Drugs used to quieten patients in autism homes

The Health Information and Quality Authority (Hiqa) has taken control of three homes run by the Irish Society for Autism, following a damning list of charges that the facilities were run unsafely and chaotically.

Drugs were used as “chemical restraints” to quieten patients, while some residents left the homes without being noticed, while others self-harmed. Management was poor and staff were badly trained.

The findings by the health watchdog, which followed on from demands more than a year ago for major improvements, have led to their registration being cancelled and taken over by the HSE.

The centres, homes to 47 residents, are Cluain Farm, Kinnegad, Co Westmeath; Dunfirth Farm, Johnstownbridge in Co Kildare; and Sarshill House, Kilmore in Co Wexford.

The centres had been repeatedly inspected by Hiqa over the past 18 months. Despite assurances that serious concerns would be addressed, they had not been. In May last year, Sarshill House was told that “immediate actions” were necessary, but there had been “an overall failure” to implement changes.

Dunfirth Farm, home to 34 people, was inspected on five occasions between January and November 2015. These inspections found accidents were poorly managed, causing risk to residents.

One resident “was engaging in self-injurious behaviour resulting in multiple incidents, of which there were approximately 30 since June 2015”, said a report Hiqa published yesterday. This resident was given a protective helmet and medication “when they were heightened”, but the drugs’ use was not properly recorded.

No guidance

There was no guidance for staff on administering anti-psychotic, sedative and pain-relief medication. The inspectors found abuse between residents requiring medical attention was not reported to Hiqa.

Skill mix of staff was “insufficient” and staffing numbers were “at a minimum level”. Residents “had ongoing complex health needs” but “there was no appropriately skilled staff”.

Hiqa issued immediate warnings and escalated monitoring. Management failed to address the concerns and Hiqa moved to cancel the registration on January 13th. The Irish Society for Autism prepared to appeal this to the district court, but withdrew the appeal on May 9th. The HSE took over the service from that date.

Cluain Farm, home to eight people, had an unannounced inspection in January, the fourth since November 2014. Inspectors found “continued significant and sustained non-compliances”. It emerged a resident had recently left the premises unknown to staff. Inspectors told the centre to get an electric gate. “The response received was to ask a parent of a patient to pay for it.”

Residents with difficult behaviour did not have behavioural support plans.

Other residents were traumatised when some incidents occurred. One resident told inspectors they would “leave the room and go to their bedroom” and “shake like a leaf”, while another would “self-injure” after witnessing them.

The inspectors found “deficiencies” in the administration of anti-psychotic, sedative and pain-relief medication, including that they had no guidance on when or how often they should be given, or their possible side-effects.

Though the centre’s statement of purpose was to provide “autism-specific care”, none of the nine staff had training to deal with autistic patients, while just three had social care-related qualifications.

On residents’ cholesterol levels, inspectors found that staff were “vague” about what they should do.

Appeal

On February 3rd, Hiqa told the charity it would cancel its registration for Cluain Farm. It indicated intention to appeal but withdrew this on May 18th, and the HSE took it over.

Sarshill House in Wexford, home to six people, was inspected for a fifth time in May and its registration cancelled on June 17th. Inspectors found assaults between residents occurring consistently. It was unclear who was in charge of residents’ safety, and a previous Hiqa recommendation that a safeguarding committee be established was “ignored”.

Since the previous inspection “significant issues remained with regard to . . . governance and management” and the person in charge “had no access to an adequate budget to operate the centre”.

It had been inspected previously over two dates in February and April, when it said: “There continued to be a high level of non-compliance in all areas of care and support . . . in particular there were inadequate measures to protect residents from serious physical assault by other residents.”

Other areas of “major non-compliance” included “ongoing risks to residents” as a result of not being properly managed; poor governance; healthcare interventions and diet restrictions; and inadequate staff training.