‘Dysfunctional systems’ at psychiatric care unit

THE number of regulation breaches at a psychiatric care unit for the elderly in Ennis dropped by 66% following a second inspection requested by the Mental Health Commission (MHC) it emerged this week.
Concern about a number of “dysfunctional systems” were expressed by the Inspectorate of Mental Health Services following an announced visit of Cappahard Lodge, Tulla Road, Ennis on June 3 last.

In view of the number of breaches on the day, which totalled 20, a copy of a draft report was sent as a matter of priority to the acting chief executive officer of the MHC five days later.
The MHC subsequently requested the inspectorate undertake an unannounced visit within three months, which took place on September 22, when seven breaches were discovered.
The breaches uncovered in June included no written policies concerning the ordering, prescribing and storage of medicines, breaches in relation to food safety, recreational activities, individual care plan, therapeutic services, general health, premises, staffing, risk management procedures, mechanical restraint, reporting of deaths and incidents.
There was no current report from the environmental health officer after he had identified in August 14, 2008 that the deep cleaning of the kitchen facilities remained unsatisfactory. The local health manager subsequently reported remedial steps were taken to ensure compliance.
On examination of clinical files, there was no evidence that each resident’s general health needs were assessed or that six-monthly physical examinations were carried out.
It found the practices and procedures for ordering, prescribing, storing and administering medicines were not appropriate, suitable and unsafe.
A recent audit found nurses were spending up to 90 person hours completing non-nursing duties. It was reported that the agreed staff complement had not been reached, while health and social care staff were limited to one weekly session of occupational therapy.
It made 10 recommendations for changes and when the inspectorate returned they found a “significant improvement in the practices and procedures in Cappahard Lodge”.
According to the Inspectorate, the male and female units were amalgamated and practices integrated. “Systems had been implemented to ensure regular physical, psychiatric and nursing reviews. Medication management systems had been reviewed and improvements implemented although the inspectorate remained concerned about the risks of duplication in the writing of prescriptions.
Risk management system had also been amended to ensure compliance. The inspectorate made seven recommendations for further improvements across a range of services.
The HSE welcomed the inspections by the MHC and the opportunity the report provided to review and bring about improvements in the quality of the services.
“The Clare Mental Health Services are confident that they offer good quality services, delivered by dedicated personnel,” a HSE spokesperson said.
Meanwhile, a report into the care provided to the late Gerard Finn (69), Kilrush at Cappahard Lodge, chaired by Dr Lyons, the head of the Mental Welfare Commission for Scotland, is due to be published in the New Year.
His daughter, Lourda Finn, expressed grave concern that breaches were still being uncovered at Cappahard Lodge almost four years after they were highlighted by herself and her sister, following their dissatisfaction with the overall standard of care provided to Mr Finn.
Her complaints pre-date Cappahard’s registration as an approved centre for psychiatric care of the elderly in October 2008.