Our inspection reports identify seven high risk non-compliances in two centres4 March 2021
The Chief Executive of the Mental Health Commission (MHC) says that people who require treatment in an in-patient facility must be treated as close to home as possible to better facilitate contact and visits from family and loved ones.
John Farrelly was commenting following an inspection report into the Lakeview Unit at Naas General Hospital which stated that its total of 29 beds no longer reflected the needs of the population in the area. Due to the under provision of beds at the centre, it was obliged to arrange accommodation 50km away with the Department of Psychiatry in Portlaoise.
The inspection reports published today - comprising of two centres in Naas and Cork - identified seven high-risk and six moderate non-compliance ratings at two approved centres.
Mr Farrelly said that patients are dealing with a serious mental illness and having visits and involvement from loved ones in their recovery is important.
“Research shows that one of the goals of any mental health service is towards community-based treatment and care,” he said. “When people are acutely ill and undergoing treatment, ideally they should ideally remain within their locality. Maintaining close linkages with friends, family and their community during their illness contributes to a reduction in stigmatization of patients in their community and helps with recovery. Being treated far away from home is challenging for both staff and patients”
The Inspector of Mental Health Services, Dr Susan Finnerty, said it is important to note the continuous improvement in approved centres with increasing compliance with regulations. There is still room for significant improvement in areas of non-compliance with regulations identified by our inspections that the approved centres need to address to the satisfaction of the Mental Health Commission.”
Lakeview Unit, Naas General Hospital serves the communities of County Kildare and West Wicklow, with a population exceeding 241,538. The 29-bed capacity of the approved centre does not reflect the needs of the population. Due to under provision of beds, the approved centre had a service level agreement with the Department of Psychiatry, Portlaoise which is approximately 50km away. This arrangement provided for the admission of up to 10 residents who required higher levels of observation. The approved centre accommodated 28 residents, in two six-bed dormitories, three four-bed dormitories, and five single rooms.
At the time of the inspection, there were three conditions attached to the registration of Lakeview. Two conditions related to premises; incorporating the implementation of a programme of maintenance, and the development of a costed, funded and time-bound plan for proposed new build works. The other condition related to staffing to ensure all healthcare professionals are up to date in mandatory training areas.
Compliance had increased from 64% in 2019 to 83% in 2020. The report found the centre to be rated high risk non-compliant on one regulation relating to the premises and five moderate non-compliances related to transfer of residents; maintenance of records; both rules and codes governing the use of ECT; and admission, transfer and discharge of patients.
St. Catherine’s Ward is located on the grounds of St. Finbarr’s Hospital, Douglas Road in Cork. A 21-bed approved centre, St Catherine’s Ward had 19 residents at the time of the inspection - 18 of whom were present for more than six months.
There were three conditions attached to the registration at the time of inspection related to individual care planning; staffing, where not all healthcare professionals were up to date with the mandatory training; and staffing in relation to access to a suitably qualified speech and language therapist and dietitian.
There had been an increase in compliance with regulations from 62% in 2019 to 72% in 2020.
The report found the centre to be rated high risk non-compliant on six regulations relating to transfer of residents; privacy; premises; ordering, prescribing, storing and administration of medicines; staffing; and admission, transfer, and discharge. The centre had one moderate non-compliance for food safety and one low non-compliance with personal property and possessions.
There was a high-risk rating of privacy and staffing as all residents were required to vacate their bedrooms in the morning. The bedroom area was locked during the day and not opened again until around 9.30pm, when residents went to bed. This restrictive practice prevented residents from sleeping or resting during the day in their rooms.
The numbers and skill mix of staffing were not sufficient to meet resident needs, as the approved centre lacked sufficient dietetic and speech and language therapy staff. Staffing numbers also contributed to the bedroom areas being locked during the day, preventing access and free movement of residents to their rooms.
There was no programme of general maintenance, decorative maintenance, cleaning, decontamination, and repair of assistive equipment. Externally, the courtyard area was littered with numerous cigarette butts and pieces of litter on the ground. There was a hole in the wall and chipped paintwork in one of the bedrooms and there was an area in which there was a smell of cigarette smoke and the floor and a plastic chair displayed burn marks. There were no curtains in place on the windows in several bedrooms.
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