Inver 3, Holywell Hospital - 31 July and 1 August 2012

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3.0 Inspection Summary An announced inspection of Inver 3 Holywell Hospital was undertaken on 31 July 2012 from 9.30am – 5pm and 1 August 2012 from 9am – 1pm. The inspectors were Carolyn Maxwell and Margaret Cullen. The purpose of this inspection was to assess the ward’s arrangements and procedures for safeguarding vulnerable adults. The following is a summary of the inspection findings of the arrangements for safeguarding vulnerable adults on this ward. There were 10 patients on the ward at the time of the inspection, two of whom were detained under the Mental Health (NI) Order, 1986. The average age of the patients at time of inspection was 69 years. Two patients had been in the hospital for over 50 years, with the average stay in Inver 3 being 10 years. Although previously designated as continuing care the ward has recently achieved several discharges to community facilities. Community resettlement remains an aspiration for most of the patients. Two patients have no regular visitors. Patients were observed moving freely around the ward and availing of access to the dining room, seating areas, the quiet room, activity room and their bedrooms. Patients could access a snack bar for refreshments and snacks at any time. One patient used a walking aid to assist mobility another patient chooses not leave the ward on any occasions. Four patients have diabetes. One has Parkinson’s disease and one is being assessed for dementia. One patient was subject to restrictions due to potential MRSA. There was evidence of allied health professional’s involvement with patients where indicated. The ward maintains a range of policies, procedures and guidance documents in relation to the safeguarding of vulnerable adults and children. Staff were aware of safeguarding arrangements and a wide range of policies to support a safe and healthy workplace. A number of staff have undertaken training in safeguarding and there had been referrals made by ward staff with regard to vulnerable adults concerns. A recommendation was made for all staff to attend training. Inver 3 ward’s vision statement was on display on the ward along with information about complaints, hospital services, health promotion literature, advocacy, activities and the ward routine. 6
Several patients were experiencing restrictions on the ward at the time of the inspection due to the locked environment. A care plan was in place which referenced this restriction although it was not detailed or personalised sufficiently. There was evidence of physical interventions being used to escort a patient back to the ward and restrictions on spending money. A specific recommendation was made with regard to one patient. The wards procedures for safeguarding patient’s monies were examined. This was complicated by a lack of clarity regarding existing competency assessments. Patients were paying for communal toiletries and tuck. Receipts, whilst provided to account for money, were not itemised. A recommendation was made to change this practice and for review of all patients capacity to handle their own money. A patient complained about the quality of food offered. The inspector observed the lunch being served on day one of the inspection and noted that patients were given the opportunity to supplement from their chosen menu choice and food appeared appetising and was plentiful. There was also fresh fruit available in the snack bar. The ward’s incident records reflected a number of incidents in which staff were subject to physical and verbal aggression by one particular patient. Inspectors also noted incidents in which staff were reported to have used physical interventions to restrain patients. This was not documented fully in records. Staff training records were examined and reflected overdue updates in training in the use of physical interventions, manual handling and fire safety. Nursing staff were receiving supervision and some had undertaken an annual appraisal. All staff confirmed they had had an induction process. The corporate induction did not specify vulnerable adult policy. Recommendations were made in relation to these issues. Staff are referred to HSC/MHDP – MHU 1/10 deprivation of liberty safeguards (DOLS) - Interim guidance issued by the Department Health, Social Services and Public Safety (DHSSPS) 7
Page 1 and 2: MENTAL HEALTH AND LEARNING DISABILI
Page 3 and 4: 1.0 Introduction The Regulation and
Page 5: The ward is situated off the main c
Page 9 and 10: 4.0 Stakeholder Engagement Question
Page 11 and 12: 5.0 Additional Concerns Noted by In
Page 13 and 14: 7.0 Summary of Compliance - RQIA As
Page 15: 24 Outline the safeguarding arrange

Inver 3, Holywell Hospital - 31 July and 1 August 2012

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