'High risk' due to staffing at €200k refurbished Covid hit Laois health unit
A refurbished mental health facility for elderly people in Portlaoise which was at the centre of a fatal Covid-19 outbreak has not complied with a key regulation on staffing despite a €200 k investment in facilities by the HSE.
The Maryborough Centre, based in St Fintan's Hospital on Portlaoise Dublin Road, is a 16-bed unit that was registered in November 2022 following major refurbishment following the onset of Covid in 2020 to provide safe and compliant accommodation and recreational areas for residents.
The approved centre has 16 beds and provides continuing care and psychiatry of later life services for the Laois/Offaly area.
The Mental Health Commission (MHC) has published seven annual inspection reports, and two focused reports, which show non-compliances for the regulation on staffing across eight out of the nine approved mental health centres inspected.
The report on the Portlaoise facility was produced on the back of the inspection in December 2022. It found that out of 34 regulations, the new centre was non-compliant in two key areas - Staffing and Individual Care planning. High risks identified in both.
The Regulator found that there was no occupational therapist and while an agency occupational therapist had been sanctioned but there was no candidate for the position.
No direct access to a dietitian, as had previously been available in the service, but referrals for dietetics could be made through primary care.
There was no access to a general practitioner. There was an additional non-consultant hospital doctor but while they were
available to the approved centre on a daily basis, the regulator said access to a GP was required.
The Regulator found non-compliance because the numbers and skill mix of staffing were not sufficient to meet resident needs. It said there was no occupational therapist (OT) working in, or available to the centre.
The Regulator also found that not all healthcare professionals were up-to-date with the mandatory training of basic
life support, fire safety and the management of violence and aggression.
The staff problem was linked to the second failure to meet regulations. In the Individual Care planning section, the Mental Health Commission found a high-risk non-compliance because residents’ individual care plans were not developed by a multi-disciplinary team as there was no occupational therapist on the multi-disciplinary team.
The Commission gave the chance to the HSE to respond to the inspection findings before publishing its report in May 2023. The response is included in what the Commission published.
The HSE says Occupational Therapy Manager for Mental Health was in post as of March 20, 2023. While links were created with primary care to bridge the gap, an Occupational Therapist had not yet been recruited. The HSE said the Occupational Therapy Manager would "expedite funding request to create new post".
The HSE said a link was established with OT from Primary Care Services, who will facilitate equipment needs in the Maryborough Centre, until a post is created specifically.
On the issue of training the HSE reported that training shows improvements across all disciplines but one area is
being monitored by the Head of Department pending staff member returning to site.
The Mental Health Commission has the power to initiate escalating enforcement actions up to, and including, the removal of an
approved centre from the register and the prosecution of the registered proprietor.
A total of nine residents in the Maryborough Centre died over the Easter bank holiday in 2020 after a Covid-19 outreak. This ultimately led the HSE to overhaul the unit. Residents were transferred temporarily to a facility in Tullamore to allow refurbishment work to be carried out.
In a statement announcing the publication of the reports on Maryborough and other facilities, the Inspector of Mental Health Services, Dr Susan Finnerty highlighted the links between staff shortages, staff training and risk management.
“There are risks associated with an inability to recruit and retain staff which results in an inappropriate skill mix to meet the needs of residents – concerns all of which are highlighted across today’s eight inspection reports. The provision of up-to-date training for staff to ensure the centre meets the basic and mandatory requirement for compliance is essential for the safety and wellbeing of patients and residents," she said.
The statement said the MHC requires corrective and preventive action plans (CAPAs) from all services where non-compliances are identified, each of which must address each non-compliance specifically. It says the MHC monitors the implementation of these on an ongoing basis and requests further information and action as necessary.
It said enforcement action is taken when the MHC is concerned that the care and treatment provided in an approved centre may be a risk to the safety, health and wellbeing of residents, or where there has been a failure by the provider to address an ongoing area of non-compliance.