Mental health unit urged to take ‘immediate action’ following breach of registration condition20 April 2021
We have published inspection reports on three inpatient mental health centres, two located in Mayo and one in Westmeath.
One unit in Mayo decreased its overall compliance by 8% in the space of 12 months, while the other two centres – based in Castlebar and Mullingar – both scored 90% and 100% compliance respectively.
At the time of the inspection of the adult mental health unit at Mayo University Hospital, there were four conditions attached to its registration. Although the centre was not in breach of three of these conditions, it was found to be in breach of one which required the centre to implement a programme of maintenance to ensure that the premises is safe to meet the needs of the resident group and provide a progress update to the Mental Health Commission. The centre was also non-compliant with the regulation related to premises on the inspection.
“The purpose of attaching conditions to centres we regulate is to ensure that the safety and quality of care and treatments provided to the residents are always maintained,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “All centres must be consistently maintained in a good state of repair and any identified maintenance issues must be carried out in a timely manner. We treat any contravention of a condition of registration very seriously and we have a range of enforcement actions we take to address the breach immediately.
“I am pleased to note, however, that overcapacity at the centre is being addressed. There have been no episodes of overcapacity reported to the MHC since the last inspection. Bed occupancy rates are now reviewed weekly at the clinical risk governance group meeting, which has representations form each clinical team.”
The Chief Executive of the Mental Health Commission, John Farrelly, urged immediate action by the registered proprietor on key issues that had been identified as part of a survey carried out by the MHC in advance of the inspection.
“It is clear that all of the issues have been identified in this centre and are known to all concerned,” he said. “While some action has been taken in addressing the issues identified, the centre must now focus on the remaining issues to the satisfaction of the MHC. By working together, we can ensure that the residents receive the best possible care.”
The Adult Mental Health Unit at Mayo University Hospital is located on the ground floor of the hospital in Castlebar, Co Mayo. The unit comprises of a 28- bed single ward area consisting of six dormitories and two single rooms and an accompanying high dependency unit with four single bedrooms. The capacity of the approved centre is consistent with those of the ‘Vision for Change’ guidelines, although there were occasions when overcapacity of residents occurred.
Key issues identified in the MHC’s governance questionnaire conducted in advance of the inspection included lack of regular maintenance; non-compliance in terms of anti-ligature standards; inadequate space in a unit that was not purpose built; the increasing demand for in-patient care; overcapacity; staffing of allied health professionals positions especially OTs; the constant tension between providing community services while also providing in-patient care on a sector basis; the unpredictable level of involuntary admissions particularly from the Gardai. Other issues cited were overcapacity on occasions; delayed discharges; MHC conditions attached in 2020 and high level of ‘one to one’ (staff/resident) observation requirements.
The centre achieved 72% compliance on the inspection, a decrease of 8% over its 2019 inspection.
The inspection identified one critical risk non-compliance on premises, four high risk non-compliances for general health, privacy, risk management and consent to treatment, and five moderate non-compliances on transfer of residents; use of seclusion; use of physical restraint; admission transfer and discharge; and ordering, storing, prescribing and administration of medicines.
In relation to non-compliance with premises there was no programme of general maintenance, decorative maintenance, decontamination, and repair of assistive equipment. Notwithstanding the impacts of COVID-19, it was reported by staff that there was a lethargic and lengthy response to many maintenance requests. It was noted that there were frustrations regarding communications between maintenance and Mayo Mental Health Services. Despite this, some progress was made with upgrades to the high dependency unit which were in train at the last inspection and had been completed. A supply of new beds as well as new supportive armchairs, had also been provided and some painting had also been undertaken.
In relation to privacy, the inspectors found that the approved centre compromised the dignity and privacy of two residents who had been admitted to the approved centre overnight and who were accommodated on a combination of chairs and on a couch, due to overcapacity. One resident was accommodated in this way for two consecutive nights. Not all resident bedrooms were appropriately sized to address the resident needs; and the unit experienced sporadic overcapacity, and additional beds had to be erected in dormitories to accommodate these residents.
St Anne’s is a single storey building adjacent to the Sacred Heart Hospital in Castlebar. There were four single bedrooms and four dormitory style rooms, the latter with adjoining bathroom facilities. None of the single rooms offered an en suite facility. However, plans were progressing to provide this in one room. The centre was registered for 12 beds but at the time of the inspection it had five patients.
The centre achieved 90% compliance on the inspection, an increase of 13% over its 2019 inspection,
with three moderate non-compliances recorded relating to general health; ordering, storing, prescribing and administration of medicines; and the use of physical restraint. There were no conditions attached to the registration of the centre at the time of inspection.
Cluain Lir Care Centre is located on the grounds of St. Mary’s Care Centre in Mullingar, in a two-storey building. St Bridget's Ward is located on the ground floor and St. Marie Goretti’s Ward on the first floor. It is registered for 42 residents. However, the capacity had been temporarily reduced to 36 because of COVID-19 restrictions so that all residents could be accommodated in single, en-suite rooms.
The centre achieved 100% compliance on the inspection with no non-compliances recorded. This had increased by 9% on its 2019 rate. There were no conditions attached to the registration of this approved centre at the time of inspection.
Each resident had a multi-disciplinary care plan which was developed and reviewed in collaboration with the resident. One-to-one sessions that were provided to residents included cognitive and functional assessments, and discharge planning. Group therapies were delivered by different disciplines. Occupational therapy and psychology ran a mindfulness group. A music group was delivered by occupational therapy and social work. Residents had access to a range of appropriate recreational activities during the weekdays and at the weekend, which were delivered by occupational therapists and nursing staff. The activities available in the approved centre included films and television, arts and crafts, books, a daily newspaper, drums, jigsaws, puzzles, soft toys, music, garden walks and beauty therapy.
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