Ferrard House EMI Unit 1.0 Background Ferrard House is a statutory residential home for the Elderly Mentally Infirm located on the Station Road, Antrim. On Wednesday 27 June 2012 flood waters entered the interior of Ferrard House. Given the seriousness of the breach and the risk to residents the decision was made to immediately evacuate all 28 residents to alternative accommodation as follows; 24 were transferred to Inver 3 and Tardree 2 Holywell (Tardree 2 is a recently vacated ward at the hospital) 3 were accommodated in Brooklands Care Home, Antrim 1 shared care resident returned home These 28 were comprised of 20 permanent residents, 7 respite and one assessment bed. As of 15th August 2012 there were nine permanent residents remaining in Holywell ( all in Tardree 2), with one permanent resident currently in Brooklands. One respite service user is also currently in Tardree 2, awaiting an alternative placement. The total residents in Tardree 2 have reduced as a number of relatives chose to move their relatives from Tardree 2 to more appropriate alternative EMI accommodation in the community. The breakdown of residents that have moved is as follows: Permanent Residents Currently in Tardree/ Brooklands Permanent Residents Transferred to EMI Residential Care Permanent Residents Transferred to Nursing Care 9 7 4 Of the nine permanent residents currently in Tardree 2/Brooklands a further four families have expressed an interest in moving to alternative appropriate care. These moves will be accommodated within the next 4-6 weeks. Staff continue to engage with the relatives of the five remaining residents regarding their future care. 2.0 Ferrard House - Estates Issues Ferrard House has experienced a degree of water ingress on several occasions in recent years however the flooding in June was the most extensive and could not be managed through decant to one end of the building as had been the case previously. NHSCT estates department have worked closely with Water Services over recent years to seek to protect the building from storm water ingress however the measures
implemented to date could not protect against the levels of storm water experienced in June 2010. An extract from an Estates Report following the flood in June is attached as Annex 1 It is clear from this report that the Ferrard Building should remain closed for the foreseeable future given the damage to the building and the fact that Estates cannot guarantee that it will not flood again putting residents at risk. It should also be noted that the Trust had been actively considering the future of this building given its deficits in providing accommodation for dementia care and that it fails to meet contemporary registration standards. An extract from a draft report on EMI reprovision which considers the quality of the accommodation in Ferrard (and Moylinney in Newtownabbey) is attached as Annex 2. The current accommodation provided in Tardree 2 is only adequate as a short term decant given that it is designed for inpatient care, does not provide accommodation which meets residential care registration standards and is inappropriately located on a hospital campus. 3.0 Staff Impact The staff group at Ferrard are currently working with those residents decanted to Tardree 2. However, as resident numbers decrease staff numbers required on each shift is lowered. In the first instance temporary and as and when staff hours have been reduced and as resident numbers reduce further in the next 4-6 weeks the staff numbers will continue to be reviewed. Alternative employment will be required for the 21 permanent staff as residents numbers reduce. Arrangements for managing this and staff engagement is actively being progressed by Mental Health Services utilising the Trust s Human Resource Management of Change Framework 4.0 Options available to NHSCT Given the current situation three options for the service were identified; Option 1 Transfer Remaining Residents back to Ferrard Positives 1. Residents will go back to a previously familiar environment 2. Would address remaining relatives concerns about residents moving to an alternative care environment. Constraints 1. No guarantee can be made that flood waters will not breach the home in the future 2. Currently the unit remains unfit to provide safe accommodation for residents with particular electrical and infection control issues 3. Unsustainable number of residents returning to Ferrard
4. Safety concerns due to managing a small number of residents in a large building Option 2 Maintain Remaining Residents in Tardree 2 Positives 1. Residents will remain in a safe and secure setting 2. Residents will remain in a familiar setting Constraints 1. RQIA has approved the use of Tardree 2 only as a decant unit. 2. Limitations of environment of Tardree 2 eg use of wards/no outside space 3. Located on a hospital campus 4. Unsustainable to maintain a unit to care for a diminishing number of residents Option 3 Relocate Remaining Residents to Appropriate Alternative Community Placements Positives 1. Residents will be in a safe secure environment that can provide long term care. 2. The transfer will involve one move whereas a move back to Ferrard may result in an unnecessary additional move. 3. Residents will be in a home registered by RQIA Constraints 1. Anxieties of remaining families in respect of relatives transfer. It is considered that neither Option 1 nor 2 provides a feasible solution and that the Trust should accordingly proceed with Option 3 as the preferred Option. 5.0 Consultation The situation which the flooding of Ferrard created had serious and immediate implications regarding the safety and welfare of residents. The Trust is committed to its legal duties and fundamental principles under Section 75 of the Northern Ireland Act 1998. In terms of equality assessment of this proposal, it is recognised that the immediate need to address the future needs of the clients in Ferrard House superseded the need to do a full Equality Impact Assessment in the first instance but the Trust is cognisant of the need to nonetheless consider and mitigate any potential adverse impact. In keeping with the legislative requirement, Option 3 has been screened to assess the impact on the 9 equality categories. The Trust considers that at this stage
Option 3 will be subject to ongoing screening in order to monitor for any unforeseen major adverse impact. Option 3 will impact on staff. The mitigation for this impact will be the Trust s Human Resource Management of Change Framework which will be applied in the management of people undergoing the change process. Steps will be taken to ensure that the implementation process in no way conflicts with the requirements of existing equality and anti-discrimination legislation. The Trust will put systems in place to support staff through the changes. The ongoing engagement with affected residents and carers will ensure a human rights based approach to the implementation of Option 3 and that residents are cared for in appropriate settings. The Trust will consult and engage with those affected by the implementation of Option 3.. 6.0 Recommendation Given that client safety, comfort and welfare cannot be guaranteed in Ferrard and that it is not feasible for Tardree 2 to be used in the longer term it is recommended that the Trust Board endorse Option 3 whereby the Trust works with residents and their families in transferring the remaining Ferrard residents in Tardree 2 to alternative appropriate placements in the community.
Annex 1 The information below is taken from NHSCT Estate Report Following Ferrard Flooding (July 2012) The Estates report highlighted the following damage as a result of the flood: 1. Fabric of the building floors and walls finishes 2. Contamination by mud silt and sewerage 3. Damage to electrical installations 4. Damage to Heating installation 5. Contamination of kitchen areas and food supplies 6. Damage to furniture and fittings CAUSE OF FLOODING Ferrard House is located at a much lower level that the surrounding ground levels and properties. The unit is approximately 3.0m below the main entrance roads into the Station Road site. All access routes have considerable falls to the building and floor level is at ground level in some locations. Historically it is in a location which has been known to flood in the past. Additional resurfacing over the years and existing hard surfacing around Ferrard House may also have exacerbated the water run-off towards Ferrard House. Surface water coming from road network enters road gullies which despite being cleaned out can blocked quickly or the road gullies and the 100mm storm water pipe work was incapacity of dealing with flash flooding. Recent construction of Tesco on higher ground may have exacerbated the water run-off to our properties. Development of the surrounding area and the increased in hard surfacing may have rendered the storm system inadequate in dealing with flash floods. There is the consideration of climatic change with the increasing rainfall precipitation and increase flash flooding. June and July have recorded the highest rain fall levels on record. We have been subject to heavy and persistent rainfall which has tested the storm drainage system. All of the above factors are not helped with Ferrard being low lying and at risk with the drainage system being incapable of taking the volume of water during periods of very heavy rain. We also have a situation where the services from the plant house enter the building at the kitchen area in a duct chamber below floor level, which continues into the building under the Kitchen and Food storage areas to the control cupboards accessed in the corridor area. There may be a risk that as a result of the exceptional amount of surface water produced during this period of heavy rain is able to use this route to enter the building causing a possible risk with dirty and stagnating water.
ACTIONS TAKEN BY ESTATE SERVICES As a results of previous incidents when there had been minor ingress of water into the building the following actions were taken Arco Drainage Channels and additional gully traps installed at various locations and at the main entrances to divert storm water. Cleaning out of all gully traps and storm drainage runs around Ferrard House on a frequent basis. As we did not have a drawing detailing the Storm drainage system at the Station road site, Estates Services surveyed the Storm Drainage system around Ferrard House and the Station Road Site. We identified a manhole on the Ferrard site which was continually blocking up during periods of heavy rainfall. This had the effect of backing up the remainder of the storm system causing it to flood the area around Ferrard. Estates carried out further investigation with CCTV surveys and discovered that there was a storm drainage run which entered Tesco s site formerly the old Masserene Hospital site. Paul Cooke made contact with Mr. Ken Glass of Patton s who manages the Tesco s property on their behalf. In the interim period Estates monitored the above manhole and storm system during heavy rain and on occasions had the manhole and storm system cleaned or pumped out to alleviated the build up of storm water. The survey work with Tesco s resulted in Estates being able to identify the storm drainage system runs from our site into the Tesco s property and back into our site. The above work has identified that our storm drainage system enters into a 1350mm culvert at the rear of the Station Road site. We are proposing to carry out further work to survey and clean out this storm drainage run on Monday 30 July. We believe that this work will under normal rainfall conditions alleviate the blockage in the storm system. However we have some concerns about the design of the manhole where it enters the culvert as the angle of entry is against the flow of the 1350mm culvert. This may cause a negative pressure which may prevent the storm water from our site entering into the culvert in a period of an extreme flash flood such as we had on Wednesday 27 June and therefore still cause the system to back up and flood. It is planned to open the services duct system to investigate the extent of water ingress. Estates Services cannot give any guarantee that a similar event will not recur and require further time to fully assess the situation / recommendations.
Annex 2 Design of current buildings Ferrard and Moylinney provide care in a traditional residential setting, with a number of shared rooms, narrow corridors and limited toilet facilities. Both buildings were designed forty years ago, for generally more able populations and are based on a race track model of care where residents are enabled to walk continually around the home. While this model of care was seen as best practice at the time of development, there have been vast developments in the design of facilities that provide care to people with dementia in recent years. A number of challenges to the race track design have been identified; including the potential for bottlenecks, where residents will congregate and can lead to incidents and the fact that walking continually can lead to fatigue and result in injuries to residents. In addition the buildings do not meet contemporary registration standards for residential care as determined by the Regulation and Quality Improvement Authority (RQIA). Two examples of standards not met are; All accommodation is provided in single bedrooms Ensuite facilities (minimum of a toilet and wash hand basin) are provided in all residents private accommodation. Regulation and Quality Improvement Authority (RQIA) estates inspections have highlighted the issues above and while the NHSCT has made many improvements over the years there are limitations due to the sites the buildings are situated on and the fabric of the buildings themselves. NHSCT is committed to ensuring the highest standard of care is provided to service users and the limitations of the environment in Ferrard and Moylinney negatively impact on the service.