Care centre treatment shock

PUNISHMENTS including the restriction of food and personal items was found to prevelant during a visit by the health watchdog to a centre for adults with disabilities in County Wexford.

Residents were deprived of snacks and food, fined for ‘ breakages’ and had to hand over their mobile phones at night, according to the report on Highwater Lodge compiled by the Health Information and Quality Authority (HIQA) following an unnanounced visit on November 3 last year.

The centre is a large spacious house in a rural setting said to be in the Blackwater area.

The services it offers are available to adult men and women, however, HIQA inspectors found that the provider had not put adequate arrangements in place to safeguard residents, and in a previous inspection last July concerns were raised over the safety of a mix of residents living together.

‘As on the previous inspection, the inspectors found that there was a significant level and frequency of aggressive behaviour which required residents to be moved from their living areas in order to protect them from injury.

‘ The provider had not put in place adequate arrangements to safeguard residents from the risk of fire, and the inspectors issued an immediate action relating to this. Inspectors requested staff to remove various items of risk in relation to fire safety.

Fire risks included candles in residents’ and staff bedrooms, poor management of cigarette smoking and extinguishing of cigarettes and no fire risk assessments in place.

Residents and staff were also sharing bathroom facilities, but there were no privacy locks on the doors of bathrooms or toilets.

The provider was required to engage the services of an appropriately qualified fire safety professional on the day following the visit to ensure that all risks associated with fire safety were assessed and mitigated.

The unannounced inspection followed reports of an incident notified to HIQA in which one resident struck another, causing a head injury.

An earlier inspection in July 2016 had raised concerns in relation to the mix of residents living together and the safety of residents in relation to behaviours that challenge.

Inspectors found that residents had very little opportunity for making choices, and that there were various structures and rules in place, with very little evidence that some of them were in the best interest of residents.

‘Punishment regimes including the removal of personal property and the withholding of edible treats in place were prevelant throughout the centre,’ the inspectors said in the report.

‘ There was frequent reference to residents being obliged to ‘comply’, family visits were described as ‘access’, and the prescribed consequences for some residents’ behaviour was clearly identified as ‘punishment’.”

There was a section in the care plan for a resident detailing the requirement for residents to leave their mobile phones with staff when they went to bed, however, there was no documented rationale for this other than ‘ health and safety’ reasons.

This was initially explained by staff as being in case of the risk of fire while the device was charging. The inspectors later spoke to other staff who gave a rationale for the resident not keeping the phone overnight, however, this information was not documented.

It was clear from the documentation that the residents did not wish to leave their phone with staff and that there was a punishment applied if they did not hand over their phone.

Staff described occasions where two of the residents had to be taken out to the car to ensure their safety from the behaviour of the other resident.

Staff were that in situations where items were damaged by the behaviour of residents, the resident was to ‘pay for the item, and that the staff on duty were to apply this charge immediately.’

The provider was required to immediately ensure that all staff were informed that punishment was no longer to be used, and the threat of withholding snacks was to be removed from all guidance and that all the issues raised by the inspectors were satisfactorily resolved.