HSE takes over three autism centres after safety concerns

The HSE has taken over control of three residential centres for people with autism following concerns for the safety and wellbeing of residents.

The centres, all operated by the Irish Society for Autism (ISA), had been subject to inspections by the Health Information and Quality Authority (Hiqa) over the past 18 months.

Despite assurances that serious concerns would be addressed, further inspections found they had not been. Hiqa then cancelled their registration.

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.

Dunfirth Farm, home to 34 people, was inspected on five occasions between January and November 2015.

Hiqa found “poor outcomes” for residents and risks in “health and safety, risk management, social care needs, safeguarding and safety, governance and management, use of resources and workforce”.

The watchdog issued immediate warnings and escalated monitoring of the service. Management failed to address the concerns and Hiqa moved to cancel the registration on January 13th.

The ISA 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 this year - the fourth since November 2014.

‘Sustained non-compliances’

Inspectors found “continued...significant and sustained non-compliances”, Hiqa reported.

During one inspection it emerged a resident had recently left the premises unknown to staff. Inspectors told the centre to have an electric gate fitted. “The response received was to ask a parent of a patient to pay for it.”

A number of residents with difficult behaviour did not have behavioural support plans. “The knowledge of staff... varied as to how they would respond if certain behaviour was demonstrated.”

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”, when such incidents occurred, 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.

One resident was prescribed buccolam midazolam for seizures. “Staff spoken to were unaware of the administration guidance,” Hiqa said, regarding usage of the potentially dangerous medication.

‘Autism-specific care’

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

A number of residents had high cholesterol, but “when inspectors spoke to staff they ere vague regarding the residents’ cholesterol levels”. One staff member who prepared meals was “unsure what the dietary requirements were for residents who had high cholesterol”.

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

The Wexford centre, home to six people, was inspected for a fifth time in May this year, after which its registration was cancelled.

It had been inspected previously over two dates in February and April, when “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 without adequate evidence and inadequate staff training.