Report of the Inspector of Mental Health Services 2012

Report of the Inspector of Mental Health Services 2012 EECUTIVE CATCHMENT AREA/INTEGRATED SERVICE AREA Galway, Mayo and Roscommon HSE AREA MENTAL HEALTH SERVICE APPROVED CENTRE West Mayo Adult Mental Health Unit, Mayo General Hospital NUMBER OF WARDS 1 NAMES OF UNITS OR WARDS INSPECTED Adult Mental Health Unit TOTAL NUMBER OF BEDS 32 CONDITIONS ATTACHED TO REGISTRATION No TYPE OF INSPECTION Unannounced DATE OF INSPECTION 19 June 2012 Summary There was a repeated failure by the approved centre to have due regard for the safeguards provided for by the Rules Governing the Use of Seclusion. There was little evidence that residents were involved in care planning. Because therapeutic services and programmes were not specified in each resident s Individual Care Plan, the conditions of Article 16 Therapeutic Services and Programmes were not met. Page 1 of 53

OVERVIEW In 2012, the Inspectorate inspected this Approved Centre against all of the Mental Health Act 2001 (Approved Centres) Regulations 2006. The Inspectorate was keen to highlight s and initiatives carried out in the past year and track progress on the implementation of recommendations made in 2011. In addition to the core inspection process information was also gathered from self-assessments, service user interviews, staff interviews and photographic evidence collected on the day of the inspection. DESCRIPTION The Adult Mental Health Unit (AMHU) was opened in 2003 and was located in Mayo General Hospital, Castlebar, County Mayo. On the day of inspection there were 22 residents, six of whom were detained under the Mental Health Act 2001. SUMMARY OF COMPLIANCE WITH MENTAL HEALTH ACT 2001 (APPROVED CENTRES) REGULATIONS 2006 COMPLIANCE RATING 2010 2011 2012 Fully Compliant 26 26 23 Compliance 2 2 6 Compliance 2 1 2 Not Compliant 0 1 0 Not Applicable 1 1 0 Page 2 of 53

PART ONE: QUALITY OF CARE AND TREATMENT SECTION 51 (1)(b)(i) MENTAL HEALTH ACT 2001 DETAILS OF WARDS IN THE APPROVED CENTRE WARD NUMBER OF BEDS NUMBER OF RESIDENTS TEAM RESPONSIBLE Adult Mental Health Unit 32 22 5 General Adult Teams Rehabilitation Psychiatry of Old Age Mental Health Intellectual Disability QUALITY INITIATIVES 2011/2012 A strategic multidisciplinary management group had been established to look at the management of the unit. A pilot programme networking the Community Mental Health Teams with the AMHU electronically had been commenced. An appointment texting service had been set up in outpatient service and this has reduced the incidence of non-attendance at outpatients by eighty per cent. A peer support worker had started to visit the residents on a weekly basis. Further enhancements were made to the garden area. PROGRESS ON RECOMMENDATIONS IN THE 2011 APPROVED CENTRE REPORT 1. All doctors and nurses involved in seclusion must be cognisant of their professional duties and responsibilities under the Rules Governing the Use of Seclusion. Outcome: Staff in the approved centre, as previously reported in the 2010 and the 2011 inspections, had failed once again to achieve full with the Rules Governing the Use of Seclusion. 2. The approved centre should comply with the Code of Practice on the Use of Physical Restraint in Approved Centres. Outcome: Structures had been put in place to ensure that all Physical Restraint Clinical Practice Forms were completed and placed in clinical files. However when next of kin were not informed of the resident s restraint, a record of why this had not occurred was not entered into resident s clinical file. 3. It must be documented in the resident s individual care plan why they are wearing night clothes during the day. Outcome: In the case of four residents it was documented in individual care plans the reasons why night clothes had to be worn. 4. All residents in hospital for six months or more must have six-monthly physical reviews. Outcome: No resident had been in the approved centre for a period greater than six months. 5. Curtains should be made available for the four single bedrooms which have an observation window in the door to ensure privacy for residents. Outcomes: Four single rooms had no curtain on the observation window of the doors. Page 3 of 53

6. There should be increased occupational therapy input into the therapeutic services and programmes in the approved centre. Outcomes: Three occupational therapists on the sector teams admitting to the unit planned to provide greater input into the therapeutic services and programmes in the approved centre. The Activities Nurse had been replaced by an occupational therapy assistant. 7. Adequate ventilation should be installed in all en suite shower rooms to prevent dampness and the potential for mould. Outcome: A new ventilation system had been installed with positive results. Page 4 of 53

PART TWO: EVIDENCE OF COMPLIANCE WITH REGULATIONS, RULES AND CODES OF PRACTICE, AND SECTION 60, MHA 2001 2.2 EVIDENCE OF COMPLIANCE WITH REGULATIONS UNDER MENTAL HEALTH ACT 2001 SECTION 52 (d) Article 4: Identification of Residents is still Two registered nurses or a registered nurse and a nursing student administered medication. The resident s identification was ascertained prior to receiving medication, health care or other services by affirming name of resident and date of birth. Page 5 of 53

Article 5: Food and Nutrition is still Fresh, filtered drinking water was available to residents on the unit. There was a good choice of main meal. A menu was displayed. Food was cooked by a private catering service from the kitchens of Mayo General Hospital. Page 6 of 53

Article 6 (1-2): Food Safety is still The Environmental Health Officer s Food Safety report of 22 December 2011 was made available to inspectors. Page 7 of 53

Article 7: Clothing is still An adequate supply of clothing was provided to residents in the event of their not having their own. On the day of inspection four residents were required by staff to wear night clothes and this was specified in the residents respective individual care plans. Page 8 of 53

Article 8: Residents Personal Property and Possessions is still The approved centre had written operational policies and procedures relating to residents personal property and possessions. A record, in triplicate form, was maintained of each resident s personal property and possessions, a copy of which, was available to the resident. Each resident retained control of his or her personal property and possessions except under circumstances where this posed a danger to the resident. Provision was made for safe-keeping of all personal property and possessions. Page 9 of 53

Article 9: Recreational Activities is still There was a sensory garden and a well-stocked book shelf. There were a number of TVs throughout the unit. There was a weekly outdoor walking group. There was a programme of activities during the day. Page 10 of 53

Article 10: Religion is still All residents were facilitated in the practice of their religion. Page 11 of 53

Article 11 (1-6): Visits is still A quiet room was available for visitors. Child visitors could be accommodated here and had to be accompanied by a responsible adult. Visiting times were flexible apart from when therapeutic programmes were attended by a resident and during mealtimes. The approved centre had written operational policies and procedures for visits. Page 12 of 53

Article 12 (1-4): Communication is still The approved centre had written operational policies and procedures on communication. Mail was sent and received by residents. Phone calls could be facilitated by staff. Mobile phones were retained by residents except when specified in the resident s individual care plan. Page 13 of 53

Article 13: Searches is still Searches of residents did take place. The clinical file of one resident who had been searched was examined by inspectors. The search had been documented in the resident s clinical file. The approved centre had appropriate policies and procedures in place to satisfy this Article of the Regulations. Page 14 of 53

Article 14 (1-5): Care of the Dying is still No resident had died in the approved centre in 2012 up to the time of inspection. The approved centre had written operational policies and protocols for care of residents who are dying. Page 15 of 53

Article 15: Individual Care Plan is still Nine individual care plans (ICPs) were inspected. They were of poor quality, giving minimal information. In some no goals were specified. In one ICP the only intervention consisted of the words Mx charted. In the majority of ICPs inspected there was no evidence that service users had been involved in their individual care plans. One ICP had not been reviewed for four months and the original ICP was stored in a previous clinical file. Multidisciplinary team (MDT) input was not evident in most ICPs. The format of the ICPs was good and included needs, strengths, goals and interventions and included a MDT and service user input as well as reviews. It was unsatisfactory that these were not being fully utilised. Breach: 15 Page 16 of 53

Article 16: Therapeutic Services and Programmes is still In most ICPs inspected, therapeutic services and programmes were not specified. This was despite the approved centre having a good range of therapeutic programmes. The activities nurse had been redeployed within the service and an assistant occupational therapist was in the process of taking over the therapeutic programmes. The range of activities was impressive and included art, music, relaxation and individual therapies. These were timetabled and clearly displayed. Because therapeutic services and programmes were not specified in each resident s ICP the conditions of this Article were not met. Breach: 16 Page 17 of 53

Article 17: Children s Education APPLICABLE APPLICABLE is still One child had been admitted to the approved centre. Access to education was not applicable for this child. The approved centre had a written operational policy on Children s Education. Page 18 of 53

Article 18: Transfer of Residents is still When a resident was transferred for treatment to another approved centre, hospital or other place, all relevant information, including a doctor s referral letter, nursing documentation and a copy of the resident s prescription was provided by the nurse carrying out the transfer as well as a verbal report. The approved centre had a written policy and procedures on the transfer of residents. Page 19 of 53

Article 19 (1-2): General Health is still Adequate arrangements were in place for access by residents to general health services. From a sample of clinical files examined by inspectors, there was evidence that the general health needs of residents were attended to. No resident had been in the approved centre for a period exceeding six months. The approved centre had written operational policies and procedures for responding to medical emergencies. Page 20 of 53

Article 20 (1-2): Provision of Information to Residents is still Details of the resident s multidisciplinary team were available to residents. House-keeping practices, including arrangements for personal property, mealtimes, visiting times and visiting arrangements were available to residents. Verbal and written information on diagnoses was available. Details of the relevant advocacy and voluntary services were displayed. Information on indications for use of all medications to be administered to the resident, including any possible side-effects were available. The approved centre had written operational policies and procedures for the provision of information to residents. Page 21 of 53

Article 21: Privacy is still Four single-bed rooms which had observation windows in the doors had no privacy curtain on the inside to ensure the residents privacy and dignity. This was reported in the 2011 inspection report and was one of the recommendations in the 2011 report. Breach: 21 Page 22 of 53

Article 22: Premises is still The premises was clean, bright, well-lit, ventilated and heated. The problems with the ventilation in the en suite shower rooms, as reported in the 2011 inspection report had been remedied. There were appropriate and suitable furnishings in the unit. The garden area was well-maintained. Maintenance by the Maintenance Department was described as being very good. Page 23 of 53

Article 23 (1-2): Ordering, Prescribing, Storing and Administration of Medicines is still The approved centre had appropriate and suitable practices. The approved centre had a written operational policy relating to the ordering, storing, administration and prescribing of medicines. Page 24 of 53

Article 24 (1-2): Health and Safety is still The Health and Safety Statement was available for examination by inspectors in the approved centre. Page 25 of 53

Article 25: Use of Closed Circuit Television (CCTV) is still CCTV was used in the seclusion room. CCTV was not clearly labelled in the seclusion room area. The approved centre had a clear written policy and protocols articulating its function in relation to the observation of residents. CCTV was incapable of recording. Breach: 25(1)(b) Page 26 of 53

Article 26: Staffing WARD OR UNIT STAFF TYPE DAY NIGHT Adult Mental Health Unit Nursing 7 RPNs including 1 CNM2 6 RPNs + one CNM3 based in approved centre Health Care Assistant 1 0 Clinical Nurse Manager (CNM), Registered Psychiatric Nurse (RPN), Non Consultant Hospital Doctor (NCHD),Director of Nursing, (DON), Assistant Director of Nursing (ADON), Health Care Assistant (HCA).. is still Not all teams were fully staffed with health and social care professionals: psychologists, occupational therapists (OTs) and social workers. Three new OT positions had not yet been recruited. Three social worker posts and two psychologist posts were reported to be in train. There was an appropriately qualified member of staff on duty and in charge of the approved centre at all times. Staff had access to education and training and the staff training register in relation to nursing staff was examined by inspectors. Copies of the Mental Health Act 2001, Rules, Regulations and Codes of Practice were available to staff of the approved centre. Breach: 26(2) Page 27 of 53

Article 27: Maintenance of Records is still Some clinical files were bulky and, although maintained in a manner so as to ensure completeness and accuracy, it was difficult to retrieve some information. A written policy and procedures relating to the creation of, access to, retention and destruction of records was stated to be generic HSE policy but was not available to inspectors on the day of inspection. Documentation of inspections relating to food safety, health and safety and fire inspections were maintained in the approved centre and were examined by inspectors. Breach: 27(1),(2) Page 28 of 53

Article 28: Register of Residents is still The Register of Residents was compliant with Schedule 1 to the Regulations. Page 29 of 53

Article 29: Operating policies and procedures is still The Records policy was unavailable to inspectors on the day of inspection and the Complaints policy was a generic HSE policy dated 2006 and there was no record that this had been reviewed at least every three years. Breach: 29 Page 30 of 53

Article 30: Mental Health Tribunals is still The approved centre cooperated fully with Mental Health Tribunals. Any assistance required by residents in relation to Mental Health Tribunals was attended to by staff of the approved centre. Page 31 of 53

Article 31: Complaint Procedures is still The Complaints policy was a generic HSE policy dated 2006 and there was no record that this had been reviewed at least every three years. The complaints procedure was displayed in a prominent position in the approved centre. A nominated person was available in the approved centre to deal with complaints. A record of complaints was available to inspectors on the day of inspection. Breach: 31(1) Page 32 of 53

Article 32: Risk Management Procedures is still The risk management policy satisfied all the requirements of this Risk assessment and risk management were evident in a sample of clinical files examined. Page 33 of 53

Article 33: Insurance is still The approved centre was covered by the Health Service Executive (HSE) State Indemnity Insurance and the insurance certificate was available for examination by inspectors. Page 34 of 53

Article 34: Certificate of Registration is still The Certificate of Registration was framed and displayed in a prominent position in the approved centre. Page 35 of 53

2.3 EVIDENCE OF COMPLIANCE WITH RULES MENTAL HEALTH ACT 2001 SECTION 52 (d) SECLUSION Use: The approved centre used seclusion. SECTION DESCRIPTION FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT 1 General principles 3 Orders 4 Patient dignity and safety 5 Monitoring of the patient 6 Renewal of seclusion orders APPLICABLE 7 Ending seclusion 8 Facilities 9 Recording 10 Clinical governance 11 Staff training 12 CCTV 13 Child patients APPLICABLE Page 36 of 53

There was a failure by the service to have due regard for the safeguards provided for by the Rules Governing the Use of Seclusion. The clinical file of one current resident and one former resident who had been secluded were examined by inspectors. The seclusion register was examined. In the clinical file of the former resident there was no documentary evidence that this seclusion episode had been in the best interests of the resident or that the resident had posed an immediate threat of serious harm to self or others. There was no documentary evidence to suggest that the service had considered all other interventions to manage the resident s unsafe behaviour before deciding to use seclusion. For this episode of seclusion the medical notes were not clear so as to indicate the reasons why seclusion had been used. In the nursing notes, the reason for secluding the resident was documented as: Placed in seclusion for a period of assessment due to [their] ongoing maladaptive behaviour. photographic evidence was taken of these notes. In the two clinical files examined there was no documentary evidence that each resident had been afforded the opportunity to discuss the seclusion episode with members of the multidisciplinary team following seclusion. The Seclusion Register, in one instance of seclusion initiated by a registered nurse, had not been fully completed in that the date and the time that seclusion had commenced for this episode of seclusion had not been recorded, the approved centre name had not been recorded and the signature of the member of nursing staff who had initiated seclusion had not been recorded. This seclusion episode occurred 27 days prior to the day of inspection. Photographic evidence was taken. This copy of the Seclusion Register had not been placed in the resident s clinical file. For one episode of seclusion, although it was indicated in the seclusion register that the next of kin had not been informed, the reason for not doing so was not documented in the clinical file. The nearest toilet/washing facilities were some ten metres distant, across the corridor from a residents sitting room and a bedroom. There was no seclusion mattress in the seclusion room. It was reported that the old one had been damaged and had needed replacement. The service had purchased two new seclusion mattresses but it was reported that these were not suitably safe due to the design and were currently being stored in the ECT recovery room. The service had a written operational policy on seclusion. There was no documentary evidence in both clinical files that the episodes of seclusion had been reviewed by members of the multidisciplinary team involved in the residents care and treatment. All staff had been trained in Crisis Prevention Intervention (CPI). The seclusion monitor was in such a position outside the seclusion room so as not to ensure viewing was restricted to designated personnel. CCTV signage was not evident in the vicinity of the seclusion room. Breach: 1.1, 1.2, 3.3(b), 3.7, 7.4, 8.1, 8.3, 9.3, 10.3, 12.2(a),(b). Page 37 of 53

Electroconvulsive Therapy (ECT) (DETAINED PATIENTS) Use: ECT was administered in the approved centre. No detained patient was receiving ECT at the time of inspection. SECTION DESCRIPTION FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT 2 Consent 3 Information 4 Absence of consent APPLICABLE 5 Prescription of ECT APPLICABLE 6 Patient assessment APPLICABLE 7 Anaesthesia APPLICABLE 8 Administration of ECT APPLICABLE 9 ECT Suite 10 Materials and equipment 11 Staffing 12 Documentation APPLICABLE 13 ECT during pregnancy APPLICABLE Page 38 of 53

The approved centre had ECT Accreditation Service (ECTAS) approval. The ECT suite was very good and fully compliant with the Code of Practice. Consent forms and appropriate information packs were available. There was a nominated consultant psychiatrist for ECT and there was a nurse trained in ECT. Page 39 of 53

MECHANICAL RESTRAINT Use: Mechanical restraint was not used in the approved centre. Page 40 of 53

2.4 EVIDENCE OF COMPLIANCE WITH CODES OF PRACTICE MENTAL HEALTH ACT 2001 SECTION 51 (iii) PHYSICAL RESTRAINT Use: Physical restraint was used in the approved centre. SECTION DESCRIPTION FULLY SUBSTANTIALLY MINIMAL COMPLIANT COMPLIANT COMPLIANCE COMPLIANT 1 General principles 5 Orders 6 Resident dignity and safety 7 Ending physical restraint 8 Recording use of physical restraint 9 Clinical governance 10 Staff training 11 Child residents APPLICABLE The clinical practice form book for physical restraint was inspected. The clinical files of two residents who had recently been physically restrained were examined. The physical restraint clinical practice forms were completed and placed in the residents clinical files. There was documentary evidence in the clinical files as to why physical restraint was necessary to manage the residents behaviour. It was noted in the clinical practice forms of both residents that the next of kin had not been informed, but it was not recorded in the clinical files examined as to why the next of kin had not been informed. There was evidence in the clinical files examined that the resident had discussed the episode of physical restraint with a member of the multidisciplinary team. All staff had been trained in Crisis Prevention Intervention (CPI) Breach: 5.9 Page 41 of 53

ADMISSION OF CHILDREN Description: One child had been admitted to the approved centre since January 2012 to the time of inspection. No child was currently resident in the approved centre. SECTION DESCRIPTION FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT 2 Admission 3 Treatment APPLICABLE 4 Leave provisions APPLICABLE The approved centre was not suitable for the admission of children. Breach: 2.5 Page 42 of 53

IFICATION OF DEATHS AND INCIDENT REPORTING Description: The approved centre forwarded a summary of all incidents to the Mental Health Commission. SECTION DESCRIPTION FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT 2 Notification of deaths APPLICABLE 3 Incident reporting 4 Clinical governance (identified risk manager) No deaths had occurred in the approved centre in 2012 to the date of inspection. A record of incidents was examined by inspectors. The approved centre was compliant with Article 32 of the Regulations. The Risk Management policy identified the risk manager. Page 43 of 53

Electroconvulsive Therapy (ECT) FOR VOLUNTARY PATIENTS Use: ECT was administered in the approved centre. No resident was receiving ECT at the time of the inspection. SECTION DESCRIPTION FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT 4 Consent 5 Information 6 Prescription of ECT APPLICABLE 7 Assessment of voluntary patient APPLICABLE 8 Anaesthesia APPLICABLE 9 Administration of ECT APPLICABLE 10 ECT Suite 11 Materials and equipment 12 Staffing 13 Documentation APPLICABLE 14 ECT during pregnancy APPLICABLE Page 44 of 53

The approved centre had ECT Accreditation Service (ECTAS) approval. The ECT suite was very good and fully compliant with the Code of Practice. Consent forms and appropriate information packs were available. There was a nominated consultant psychiatrist for ECT and there was a nurse trained in ECT. Page 45 of 53

ADMISSION, TRANSFER AND DISCHARGE Part 2 Enabling Good Practice through Effective Governance The following aspects were considered: 4. policies and protocols, 5. privacy confidentiality and consent, 6. staff roles and responsibility, 7. risk management, 8. information transfer, 9. staff information and training. Level of : FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT There were policies regarding admission, transfer and discharge and were available in the approved centre. They included procedures for involuntary admission, self presentation, older people and people with intellectual disability and mental illness. There were policies on medication in accordance with Article 23 of the Regulations Ordering, Prescribing, Storing and Administration of Medicines and on Residents Personal Property and Possessions in accordance with Article 8 of the Regulations. There was a risk management policy in accordance with Article 32 of the Regulations. There was a key worker system in place. Page 46 of 53

Part 3 Admission Process The following aspects were considered: 10. pre-admission process, 11. unplanned referral to an Approved Centre, 12. admission criteria, 13. decision to admit, 14. decision not to admit, 15. assessment following admission, 16. rights and information,17. individual care and treatment plan, 18. resident and family/carer/advocate involvement, 19. multidisciplinary team involvement, 20. key-worker, 21. collaboration with primary health care community mental health services, relevant outside agencies and information transfer, 22. record-keeping and documentation, 23. day of admission, 24. specific groups. Level of : FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT There was an excellent admission process. The decision to admit was made by the consultant psychiatrist. Each resident had a mental health examination and a physical examination. A risk assessment was carried out on each resident. The approved centre was compliant with Article 20 of the Regulations on provision of information to the resident. There was a key worker system in place and advocacy services were available. The approved centre was compliant with Article 7 and 8 of the Regulations in respect of clothing and personal property and possessions. The approved centre was not fully compliant with Article 27 of the Regulations Maintenance of Records, in that the clinical files were not well maintained. Not every resident had an Individual Care Plan in accordance with Article 15 of the Regulations. Breach: 17.1, 22.6 Page 47 of 53

Part 4 Transfer Process The following aspects were considered: 25. Transfer criteria, 26. decision to transfer, 27. assessment before transfer, 28. resident involvement, 29. multidisciplinary team involvement, 30. communication between Approved Centre and receiving facility and information transfer, 31. record-keeping and documentation, 32. day of transfer. Level of : FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT The decision to transfer was made by the consultant psychiatrist. The approved centre was compliant with Article 18 of the Regulations in respect of transfer of information. The clinical file accompanied the resident on transfer. Page 48 of 53

Part 5 Discharge Process The following aspects were considered: 33. Decision to discharge, 34. discharge planning, 35. predischarge assessment, 36. multi-disciplinary team involvement, 37. key-worker, 38. collaboration with primary health care, community mental health services, relevant outside agencies and information transfer, 39. resident and family/carer/advocate involvement and information provision, 40. notice of discharge, 41. follow-up and aftercare, 42. record-keeping and documentation, 43. day of discharge, 44. specific groups. Level of : FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT The approved centre had an excellent discharge procedure. The decision to discharge was made by the consultant psychiatrist and the multidisciplinary team and was discussed with the resident and, where appropriate, with the resident s family. A discharge letter was sent to the general practitioner and the community mental health team. Follow-up was arranged. Page 49 of 53

HOW MENTAL HEALTH SERVICES SHOULD WORK WITH PEOPLE WITH AN INTELLECTUAL DISABILITY AND MENTAL ILLNESS Description: There was no resident with intellectual disability and mental illness in the approved centre at the time of inspection. The following aspects were considered: 5. policies, 6. education and training, 7. inter-agency collaboration, 8. individual care and treatment plan, 9.communication issues, 10. environmental considerations, 11. considering the use of restrictive practices, 12. main recommendations, 13. assessing capacity. Level of : FULLY COMPLIANT SUBSTANTIALLY COMPLIANT MINIMAL COMPLIANCE COMPLIANT There was a policy with regard to people with an intellectual disability and mental illness. The approved centre had arranged training in intellectual disability and mental illness due to start the following week. This was open to all staff. Page 50 of 53

2.5 EVIDENCE OF COMPLIANCE WITH SECTIONS 60/61 MENTAL HEALTH ACT 2001 (MEDICATION) SECTION 60 ADMINISTRATION OF MEDICINE Description: One detained patient was in hospital for a period exceeding three months. SECTION FULLY COMPLIANT COMPLIANT Section 60 (a) Section 60 (b)(i) APPLICABLE Section 60 (b)(ii) APPLICABLE This patient had signed a consent form for the administration of medication. Page 51 of 53

SECTION 61 TREATMENT OF CHILDREN WITH SECTION 25 MENTAL HEALTH ACT 2001 ORDER IN FORCE Description: No child was detained in the approved centre since January 2012 to the time of inspection. Page 52 of 53

SECTION THREE: OTHER ASPECTS OF THE APPROVED CENTRE SERVICE USER INTERVIEWS One service user spoke with the inspectors. They stated that they considered the care in the AMHU to be of good quality and that staff listened to residents. OVERALL CONCLUSIONS Despite a perfectly adequate format for individual care plans, entries were sloppy, contained minimal information and had little multidisciplinary input. There was little evidence that the resident was involved in his or her individual care plan. This was a slippage since the inspection in 2011. The service had planned to carry out an audit on care planning and this should be done immediately. As identified in the inspections in 2010 and 2011, the approved centre continues to fail to pay due regard to the safeguards provided to residents in the Rules Governing the Use of Seclusion and this might warrant a re-inspection later in 2012. RECOMMENDATIONS 2012 1. Each resident must have an individual care plan as defined in the Regulations. The individual care plan must be fully completed, show multidisciplinary input, service user involvement and demonstrate that it is meaningful for the resident. 2. An audit on individual care planning should commence immediately. 3. Staff in the approved centre must ensure full with the Rules Governing the Use of Seclusion. This was a recommendation of the 2010 and 2011 inspection reports. 4. An audit on the use of seclusion in the approved centre must commence immediately. 5. Therapeutic services and programmes must be specified in each resident s individual care plan. Page 53 of 53