Mental Health Commission raises issue of concern at Mayo facility

The Mental Health Commission has published an inspection in respect of St. Anne's Unit at the Sacred Heart Hospital in Castlebar.

One of the issues that came to light was that not all health professionals had up-to-date mandatory training.

The chief executive of the Mental Health Commission, John Farrelly, explained: “While we recognise the difficulties with recruitment and retention in the health sector, mandatory training is just that.

“You cannot be permitted to work in certain environments, including approved centres for mental health, if you do not have the critical training required.

"We are working with these approved centres to ensure they have a schedule of training in place for all staff to be properly trained as required.”

The Inspector of Mental Health Services, Dr. Susan Finnerty, said that while the Covid-19 pandemic did pose challenges and cause issues for some approved centres, staff must keep up with mandatory training in order to provide safe care for residents.

“It is vitally important that the physical health of residents is monitored and treated where necessary. Failure to do so puts the resident at risk of serious illness.”

A summary of the inspection report for the Castlebar facility is as follows:

St. Anne’s Unit is a single storey 12-bed unit adjacent to the Sacred Heart Hospital in Castlebar.

The approved centre provides admission, assessment, care and treatment for two Psychiatry of Later Life teams which covered north and south Mayo.

There were only five residents in the unit and the overall bed occupancy rate in 2021 was 40%.

The centre’s compliance rating dropped from 93% in 2021 to 83% in 2022.

Three fire doors were observed to be wedged open. This was rectified when pointed out to staff.

A fire extinguisher was out of date.

The service also managed this risk during the week of inspection.

Radiators were not guarded and were hot to touch during the inspection, which resulted in a risk of burns for the residents.

Not all staff were trained in basic life support, fire safety or management of violence and aggression.

It was found that the approved centre provided services in a way that met the needs of residents and their families, and that staff provided therapeutic activities and physical health monitoring appropriate to needs of residents.

Recreational activities included a gentle exercise group, quizzes, musician on a Monday, jigsaws, colouring, boardgames, movies, music, gardening, cards, television and arts and crafts.

Quality initiatives identified on inspection included the establishment of a ligature reduction subgroup to reduce ligatures; and the introduction of a new patient information booklet in November 2021.

At the time of the inspection a double lock system - a magnetic lock and a lock and key mechanism - was in place for the front door, which was a main fire exit.

The approved centre’s rationale for this measure related to safety concerns for individuals with dementia.

However, at the time of the inspection five individuals using the service were voluntary and did not have a diagnosis of dementia.

This risk was not on the risk register. This was one of the primary causes of a high-risk rating being ascribed to St. Anne’s risk management procedures.

Fire safety training was not up to date within the nursing department; 36% of nursing staff had not completed the relevant fire training at the time of the inspection.

In terms of corrective and preventative action, staff have been facilitated to attend or have completed all mandatory training.

In terms of the locking system, a risk assessment has been completed and the locking system has been added to the local risk register.

Advice has also been sought from the maintenance manager and the HSE fire officer with regard to amending the locking system and an update from the fire officer was expected by the end of September 2022.

In the interim, all staff hold exit door keys and have a code for exit doors; they have completed online fire training, while unannounced fire drills are completed regularly by an external fire inspector or trainer.

An emergency plan policy is also in place that specifies responses by staff in relation to possible emergencies.