‘Privacy and dignity’ lacking at acute psychiatric unit

Four bedrooms at an acute psychiatric unit in University Hospital Limerick did not have adequate screening or curtains to ensure residents' "privacy and dignity", according to an inspection by the Mental Health Commission.

The unannounced inspection at acute psychiatric unit 5B at the hospital also found bins were overflowing with rubbish and floors were dirty in certain areas.

The inspection report, published by the commission on Thursday, said the acute psychiatric unit was non-compliant in areas of privacy, premises and risk-management procedures.

Inspectors said staff used a PA system to call residents to therapy groups and for the dispensing of medication.

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“The system was also used to alert staff that they were needed at the nurses’ station,” the report said. “The system was very loud and intrusive and not conducive to resident privacy and dignity.”

It said residents could use the office phone, which was not portable, and the handset was passed to the resident through a Perspex panel, meaning that conversations were held in public and could be overheard.

The focus inspection, which took place on January 24th, was a follow-up to an annual inspection in November 2016. A focus inspection takes place where issues of concern regarding the approved centre have arisen.

Inspectors also found although a cleaning schedule was implemented, the approved centre was not “clean, hygienic and free from offensive odours”.

‘Overflowing with rubbish’

“In the male and female accommodation and in the Psychiatry of Later Life area, bins were overflowing with rubbish and floors were dirty,” the report said.

“In one of the male dormitories, there were cigarette butts and burns on the floor, radiator, table and windowsill . . . The linen room was not adequately ventilated and smelled malodorous.”

The report noted while each resident was provided with a wardrobe and lock to store their clothes and belongings, the wardrobes were fitted with specially designed anti-ligature rails, but they collapsed when clothes hangers were placed on them, which prevented residents from hanging up their clothes.

Inspectors said there was evidence that residents were smoking inside the facility and there was a smell of smoke in the sitting room.

“The inspection team observed one resident smoking in a communal lounge,” the report said. “There was also evidence of two residents smoking in bedrooms, one of which was a dormitory where three other residents were accommodated.”

Inspectors said a risk of fire was identified due to residents leaving lit cigarettes on the floor and window ledges.

Nine residents agreed to speak with the inspection team. One resident, who was preparing for discharge, was “very complimentary” about the staff and grateful for all they had done during their stay. Another resident, who was a new admission, was not happy with the cleanliness of the premises while one resident said the unit “was often untidy”.

Newcastle Hospital, Greystones

Separately, an annual inspection carried out at the Avonmore and Glencree units in Newcastle Hospital, Greystones, in March found 14 areas of non-compliance including clothing, individual care plan, privacy, premises, staffing, risk management, rules on the use of seclusion and the use of physical restraint.

The inspection report said in one episode where physical restraint was used, there was no documented evidence of the consultant psychiatrist being notified as soon as was practicable. In two other episodes, the next of kin were not informed and no reason for this was provided in the clinical file.

In terms of risk-management procedures, inspectors said it was unclear who had responsibility for assessing and reviewing risks in the facility.

“Not all staff were aware of who the risk manager was,” the report said. “Risk assessment forms had not been reviewed for more than three years and were not reflective of the current risks in the approved centre.

“The approved centres policy on risk management identified that safety statements associated assessments should be reviewed at least annually or where the risk has changed.”