Two mental health centres breach conditions of registration

The Mental Health Commission (MHC) has this morning published inspection reports for two centres - based in Dublin and Limerick - both of which were in breach of conditions of registration relating to staffing at the time of their inspections.

The MHC has the power to attach conditions to an approved centre’s registration. The most common reason to attach conditions is continued non-compliance with a regulation or statutory rule. It is an offence to breach a condition of registration.

“Any breach of condition is worrying, but it is particularly so when it is related to staffing,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “An appropriate skill mix of staff who have completed all the mandatory training courses in areas such as basic life support, fire safety and management of aggression and violence, is essential for the successful running of an approved inpatient mental health centre. We really must look carefully at any centre that has not ensured that its staff have completed their mandatory training and education.”

The Chief Executive of the Mental Health Commission, John Farrelly, said that the MHC treats any breach of condition extremely seriously and that this should serve as a warning to all approved centres. “Conditions of registration are not just imposed out of the blue, “he said. “Any centre that receives a condition will have received one or more high or critical risk non-compliances over a period of time and will have been given every opportunity to correct the situation. They will also know that the only steps we can take above and beyond imposing a condition is either removal from the register or prosecution.”  

St. Joseph’s Intellectual Disability Service is located on St Ita’s Campus in Portrane, Co. Dublin. The centre provides a service for adults who have an intellectual disability and a mental health diagnosis for the Dublin North, Dublin North Central and Dublin North-West Community Healthcare Organisation. The centre is registered for 79 beds, and at the time of inspection 64 beds were occupied.

There was one condition attached to the registration of the centre at the time of inspection related to staff training. The centre was in breach of the condition and was non-compliant with the associated regulation. The MHC views any breach of a condition, applied in accordance with the Mental Health Acts 2001-2018, in the most serious of terms. Such conditions are applied where the MHC has serious concerns about an approved centre’s compliance arrangements. In this case the MHC initiated an escalation and enforcement process to ensure that urgent and immediate steps were taken to address this breach. In response, the HSE provided evidence that it has taken direct action to address the breach and implement sustained improvements in this area.

Overall compliance at the centre decreased from 94% in 2021 to 82% in 2022. The centre received several high-risk non-compliances, including one on the regulation for premises, which was imposed for a number of reasons. These included the finding that hazards were observed in various locations in the centre including a bottle of toilet cleaner left on a window ledge in one bathroom; an unguarded manhole in a garden, a discarded razor in another, and a brick and two steel hangers in a third.

In addition, while the outside of the premises was kept in a good state of repair, the inside was found to be in a state of disrepair and in poor structural condition. At the time of the inspection, the seclusion room had a cracked window, a damaged door and the seat was stained. There was damaged lino in a number of bedrooms and in a sitting room, walls were damaged and cracked, and painting was marked throughout the inside of the centre, including in bedroom and corridor areas. The centre was free from offensive odours, but it was not clean and hygienic. Some gardens were littered with paper, cigarette butts and plastics, while some pavements and windows were not clean.

The centre received a high-risk non-compliance rating on the day of inspection for the regulation on staffing because there was insufficient access to mandatory basic life support, fire safety, and management of aggression and violence training and education to enable staff to provide care and treatment in accordance with best contemporary practice. In addition, not all staff had completed training in the Mental Health Act 2001.

The centre also received high-risk rating for the regulations on individual care planning, food safety, and risk management procedures.

Positives from the inspection included findings that that staff provided therapeutic activities and physical health monitoring appropriate to needs of residents; that facilities and processes respected residents’ privacy and dignity and that interactions respected residents’ wishes; and that good governance structures and processes were in place.

Tearmann Ward is located in St. Camillus’ Hospital on the Shelbourne Road in Limerick. The centre is a 15-bed assessment unit for persons with advancing dementia and psychological and behavioural symptoms. Tearmann Ward was registered to provide Continuing Mental Healthcare and Psychiatry of Later Life at the time of inspection but provided assessment for people with advanced dementia and psychological and behavioural problems.

The building in which the Tearmann Ward was located was constructed in the 19th century. It is unsuitable as a mental health facility for elderly residents and comprised a long corridor with sleeping accommodation in five bedrooms, one single room, one double room, and three four-bed rooms.

The centre did not offer residents en suite toilet and shower facilities and did not have a bath. At the time of the inspection, the centre was poorly maintained and in a state of disrepair. Paint was peeling from the walls and hand sanitiser units had stained the paint on some walls. Bedroom accommodation was sparsely decorated and lacking in personalisation. The shared dormitories had an institutional atmosphere with up to four beds located within a large room. There was no dedicated therapy room and the area provided was a thoroughfare where staff and other residents moved from one area to another. As a result, some therapeutic services were delivered in the dining room.

There was one condition attached to the registration of the centre at the time of inspection related to staff training. The centre was in breach of the condition and was non-compliant with the associated regulation. In the context of compliance with the Mental Health Acts 2001 – 2018, the  MHC views the breach of a condition of registration, which is applied in accordance with the Act in the gravest of terms. The MHC initiated escalation and enforcement steps in response to this breach, in order to ensure that actions were taken to bring the approved centre back into compliance. The HSE has provided evidence of a comprehensive arrangements to address this matter and maintain compliance in the future.

Overall compliance at the centre decreased significantly from 97% in 2021 to 81% in 2022. The centre received a critical-risk non-compliance rating for the regulation on premises for several reasons. These included findings that ligature points were not minimised to the lowest practicable level, based on risk assessment as many outstanding ligature anchor points remained within the centre; there was an insufficient number of showers for residents in the centre (at the time of the inspection three showers were available to 11 residents); there was no bath available within the centre; the centre was not kept in a good state of repair internally; and the centre had not been painted for over two years.

The centre also had a high risk non-compliance with the regulation on staffing as the skill mix of staff was not appropriate to the needs of the centre; for example, there was no occupational therapist working in the centre at the time of inspection. In addition, not all staff were trained in the areas of management of violence and aggression, basic life support and fire safety.

The centre also received a high-risk non-compliance for risk management procedures as a fire drill that involved the residents was overdue at the time of inspection, while the ligature audit did not accurately assess the risk of self-harm by the residents.

Positives from the inspection included findings that the approved centre responded to meet the needs of residents and their families; and governance structures and processes were in place which demonstrated leadership and accountability. The inspection team also noted a number of quality initiatives, including the purchase and erection of a garden pergola - which had improved the comfort of residents during the pandemic where outdoor groups and outdoor visiting was facilitated as much as possible – and the installation of sensory walls on the corridor for residents to safely explore and stimulate their sense of touch.

You can find our full statement here. 

Tearmann Ward: Inspection Report 

St Joseph's Intellectual Disability Service: Inspection Report