Mental health facilities criticised in inspection reports

Long-term adult residents of a mental health facility were not allowed into their bedrooms until 9.30pm, and they were also made go to bed while it was “still bright outside” during the summer, an inspection report has found.

The Mental Health Commission (MHC), which published two reports on in-patient facilities on Wednesday, said St Catherine's ward in St Finbarr's Hospital, in Cork city, did not provide accommodation that always upheld "the dignity and privacy of residents".

It found “nursing resources were insufficient”, food storage was unsafe, there was no social worker and “insufficient access to occupational therapy staff”.

The facility did “not provide adequate therapeutic activities and programmes or physical health monitoring appropriate to needs of residents”, “did not operate safe practices in a number of areas”, and “risks were not always adequately identified, assessed, or managed”.

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There were 17 residents in the 21-bed unit at the time of inspection, between April 13th and 16th, 2021, and all had been there for more than six months.

While individual risk assessments were carried out when patients were admitted, and hazards like slippery floors and trip hazards were minimised, “there was no indication that evidence-based nursing needs assessments had been conducted, despite increasing needs of an ageing resident cohort”.

“Residents did not have access to their bedrooms until after night time medications were dispensed. Some residents were resting or sleeping in unsuitable chairs during the day because they could not access their bedrooms,” inspectors found.

Dissatisfaction

“Residents expressed dissatisfaction at having to go to bed when it was bright outside during the summer months. Residents also said they would prefer their own bedroom. Residents who had to share bedrooms said they would like to choose who they shared with. A lack of access to TV after 9.15pm was highlighted, with some expressing a wish for a TV in their bedroom.”

The commission said on Wednesday: “Following the inspection, MHC initiated an escalation process, requiring the centre to take immediate steps to address the non-compliances which were rated as critical. The service responded providing evidence that it took appropriate remedial actions. Explicit assurances were provided about the unacceptable practice of locking bedrooms.”

A second report, on the Lakeview unit at Naas General Hospital in Co Kildare, found residents did not have access to adequate personal space.

Inspectors found the 23 residents at the 29-bed unit were not allowed upstairs – which accommodated the television and other communal rooms – after 8pm. The downstairs communal room could accommodate just four residents at a time.

“Residents did not have access to occupational therapy as there was no occupational therapist in post for the approved centre,” said the report compiled after inspection on March 1st, 2021.

Isolation

In one episode, where a resident was put into isolation, their family were not informed. Though the resident had been informed of the reasons, duration, and circumstances leading to discontinuation of seclusion, their “next of kin was not informed of seclusion taking place and no reason was documented for this”.

“The resident was under direct observation by a registered nurse for the first hour and continuous observation thereafter. The resident was informed of the ending of seclusion,” said the report.

The commission said on Wednesday: “The centre also was high risk rated for the rules governing the use of seclusion and received five moderate risk non-compliances for individual care plans, therapeutic services and programmes, general health, staffing, and the use of physical restraint.

“The service responded, providing evidence and assurances of the actions which they implemented.”