Inspector raises concerns over staffing levels at Mayo adult mental health unit

A number of concerns in relation to the adult mental unit at Mayo University Hospital have been raised by the Mental Health Commission.

An inspection report conducted by the commission at the facility last October has been published today.

And while the unit has been compliant in many areas of its service, three areas of concern have been cited in the dossier, including one deemed to be a critical risk

Staffing: (non-compliant - critical risk): The numbers and skill mix of staffing in the approved centre was not sufficient to meet resident needs.

In December 2021, there were 39 registered nurses on the roster for the approved centre; in September 2022, that number had reduced by almost 25% to 29 named individuals.

As some residents in the centre required one-to-one nursing or support, this meant that the number of registered psychiatric nurses in the approved centre was not sufficient and not in line with the centre’s registration requirements to meet resident needs, with consideration to the size and layout of the approved centre.

A staff training table submitted by the service for the approved centre in July 2021 included 44 nurses, by comparison to the staff training table in October 2022 which included 30 nurses.

Additionally, an occupational therapy assistant position had been vacant for over a year.

An appropriately qualified staff member was on duty and in charge at all times.

The Mental Health Act 2001, the associated regulation (S.I. No.551 of 2006), and all other relevant Mental Health Commission documentation were available to staff throughout the approved centre.

All healthcare staff were trained in Fire Safety and the Mental Health Act 2001.

Not all healthcare staff were trained in Basic Life Support and the Management of Violence and Aggression, but there was evidence to indicate that this had been due to Covid-19 outbreaks.

All nursing staff were trained in these subjects, and plans were in place to ensure that the remainder would receive their training soon after the inspection.

2. Premises (non-compliant - high risk): Sufficient spaces were provided for residents to move about, including outdoor spaces.

Hazards, including large open spaces, steps and stairs, slippery floors, hard and sharp edges, and hard or rough surfaces, were minimised in the approved centre.

Ligature points, however, were not minimised to the lowest practicable level, based on risk assessment.

The approved centre was not kept in good a state of repair externally and internally.

In the main garden and in the High Dependency Unit (HDU) courtyard, windowsills were dirty and the paint on the walls was peeling off.

In one single room paint on the walls and skirting board was peeling off.

In a single room in the HDU, the wall was damaged, poorly repaired, and in need of painting.

Floor coverings were badly marked and scuffed throughout resident bedrooms, activities rooms, main corridors, and in the tribunal room.

Fire doors in HDU bedrooms were damaged, broken, and ineffective.

A redundant cooker hood needed to be removed from the occupational therapy (OT) activities room. A ceiling tile in the OT assessment kitchen was badly stained due to water leaking into a vent pipe.

The covering of an accordion door in the OT activity room was damaged.

Ligatures had not all been minimised throughout the approved centre.

2. General Health (non-complaint - moderate risk): The clinical files of four residents who were in the approved centre for over six months were examined on inspection.

The six-monthly health assessments documented a physical examination, family or personal history, medication review, and dental health.

For residents on anti-psychotic medication, there was an annual assessment of their glucose regulation, blood lipids, prolactin, and electrocardiogram (ECG) heart function.

For one resident the six-monthly assessment did not record blood pressure or nutritional status.

Adequate arrangements were not in place for one resident to access general health services and for their referral to other health services as required. Referral to the dietetic service where indicated, had not been offered, at the time of inspection.

Residents could access national screening programmes that were available according to age and gender, including but not limited to breast check, cervical screening, retina check (diabetes only) and bowel screening.