of years. The centre also provided mental health rehabilitation and recovery for residents awaiting community rehabilitation placements.
There were two conditions attached to the registration of the centre at the time of inspection relating to premises and staffing. The centre was not in breach of the condition on premises, but was non-compliant with the associated regulation, while it was also not in breach of the condition on staffing and was compliant with the associated regulation.
The centre’s overall compliance disimproved by 26% from 97% in 2021 to 71% in 2022. This was primarily due to the fact that there was one critical and three high risk non-compliances observed upon inspection.
The critical risk was imposed because of a non-compliance with the regulation on residents’ personal property and possessions. The inspection team found that resident’s personal property and possessions were not safeguarded - when the centre assumed responsibility for them - because residents’ money was borrowed to fill a deficit of other residents’ monies, without permission from the residents. The inspectors also found that secure facilities were not provided for the safe-keeping of residents’ monies, in line with the centre’s personal property and possessions policy.
Following this critical finding, the MHC required the HSE to take specific actions and provide assurances that residents’ property and possessions were safe and that there were appropriate oversight and review mechanisms in place to monitor the finances of all residents in the centre. The MHC has since been provided with assurances that improved arrangements are now in place which include arrangements for notifying An Garda Síochána, as appropriate, should any future concerns be identified.
The centre received a high-risk rating for a non-compliance with the regulation on individual care planning because two individual care plans were not developed by the multi-disciplinary team within seven days of admission; two individual care plans did not identify appropriate goals for the residents; and one individual care plan was not reviewed by the multi-disciplinary team.
The centre also received a high-risk rating for the regulation on therapeutic services and programmes for several reasons which included a finding that the services and programmes provided by the centre were not appropriate and did not meet the assessed needs of the residents.
A final high-risk rating was imposed for the regulation on premises for reasons which included findings that radiators were not suitably guarded and guaranteed to have surface temperatures no higher than 43 degrees; the outside area at the back of the centre was littered with cigarette butts, rubbish, a walking aid and a sweeping brush; high risk ligature points were not minimized to the lowest practicable level; and hazards were not minimized as fire doors were kept open with stoppers, and a chair.
The inspection team also identified a number of quality initiatives on inspection, including the introduction of a model to promote residents and staff working together collaboratively to improve safety in the residence, the provision of support to residents to personalise their bedrooms; and the painting of the dining room in contemporary colours to create and foster a more homely feel.
Deer Lodge is a purpose-built, residential mental health recovery unit which opened in Killarney, Co. Kerry, in 2017. The centre consists of four households, all of which are connected through a central thoroughfare that features an entrance foyer, communal area, therapy areas, prayer room, activity rooms and other facilities, including a hair salon. Within each of the four households, each resident had their own en suite bedroom, and additionally, residents have access to a sitting room, a dining room, a quiet room, a kitchenette, and an internal landscaped garden area.
There was one condition attached to the registration of the centre at the time of inspection relating to staff training although the centre was not in breach of the condition at the time of the inspection. The centre’s overall compliance improved by 9% from 79% in 2021, to 88% in 2022. However, there were three high risk non-compliances observed upon inspection.
The first high-risk non-compliance was imposed for the regulation on individual care planning. Ten individual care plans were reviewed by the inspection team, and they found that two individual care plans had not been developed by the muti-disciplinary team; the resource required was left blank for each goal where care and treatment was identified in one of the plans; and there was no occupational therapist present at the review meeting for all 10 individual care plans. For two of them, only medical and nursing staff were present.
The centre also received high risk non-compliances for the regulations on staffing, and on therapeutic services and programmes. In relation to the latter, it was deemed by both the inspectors and staff that the residents were not receiving the care to facilitate optimal levels of physical and psychosocial functioning as there was no occupational therapist and associated therapeutic programme in operation.
A number of quality initiatives were identified at the centre, including the development of new psychiatry of later life nursing assessments and individual care plan documents, as well as the identification of individual care plan champions amongst staff and the development of an associated training schedule.
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