Dublin mental health centre found to be in breach of three conditions to registration

We have found a Dublin mental health centre to be in breach of all three of its conditions to registration which relate to regulations on individual care planning, premises, and staffing.

Attaching a condition to a centre’s registration is at the higher end of the list of enforcement actions that can be taken against a centre by the MHC. It is similar to a penalty or an endorsement on a person’s driving licence. The most common reason to attach a condition is due to ongoing and/or high-risk non-compliance with a regulation or statutory rule.

In total, the MHC released three inspection reports on centres in Dublin and Cork that showed a total of one critical and seven high non-compliance risk ratings.

Commenting on the reports, the Inspector of Mental Health Services, Dr Susan Finnerty said: “The number of non-compliances across the three centres inspected is extremely high. The main reasons for the non-compliances relate to poor individual care planning, consistent unsafe practices, and the unsuitability and poor maintenance of premises.

“Individual care plans are essential for patients to ensure they receive the right level of care for their recovery. It is extremely disappointing to see one centre being consistently non-compliant for the past three years in individual care planning, while another centre received a high-risk non-compliance because their care planning was of a poor standard.”

The Chief Executive of the Mental Health Commission, John Farrelly, said he was saddened to note the poor results around premises, which is an issue of concern for the MHC. “It was very clear from the reports that certain parts of two centres were nowhere close to the standard that we would deem acceptable,” he said. “We have taken immediate enforcement action to address the breaches in conditions and non-compliances at one centre and we are satisfied that the centre concerned has implemented extensive ligature and maintenance works, introduced additional resourcing, and we note that the centre has told us that their plan is to replace the hospital with a new unit.”

St. Vincent’s Hospital is a public voluntary hospital located in Fairview, Dublin. The building was a former convent and was built in 1899. Various extensions had been added to the main building throughout the 20th Century. Set amid expansive greenery and open space, the centre comprises three separate units: St. Louise’s Ward - a 30-bed admission ward which includes a high dependency unit containing nine beds; St. Mary’s Ward - a nine-bed ward for the continuing care of the elderly; and a six-bed psychiatry of old age ward.

The centre received an overall compliance rate of 82% which was down six per cent from the compliance rating in 2020. There were three conditions attached to the centre relating to the regulations on individual care plan, premises, and staffing. The centre was in breach of all three conditions and was non-compliant with the associated regulations.

The centre received seven non compliances on inspection, comprising one critical, two high-rated, one moderate and two low-risk ratings. The centre received a critical non-compliance for the regulation on premises as the inspectors found that ligature points previously identified in ligature audits remained throughout the centre and had not been acted upon and were not minimised to the lowest practicable level. There was no ligature reduction plan In St. Louise's Ward; some of the remedial works were not completed in the Psychiatry of Old Age Ward; and there was no ligature audit undertaken for St. Mary's Ward.

In addition, in relation to the critical non-compliance with the regulation on premises, the centre was kept in a very poor state of repair externally and internally. The inspection found dirty windows; marks and scuffs on walls throughout; walls requiring repair work and re-painting; graffiti in one toilet; and areas of damp on the ceiling due to a roof leak. The window frame of the seclusion room had paint cracks and the sink area was in a poor state of repair. The shower area of the Psychiatry of Old Age Ward required repair work. The shower area on St. Mary's Ward was discoloured. The surface of the wall in the toilet area of St. Mary's Ward was cracked and uneven. The smoking areas were malodorous, dirty and littered, and the floors and walls of the indoor smoking room on St Mary’s Ward were dirty and discoloured. One of the male toilets in the activities area had no lock on the cubicle door and there was only one privacy screen available in the two-bedded shared rooms on the Psychiatry of Old Age unit.

In terms of the high-risk non-compliance for individual care planning, the inspectors found that the standard was poor. One individual care plan was not developed within seven days of admission; three plans were not developed; three plans not reviewed by the multi-disciplinary team; another plan did not identify the care and treatment required to meet the goals identified; and another did not identify appropriate goals for the resident.

Following the inspection, the Mental Health Commission initiated enforcement steps which required the service provider to take immediate actions and provide assurances that critical risks and breaches of conditions were being addressed. The service provider responded and provided the required assurances and evidence of the steps taken to bring the centre into compliance. This included the appointment of a permanent clinical director following concerns noted by the MHC around the rolling clinical director arrangement in the service, and the carrying out of extensive ligature and maintenance works across all wards.

The MHC also note that the centre has indicated its intention to develop a new mental health facility in place of the current unit and are seeking observations and input from the MHC on same.

St Aloysius Ward is located in the Mater Misericordiae University Hospital in Dublin and is registered for 13 residents. In 2019, the registered bed capacity of the unit was reduced from 15 to 13 beds. The purpose of this reduction was to enhance the personal space and privacy of residents. For example, a shared bedroom was reduced from a six-bedded room to a four-bedded room. However, the centre is still not a suitable environment for residents due to its size and layout. The open plan layout does not allow for residents who were acutely unwell or exhibiting challenging behaviours to be accommodated in a separate area from other residents.

The centre recorded an overall compliance rate of 88%, a 16% increase on its 2020 inspection. There were no conditions attached to the registration of the centre at the time of inspection.  The centre received one high risk noncompliance for premises, two moderate risk non compliances for privacy and staffing and one low-risk non-compliance for admission of children

In relation to the high risk the inspectors found that the centre did not always have safe practices to reduce risk of harm. Residents told inspectors that there were times when they did not feel safe, particularly in the event of escalations in behaviour. The layout did not allow for residents who were acutely unwell or exhibiting challenging behaviours to be accommodated separately.

The centre received a high-risk non-compliance for the regulation relating to premises. While there was a documented programme of general maintenance, the centre was kept in a poor state of repair externally and internally. Ligature points remained and were not minimised to the lowest practicable level based on a risk assessment. Hazards were not minimised. A window latch in a single bedroom was broken, which meant it would not stay open independently and the window was propped open with books to ventilate the room. The broken window and books were a safety hazard due to the potential for injury.

The Eist Linn Child & Adolescent in-patient Unit is in Bessborough, Blackrock, Cork. Although Eist Linn was registered for 16 beds, it had only nine in-patients at the time of inspection. It is one of four national in-patient child and adolescent mental health services.

The centre received an overall compliance rate of 77%, a decrease of 13% on the compliance it received in 2020. There was one condition attached to the centre related to the regulation on staffing. The centre was not in breach of the condition but was non-compliant with the associated regulation.

The centre received five high-risk non compliances with regulations relating to individual care plans, privacy, staffing, risk management, and the use of physical restraint.

The inspection found that appropriate staffing resources were not always available to meet the needs of residents. There were seven nursing vacancies at the time of inspection with three nursing staff required to work remotely due to HSE guidelines. There was no senior nurse manager on call on 24 occasions between January and February 2021 and there was no cover for the dietitian for nine months.

Individual care plans (ICP) inspected were not of a good standard. Four ICPs did not identify appropriate goals for the resident; four ICPs did not identify the care and treatment required to meet the goals identified, including the frequency and responsibilities for implementing the care and treatment: and four ICPs did not identify the resources required to provide the care and treatment. This is the third year in succession that Eist Linn has been non-compliant with this regulation.

You can read our full statement here. 

St. Vincent’s Hospital Inspection Report 2021

St Aloysius Ward Inspection Report 2021

Eist Linn Child & Adolescent in-patient Unit Inspection Report 2021