Four inspection reports identify four critical and nine high risk non-compliances in four Cork centres1 April 2021
We published four inspection reports this morning which identified four critical and nine high non-compliance risk ratings across four mental health facilities in County Cork.
The four critical non-compliant risk ratings related to privacy; premises; the ordering, prescribing, storing and administration of medicines; and maintenance of records. These four critical risk ratings were reported in two out of the four centres.
“I was particularly disappointed to note that one centre had not managed to make any improvements in terms of ensuring residents had access to personal space,” said the Inspector of Mental Health Services, Dr Susan Finnerty. “This particular unit was not adequately sized to provide an environment that respected residents’ privacy and dignity. For example, one two-bedded room was very small and a sitting room on one ward was only available to a small number of residents at any one time. Residents also did not have access to a garden or an outdoor space.
“It is extremely important that people who are unwell are afforded an appropriate level of space and privacy to help them get well,” added Dr Finnerty. “Research has shown that psychiatric facilities need to have adequate space for people to have privacy, regulate interpersonal interactions, avoid stressful situations, and have access to outside space.”
In accordance with its escalation and enforcement procedures, the MHC took steps requiring the HSE to take action to address the non-compliances rated as critical and high. In the three centres where this occurred, regulatory compliance meetings were held where the HSE was required to produce specific plans and assurances to bring these centres into compliance. This process of engagement is ongoing, and the MHC continues to monitor the implementation of plans and remedial actions in these centres.
St Michael’s Unit is a 50-bed unit located on the first floor of the Mercy University Hospital in Cork City and comprises acute and sub-acute wards. The acute area contains 18 beds and the sub-acute area contains 32 beds. The unit provides inpatient care to Cork City North East, Cork City North West, Blarney/Macroom, Cobh, Glenville and Middleton/Youghal.
There was one condition attached to the registration of this approved centre at the time of inspection in relation to privacy and premises. The centre was found to be in breach of this condition upon inspection as it was non-compliant in both areas. Both non-compliances were rated as a critical risk.
While there was an overall increase in compliance with regulations from 71% in 2019 to 82% in 2020, the inspection found a total of six non-compliances, four high and two critical.
The first critical-risk non-compliance related to privacy. The inspection found that in one particular room which housed two residents, space was very tight, and privacy was acutely compromised. On the sub-acute ward, there was a small sitting room which under normal circumstances could not accommodate 32 residents; at the time of inspection, even fewer residents could access the sitting room due to the Covid-19 pandemic and social distancing guidelines.
The inspection also found that residents’ relaxation and recreational areas were very limited, and residents had no access to outdoor space. The approved centre had a conservatory overlooking the river which was locked at the time of inspection; residents could only access it under supervision, as some residents had been using it as a smoking area, which further reduced communal space. Due to this, the environment was restrictive in nature and impacted on the resident’s privacy and dignity.
The second critical-risk non-compliance related to premises. The inspection found that residents in the approved centre did not have access to personal space. Not all private and communal areas were suitably sized and furnished to remove excessive noise and acoustics. The residents’ relaxation and recreational areas were very limited. Residents had no access to a garden or outdoor space, as the centre was located on the first floor with the main entrance leading onto the street. Discussions had previously taken place regarding ongoing plans to reconfigure the approved centre, but little had changed in this regard since the last inspection.
Appropriate signage and sensory aids were not evident in all areas of the approved centre. Hazards were not minimised in the approved centre: several pieces of equipment were left in the corridor and communal area. Furthermore, ligature points were evident on windows and door handles, straps on bins, door mechanisms, and pipes on walls. No work had been conducted on these ligature points since the last inspection.
Overall, the approved centre was clean, hygienic, and well-maintained; however, a strong smell of cigarette smoke was noted in the female toilets on both days of inspection and several stained roof tiles were also noted. The centre did not have suitable furnishings to support residents’ independence and comfort, as there was a limited number of chairs in the communal areas.
The four high-risk non-compliances at the centre related to individual care plans, general health, risk management procedures, and the Code of Practice relating to the admission of children under the Mental Health Act 2001.
Units 2, 3, 4 and 8, St Stephen’s Hospital is located seven kilometres from Cork City, outside the village of Glanmire. The centre comprises of four buildings, co-located within the 117-acre grounds at St Stephen’s Hospital. Until March 2020, residents from all four units attended the Valley View day centre, which was also located on the grounds of St Stephen’s Hospital; due to Covid-19 restrictions, Valley View was closed at the time of the inspection.
The 87-bed centre serves the North Cork area and includes adult mental health, continuing mental health care, psychiatry of later life and mental health rehabilitation service teams. While there was an overall increase in compliance with regulations from 70% in 2019 to 74% in 2020, the inspection found a total of eight non-compliances: two high, four moderate and two low.
The first high-risk non-compliance found was in relation to premises. Hazards, including large open spaces, steps and stairs, slippery floors, trip hazards, hard and sharp edges, and hard or rough surfaces, were all minimised in the approved centre; however, ligature points were noted throughout each of the approved centre’s units. The approved centre was not kept in a good state of repair externally and internally. The sluice room in Unit 2 was in poor repair and this had been identified by the centre. The centre was clean, hygienic, and free from offensive odours and rooms were centrally heated, though pipework and radiators were not guarded.
The second high-risk non-compliance related to risk management procedures. While the approved centre had several written policies in relation to risk management and incident management procedures, these policies did not address the process for identification, assessment, treatment, reporting and monitoring of risks throughout the centre.
Cois Dalua is a 16-bed, privately-operated centre run by Nua Healthcare, located in the village of Meelin, eight kilometres from Newmarket, Co. Cork.
There was an overall increase in compliance with regulations from 73% in 2019 to 94% in 2020. The inspection found a total of two non-compliances, one moderate and one low. The moderate-risk non-compliance related to the Code of Practice on admission, transfer, and discharge to and from the centre. The low-risk non-compliance related to general health: the inspection found that the residents’ six-monthly general health assessment documented all required information with the exception of waist circumference.
The Acute Mental Health Unit at Cork University Hospital is a 50-bed unit which provides inpatient beds for the population of the South Lee catchment area in Cork. It was located within the grounds of Cork University Hospital’s campus in Wilton, Cork city.
While there was an overall increase in compliance with regulations from 71% in 2019 to 79% in 2020, the inspection found a total of seven non-compliances: two moderate, three high and two critical.
The first critical-risk non-compliance related to the Ordering, Prescribing, Storing and Administration of Medicines. While the centre had a written policy and procedures in this regard, the policy did not reference appropriate and suitable practices relating to the recording of administration and the disposal of Schedule 3 drugs. Similarly, a Medication Prescription and Administration Record (MPAR) was maintained for each resident but these did not detail a record of all medications administered to the resident. One MPAR did not include a record of resident refusals. There was also no pharmacist assigned to the approved centre.
The second critical-risk non-compliance related to the maintenance of records. While the centre had a written operational policy and procedures in relation to the maintenance of records, not all residents’ records were secure, up to date, in good order, and constructed, maintained, and used in accordance with national guidelines and legislative requirements. Several clinical files were bulky, and information was difficult to locate within the files. Resident records were developed and maintained in a logical sequence; however, due to the amount of information presented within the clinical files, the records were difficult to follow. All records were not maintained in good order, as several clinical files had loose pages.
The high-risk non-compliances identified during the inspection related to individual care plans, general health, and staffing; and the moderate-risk non-compliances related to risk management procedures and the Code of Practice on the use of physical restraint.
You can read our full statement here.