St Stephen’s one of four Cork centres with issues of non-compliance in MHC reports

Four inspection reports published last Thursday by the Mental Health Commission (MHC) identified four critical and nine high non-compliance risk ratings across four mental health facilities in County Cork, including at St Stephen’s Hospital outside Glanmire.

The four critical non-compliant risk ratings related to privacy; premises; the ordering, prescribing, storing and administration of medicines; and maintenance of records. These four critical risk ratings were reported in two out of the four centres.

Units 2, 3, 4 and 8 at St Stephen’s Hospital were found to be non-compliant. Located seven kilometres from Cork City outside the village of Glanmire, the centre comprises of four buildings, co-located within the 117-acre grounds at St Stephen’s Hospital. Until March 2020, residents from all four units attended the Valley View day centre, which was also located on the grounds of St Stephen’s Hospital; due to Covid-19 restrictions, Valley View was closed at the time of the inspection.

The 87-bed centre serves the North Cork area and includes adult mental health, continuing mental health care, psychiatry of later life and mental health rehabilitation service teams. There were eight conditions attached to the registration of this approved centre at the time of inspection in relation to Individual Care Plans, Premises, Staffing and Risk Management.

While there was an overall increase in compliance with regulations from 70% in 2019 to 74% in 2020, the inspection found a total of eight non-compliances: two high, four moderate and two low.

The first high-risk non-compliance found was in relation to premises. Hazards, including large open spaces, steps and stairs, slippery floors, trip hazards, hard and sharp edges, and hard or rough surfaces, were all minimised in the approved centre; however, ligature points were noted throughout each of the approved centre’s units. The approved centre was not kept in a good state of repair externally and internally. The sluice room in Unit 2 was in poor repair and this had been identified by the centre. The centre was clean, hygienic, and free from offensive odours and rooms were centrally heated, though pipework and radiators were not guarded.

The second high-risk non-compliance related to risk management procedures. While the approved centre had several written policies in relation to risk management and incident management procedures, these policies did not address the process for identification, assessment, treatment, reporting and monitoring of risks throughout the centre.

COMPLIANCE MEETINGS

The other three centres in the report were St Michael’s Unit, a 50-bed unit located on the first floor of the Mercy University Hospital in Cork City, providing inpatient care to Cork City North East, Cork City North West, Blarney/Macroom, Cobh, Glenville and Midleton/Youghal; Cois Dalua, a 16-bed, privately-operated centre run by Nua Healthcare, located in the village of Meelin, eight kilometres from Newmarket; and the Acute Mental Health Unit at Cork University Hospital, a 50-bed unit which provides inpatient beds for the population of the South Lee catchment area in Cork.

In accordance with its escalation and enforcement procedures, the Mental Health Commission took steps requiring the HSE to take action to address the non-compliances rated as critical and high. In the three centres where this occurred, regulatory compliance meetings were held where the HSE was required to produce specific plans and assurances to bring these centres into compliance. This process of engagement is ongoing, and the MHC continues to monitor the implementation of plans and remedial actions in these centres.

“I was particularly disappointed to note that one centre had not managed to make any improvements in terms of ensuring residents had access to personal space,” said the Inspector of Mental Health Services, Dr Susan Finnerty.

“This particular unit was not adequately sized to provide an environment that respected residents’ privacy and dignity. For example, one two-bedded room was very small and a sitting room on one ward was only available to a small number of residents at any one time. Residents also did not have access to a garden or an outdoor space.

“It is extremely important that people who are unwell are afforded an appropriate level of space and privacy to help them get well,” added Dr Finnerty. “Research has shown that psychiatric facilities need to have adequate space for people to have privacy, regulate interpersonal interactions, avoid stressful situations, and have access to outside space.”