Mental health centre fails to improve overall compliance over 5-year period
We released three inspection reports today relating to inpatient centres in Limerick and Dublin, which showed that one centre in the capital has failed to improve on an overall compliance rating of 67% over a five-year period.
The Inspector of Mental Health Services, Dr Susan Finnerty, said that it was disappointing and unsatisfactory that some centres are failing to consistently improve and maintain high compliance rates. In 2020, the average compliance rate for all approved centres was 87%.
“It is a significant concern to the MHC when a centre does not make any improvement in overall compliance over a number of years,” she said. “We would expect that the registered proprietor and management of any centre who finds itself consistently failing to improve overall compliance – as well as being in breach of one or more conditions and receiving critical and high-risk ratings - must undertake a meaningful review of its protocols and procedures and work with the MHC to help ensure that they can provide the best care possible for the people in their care.”
The Chief Executive of the Mental Health Commission, John Farrelly, said: “we acknowledge that some centres are struggling to retain staff and support levels for patients, given the ongoing pandemic and the impact that this is having on our health services. However, there is no excuse for not having in place appropriate fire doors to protect patients, or not holding a standard fire drill once every six months, as required under law. These critical safety measures and procedures must happen as a matter of course. The regulation relating to risk management is there for a reason.”
The Department of Psychiatry at Connolly Hospital is located on the lower ground floor of the hospital in Blanchardstown. The centre provides acute inpatient accommodation for the Dublin North City area from Cabra to Mulhuddart. There are 47 registered beds, and 36 of these were occupied by patients at the time of inspection.
The centre had made no progress on overall compliance over the past five years, with a rating of 67% this year comparable to the same figure in 2017, and dips in performance between those dates. There were 11 areas of non-compliance found at the unit during this inspection, including three critical and four high risk ratings.
There were significant safety concerns at the centre, including that a fire door on a bedroom sub fire compartment on one of the wards was missing. Although this was first reported for repair in February 2021, it had not been fixed by July 2021, despite repeated requests. This risk was not identified, assessed, treated, reported, or monitored on the risk register and was one of the key reasons why the centre received a critical risk rating for the regulation on risk management procedures.
Three residents had not received a documented six-monthly general health check, and this non-compliance was also rated as a critical risk.
There were two conditions attached to the registration of the centre at the time of inspection. One condition was to ensure all healthcare professionals working in the centre are up-to-date in mandatory training areas. However, it was found that members of the medical team had not completed the HSE online training in the Mental Health Act (2001), so the centre was in breach of this condition and this was also rated as a critical risk.
In accordance with its escalation and enforcement procedures, the MHC required the centre to take immediate steps to address all risks which were rated as critical. The centre has engaged with the MHC on all identified areas of non-compliance and has committed to implementing a quality improvement plan. The MHC continues to monitor the actions taken.
The Acute Psychiatric Unit 5B at University Hospital Limerick provides inpatient mental health services to the Limerick catchment area. This centre has 42 beds and is located within the University Hospital in Dooradoyle, close to the city centre. There were 34 residents at the centre at the time of inspection.
The centre received a compliance rate of 85% - in line with last year’s rate of 86% - but there were five areas where risk was identified, including one critical risk and one high risk. The inspection found that the centre did not have adequate fire safety structures and procedures. A major fire risk was identified in the form of a missing fire door. This door was crucial to the centre’s use of separate zones in order to accommodate horizontal evacuation in the event of fire. This was rated as a critical risk. MHC took steps requiring the centre to address this matter and to complete a series of further independent fire safety checks at the time of inspection.
While inspectors found that staff provided therapeutic activities, individual care plans for patients were unsatisfactory. Four individual care plans were not developed by the multi-disciplinary team, three individual care plans did not include appropriate goals, and four individual care plans were not updated by the full multi-disciplinary team.
On the positive side, a quality initiative had been put in place to reduce restrictive practices. A change in culture, practice and environment resulted in a 50% reduction in both physical restraints and special observations from 2019 to 2020. Further improvements were observed in 2021.
The Ashlin Centre is a 46-bed approved centre providing care and treatment for North Dublin Mental Health Services (NDMHS). It is located in the grounds of Beaumont Hospital. There were 35 beds occupied at the time of inspection.
The facility received a compliance rate of 85%, comparing favourably to the average rate of compliance across all approved centres [in 2020] of 87%. There were five areas of non-compliance, with two listed as high, two moderate and one low.
As per the centre’s policy, a fire drill was due to occur twice every year and be documented when they did occur; however, none had been documented for the year preceding the inspection. There was a programme of rolling closure of bedrooms to carry out remediation of defects caused by dampness. The inspection team were given evidence that the reason for the ongoing damp was under review.
There was a shortage of medical staff, occupational therapy, psychology and social work. The shortages resulted from vacant posts, extended leave, and holidays. Some disciplines had arranged cross-cover from the teams to ensure assessments and urgent follow up was carried out.
In terms of positive quality initiatives, a gym has been set up and three staff had qualifications in personal training and nutrition. Residents were provided with a platform to improve their physical and mental health. An interactive music (IMNU) cushion was introduced in one unit. The IMNU was a multi-sensory experience, a tool for sensory stimulation and music therapy and suitable for people living with anxiety, dementia or high stress levels, as it soothes, relaxes and improves sleep.
You can read our full statement here.
The Department of Psychiatry at Connolly Hospital Inspection Report 2021
The Acute Psychiatric Unit 5B at University Hospital Limerick Inspection Report 2021
