Compliance rating falls after inspection
MENTAL HEALTH COMMISSION INSPECT NEWCASTLE HOSPITAL
NEWCASTLE Hospital’s compliance rating has fallen by 8 per cent from last year following a Mental Health Commission (MHC) inspection carried out over four days in February.
Compliance with regulations, rules and codes of practice had decreased from 77 per cent in 2018 to 69 per cent in this year’s inspection.
The inspection was carried out on the Glencree Ward, the acute admission unit with capacity for 26 residents, and the Avonmore Ward providing continuing care and a long stay facility, with capacity for 26 residents.
Eleven instances of non compliance regulations were recorded in the inspection report. There were ‘High’ risk ratings for food safety, individual care plan, therapeutic services and programmes, staffing, register of residents, rules governing the use of seclusion and Part 4 of the Mental Health Act 2001 - consent to treatment.
There were moderate risk ratings for general health, rules governing the use of mechanical means of bodily restraint and code of practice on the use of physical restraint in approved centres. There were low risk ratings for regulations on premises,
Newcastle Hospital was compliant with 24 other regulations.
There were a number of good safety practices in operation but the food fridge in the Avonmore unit was rarely above 4 degrees Celsius. At the time of the inspection, the gauge showed that the fridge temperature was 8 degrees Celsius. This was considered an unsafe method of food storage.
Rooms were centrally heated, but pipes and radiators were not guarded and were exposed. Works were due to begin two weeks after this inspection time to rectify this.
In one seclusion episode, there was no documentary evidence that the resident was assessed to include a risk assessment prior to seclusion taking place.
There were some areas of appropriate care and treatment provided for residents but there was no occupational therapy input into therapeutic programmes. Social workers and psychologists did not deliver any group work but attended Multi-Disciplinary Team meetings and met with residents as required on a one to one basis. Not all residents from the approved centre could attend the Kilmullen Enterprise Centre and so had no access to therapeutic programmes. The individual care plans (ICPs) of residents were of very poor quality and showed a lack of training.
Residents’ privacy, dignity and autonomy were respected in some areas but other areas needed improvement, according to the report.
Accommodation was mainly dormitory style with only one single room available. Suitable furnishings weren’t provided to support resident independence, dignity and comfort. In Avonmore unit, four armchairs in the residents sitting room were in a poor state of repair.
None of the bedrooms in Avonmore or Glencree units had bedside lockers for residents in which to store their personal items, or for their own comfort.
The seclusion room had been used as a bedroom regularly since the last inspection. Seclusion rooms are not considered suitable for use as bedrooms and such use is in contravention of the Rules Governing the Use of Seclusion and Mechanical Restraint.
In the case of one patient who had been detained in hospital for more than three months there was no evidence that the patient had provided consent for the continuing administration of medication or if there had been a capacity assessment done to show that he/she had capacity or not to consent to treatment.
There also was no documented evidence to indicate that mechanical restraint was only practiced when the residents posed an enduring risk of harm to themselves or to others.
There was good governance of the centre, however, the number and skill mix of staffing was insufficient to meet resident needs
Not all health care staff received mandatory training in fire safety, Basic Life Support, The Professional Management of Violence and Aggression, (PMAV) and the Mental Health Act 2001.
Newcastle Hospital was found to be responsive to residents’ needs and a number of quality initiatives were identified during the inspection.
A survey was carried out to better understand the needs and interests of the service users while they were residents. Two representatives from the local Wicklow mental health forum had joined Newcastle’s operational management meeting which was held monthly.
Following an analysis of risk management and incident review processes, all National Incident Management system (NIMs) reviews are completed by the respective Multi- Disciplinary Team (MDT) prior to dissemination to the Risk Advisor and Quality and Patient Safety Committee.