Non compliant - Mental Health Commission rating for Kilkenny hospital falls on inspection

Compliance with regulations has fallen in the last year at the Department of Psychiatry at St Luke's Hospital in Kilkenny, the Mental Health Commission revealed in a report published this morning (Wednesday).

However, the medical facility has still achieved an 89% overall compliance rate. Last year that rating was 91%, but both figures are a significant improvement from the 2019 rating of 73%.

On inspection, the centre was found to be non-compliant with regulations in the area of privacy, premises and staffing, as well as the code of practice on physical restraint.

The Department of Psychiatry's catchment area is Carlow, Kilkenny and South Tipperary and it has a bed capacity of 44. On the day of inspection there were 39 residents.

The Commission found that the centre operated safe practices which reduced risk of harm to the residents and that effective systems were in place to safeguard patients.

It also found that facilities and processes respected residents’ privacy and dignity and that interactions
respected residents’ wishes and provided services in a way that met the needs of residents and their
families.

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Compliant Regulations and Rules

The Department of Psychiatry was found compliant in relation to: identification or residents; food and nutrition; food safety; clothing; residents' personal property and possessions; recreational activities; religion; visits; communication; searches; care of the dying; individual care plans; therapeutic services and programmes; transfer of residents; general health; provision of information to residents; ordering, prescribing, storing and administration of medicines; health and safety; use of CCTV; maintenance od records; register of residents; Operating Policies and
Procedures; mental health tribunals; complaints procedures; risk management procedures; insurance; certificate of registration.

The centre was also found compliant with rules under the Mental Health Act in relation to the use of electro-convulsive therapy; the use of seclusion; consent to treatment; admission, transfer and discharge. 

Non Compliant Regulations and Rules

Privacy - Risk Rating High

While staff, accommodation and facilities were deemed compliant the report said: "Residents’ dignity and privacy were not appropriately respected at all times. At the time of the inspection
there was a resident garden area accessible from the high dependency area. This garden area was not
private to residents as it was overlooked and visible from a public walkway."

Premises - Risk Rating High

"The registered proprietor did not ensure the premises were maintained in good decorative condition due to the following: external walls and garden furniture, and windows around garden areas required cleaning and painting. Pathways and paving in the garden area required cleaning, 22(1)(a).

"The registered proprietor did not ensure that the condition of the physical structure and the overall approved centre environment was developed and maintained with due regard to the specific needs of residents and the safety and wellbeing of residents. Ligature points and were not minimised to the lowest practical level, based on risk assessment. Hazards were not minimised. There were rough and uneven surfaces in the garden area that constituted trip hazards, 22(3)."

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Staffing - Risk Rating Low

An appropriately qualified staff member was on duty and in charge at all times. The numbers and skill mix of staffing in the approved centre was sufficient to meet resident needs. However the "centre was non-compliant with this regulation because the registered proprietor did not ensure that all staff had access to education and training to enable them to provide care and treatment in accordance with best contemporary practice. Not all staff had completed their training in the Management of Violence and Aggression."

Use of Physical Restraint - Risk Rating High

The inspection found the centre to be non-compliant with the code of practice under the Mental Health Act because a registered medical practitioner did not complete a medical examination for one resident within three hours after the start of the episode of physical restraint.

The clinical files of three residents who had been physically restrained were inspected. Physical restraint was only used in rare and exceptional circumstances when the resident posed an immediate threat of serious harm to themselves or others. The use of physical restraint was based on a risk assessment of the residents. Staff had first considered all other interventions to manage each of the
resident’s unsafe behaviour. Cultural awareness and gender sensitivity were demonstrated in each episode of physical restraint. The residents’ next of kin were informed about the physical restraint. The resident was informed of the reasons for, likely duration of, and circumstances leading to discontinuation of physical restraint. Physical restraint was initiated by a registered medical practitioner (RMP) or registered psychiatric nurse (RPN), and a designated staff member was responsible for leading in the physical restraint of a resident and for monitoring the head and airway of the resident. The consultant psychiatrist (CP) or the duty consultant psychiatrist was notified of the use of physical restraint as soon as was practicable.

A corrective and preventative action plan is in place to address the concerns raised by the inspection.

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The report highlighted some areas of concern, that reflected the demand on services:

A TV room had been used on three separate occasions since the 2021 inspection to accommodate
residents when the number of residents were over capacity that did not ensure that the privacy and
dignity of those residents were appropriately respected at all times. A couch had been used as an
alternative to a bed.

Covid continued to affect the operation of the facility. The report states that  training in Management of Violence and Aggression was not completed by nursing staff, medical, and psychologists last summer but took place later in the year. The centre was proactive in managing issues concerning COVID-19 and had a preparedness plan.