One critical and sixteen high risks reported in inspection of three mental health centres
16 March 2022The Mental Health Commission (MHC) has this morning published three inspection reports which found one critical and sixteen high-risk non-compliances across three mental health centres in Clare, Louth and Offaly.
“All of the centres inspected were non-compliant with the regulation relating to premises,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “We see issues with buildings not being maintained, bathrooms not being ventilated and the lack of sufficient privacy for patients. These environments are not conducive to the treatment and recovery of people with mental illness.”
The Chief Executive of the Mental Health Commission, John Farrelly, commented on the sheer number of high and critical risks identified. “It is quite shocking that across three centres you would see this number of serious issues. Frankly, it is unacceptable, and we are seeking urgent improvements from the service providers, some changes have already been made in terms of patient safety and we will be monitoring these plans going forward.”
Acute Psychiatric Unit, Ennis Hospital is located on the grounds of Ennis Hospital. The centre provides in-patient mental health care to residents of North Tipperary and County Clare. The approved centre is registered to accommodate 39 residents and consists of three separate subunits; including a 30-bed general acute unit, a four-bed high observation unit, and a five bed psychiatry of later life unit.
The centre achieved an overall compliance rate of 71%, a 7% increase on the 64% it received in 2020. However, the inspection identified one critical risk and six high-risk non-compliances.
The critical risk related to risk management procedures. Not all health and safety risks were adequately identified, assessed, and treated within the approved centre. Several issues were observed by the inspection team concerning the functionality of the fire doors. On seven occasions, fire doors were noted to be held in an open position through the use of door wedges or other obstructions. The door closer mechanism was broken on one fire door and absent on another. Two sets of the double fire doors on the corridors were noted to have gaps above the recommended size between the meeting of the doors leaves. After the inspection, the MHC agreed with the centre that daily walkarounds would take place to identify safety risks.
The regulation regarding premises was rated a high risk. The physical structure and the overall centre environment were not maintained with due regard to the safety of residents. Ligature anchor points were not minimised to the lowest practicable level, based on risk assessment. At the time of the inspection there were high risk ligature points in resident areas throughout the centre.
The centre was clean, hygienic, and free from offensive odours, but it was not maintained in a good decorative state of repair - doors were worn, marked, and damaged and needed painting. Floors were marked and damaged and needed to be replaced.
The layout and furnishings of the centre were not conducive to resident privacy and dignity. Where residents shared a room, the bed screening was not always adequate, which risked compromising resident privacy. In the two-bedded room on the high observation unit, there was no privacy screening around either bed. In another two-bedded room on the general acute unit, there were screening curtains in place, however, these curtains were not fitted to adequately function as privacy curtains. The curtains did not surround either bed completely. Privacy in the centre was rated as a high risk along with therapeutic programmes, staffing, general health and the rules governing the use of seclusion.
The Department of Psychiatry, Drogheda is located at the back of the carpark for Our Lady of Lourdes General Hospital. The centre opened in 2016 and serves the counties of Louth and Meath, with a population of circa 325,000. The service is subdivided by the two counties.
The centre recorded an overall compliance rate of 82%, a decrease of 12% from the overall compliance of 94% it received in 2020. All six non-compliances at the centre were rated as high risk: individual care plan; therapeutic services and programmes; general health; staffing; premises and the code of practice relating to admission of children.
The centre lacks age-appropriate facilities, and a programme of activities appropriate to a child’s age and ability; it is not a dedicated child and adolescent facility and therefore is not a suitable facility for the admission of a minor. There was no documented evidence to indicate that a child had their rights explained to them and information about the ward and facilities were provided in a form and language that they could understand.
The centre was not kept in a good state of repair externally and internally. Specifically, there were ongoing issues relating to fire doors, many of which had been replaced or were waiting replacement. This was being managed by the service in consultation with a fire protection and fire safety company. It was reported by staff that there were ongoing issues with dampness in the building.
The therapeutic services and programmes provided by the centre were not appropriate and did not meet the assessed needs of the residents as documented in their individual care plans. Therapeutic services and programmes were not directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of residents.
The clinical files of three residents who had been in the centre over six months were reviewed. The six-monthly health assessment template included space for a physical examination, family or personal history, blood pressure, smoking status, dental health, nutritional status, a medication review, body mass-index and weight. The review evidenced that two assessments did not document the family or personal history. One did not document the body mass-index and two did not include the waist circumference. None of the three evidenced that the residents blood pressure had been recorded and documented. Two of the three did not have an assessment of dental health.
Silver Lodge is a temporary approved centre for residents while the Maryborough Centre in Portlaoise is being refurbished. At the time of inspection, the building works were estimated to be completed by February 2022. The centre provides long-term care and treatment for residents under the care of the psychiatry of later life and the rehabilitation and recovery teams.
The centre received an overall compliance rate of 83% but there were four high risks identified upon inspection: therapeutic services and programmes; premises; staffing and individual care plans.
There is no dedicated space for therapeutic activities in the centre; communal areas were used as necessary. The therapeutic services and programmes provided by the centre were not directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of residents. The approved centre did not have a dedicated occupational therapist and residents under the care of the psychiatry of later life team did not have access to an occupational therapist. Residents under the care of the rehabilitation and recovery team did not have access to a psychologist.
While the centre was found to be generally clean, not all bathrooms were ventilated adequately. The ventilation system in the downstairs bathroom which had a toilet and shower was not working. This bathroom did not have a window. This bathroom had a ventilation system which did not activate when the light was switched on. As a result, this meant the approved centre was not free from offensive odours. This downstairs bathroom had an unpleasant, stale and musty odour. At the time of the inspection this ventilation system malfunction had been reported to the centre’s maintenance team.
You can read our full statement here.
Acute Psychiatric Unit, Ennis Hospital Inspection Report 2021
