Cavan Psych Unit takes 'corrective' action following breach of regulations

Steps are being taken to make a number of improvements at the Acute Psychiatric Unit at Cavan General Hospital after it was found to be non-compliant with nine regulations following an unannounced inspection last year.

The Mental Health Commission published its report this week arising out of the inspection, which took place over three days last August. The Commission identified a number of matters that need addressing at the unit, which it said posted a 'moderate risk' to staff or patients.

The HSE has told the Celt today that 'a corrective and preventative action plan' was developed in response to the areas of non-compliance and accepted by the commission (see full statement below).

The approved centre is located on the lower ground floor of Cavan General Hospital. The centre can accommodate up to 25 residents in seven single bedrooms, three four-bed dormitories and one six-bed dormitory.

Staffing

In relation to staffing, the Commission found that there were no written policies relating to the recruitment, selection and vetting of staff, and not all healthcare professionals had been trained in basic life support, therapeutic management of violence and aggression or equivalent, fire safety and the Mental Health Act 2001.
Also the Commission found that there was no written policy on staffing or risk management as is required.

Consent to treatment

The unit was also non compliant with regulations with regard to Consent to Treatment. Six clinical files were reviewed with regard to Consent to Treatment.
In two incidents, where the patient had provided consent to treatment, the responsible consultant psychiatrist had not documented that they were satisfied that these patients were capable of understanding the nature, purpose and likely effects of the proposed treatment. Therefore the centre was deemed ‘non-compliant’ in that regard.

Complaints procedures

Six complaints were examined by the inspector. Three had not been resolved. Two were marked 'yes'. Complaints had been discussed at the approved centre's business meetings but the outcomes or timeframes in which they had been resolved had not been documented. The inspectorate, however, found the staff to have been very open and encouraging about complaints. Neither was there any record of whether the complainants were happy with the outcome of the complaints.
The approved centre was non-compliant with this regulation because three complaints reviewed had no documented outcome and the results of any investigations were not fully and properly recorded.
Another area of non-compliance found by the Inspectorate was in relation risk management procedures and the report finds “there was no written comprehensive policy in place at the time of the inspection”.
The report did also highlight a number of areas of good practice at the unit. The approved centre had instigated a Therapeutic Activities Programme committee that met six weekly to review and identify improvements with therapies and programmes.
A Discharge Planning committee also met weekly; while two nurses were scheduled to commence specialised training in Electro-Convulsive Therapy the following month (September 2016). An induction pack had been developed for new non-consultant hospital doctors (NCHDs) and a training schedule was in place for all staff.

HSE Response 

The management of the hospital were asked to respond to the findings of the Commission. Here is their statement in full: 'The Mental Health Commission undertake an unannounced inspection of all approved centres on an annual basis to monitor compliance with the Mental Health Regulations for Approved Centres. 

'In August 2016 the Acute Psychiatry Unit in Cavan was inspected and inspectors found both areas of compliance rated as excellent and satisfactory and areas of non-compliance. A corrective and preventative action plan was developed for the areas of non-compliance and this was accepted by the Mental Health Commission. The Cavan Monaghan Mental Health Service monitors the implementation of action plans to ensure services provided are in accordance with the Regulations for Approved Centres.'