06 Oct 2022

'Psychological distress' caused to residents at Offaly care home

'Psychological distress' caused to residents at Offaly care home

'Psychological distress' caused to residents at Offaly care home

A HIQA report in the Millbrook House care centre for those with disabilities has found that a fraught environment causes psychological distress for residents.

The report, published this week, was written on foot of an inspection in November 2020.

It found that Millbrook House, located near Crinkle, had a number of issues around the safeguarding of residents, as well as governance issues, stemming from behavioural challenges.

On the date of the inspection, three residents were being cared for at the home, although two residents were away at activities at the time.

The report noted that the centre was "homely" and that interactions observed between staff and the one resident there at the time "appeared familiar and warm."

However, the centre was found to be not compliant with the governance and management policies set down while issues were also found in the areas of safeguarding and individual assessments and personal plans.

The report stated: "The person in charge had safeguarding measures in place to ensure that staff provided care in a respectful manner. Staff were trained in understanding the signs of abuse and staff reported incidents when they occurred. However, the frequency in which unpleasant verbal exchanges took place between residents resulted in psychological distress for residents and amounted to a failure to protect residents from psychological abuse."

The inspector found that staff were "striving to promote the goal of an individualised and safe service to residents" and that "there was good awareness and respect amongst staff of the challenges that residents experienced by living with each other."

However, it was also noted that "unpleasant verbal interactions between residents had escalated in the four months prior to this inspection. While most incidents were minor in nature, the frequency of them was psychologically upsetting for the residents involved and staff were aware of this."

With this in mind, much of the activities were organised in such a way that residents spent minimal time in each others company. Staff recorded incidents that occurred. Documentation viewed by the inspector indicated staff regularly sought advise from specialists around managing the behavioural challenges.

"However, the request and receipt of advice was on emails and generally difficult to piece together," the inspector noted.

The report continued: "During the early months of the pandemic, the house environment was generally calm and less anxiety displayed by a resident. At this time there were only two residents living in the house. Other factors may have also contributed to the resident experiencing low anxiety levels but the impact of a third resident in the house again, from August 2020 onwards, increased the likelihood of behaviours that challenge.

"On June 4, 2020, a risk assessment carried out indicated the likelihood of behaviours that challenge occurring as being low to medium. This risk was reassessed on September 11, 2020, and the likelihood was assessed as being the same.

"However, between June and September, a change in the cohort of residents living in the house increased the likelihood of challenges. Plans were made to try and minimise the impact of a third person moving back into the house. There were many good aspects as to how the move into the house by a third person was managed but there was no doubting the likelihood of behaviours that challenge would increase."

Notifications received by HIQA confirmed this. Again, this raised the validity, accuracy and meaningfulness of the documentation in place, HIQA stated in its report.

On the issue of governance, management and individual plans, the inspector said: "Documentation showed that requests for behaviour support plans to be updated had been made. Such updates were awaited. Most aspects of residents' health, personal and social care needs were reviewed annually; however, the documentation did not show that the written behaviour
support plans were a meaningful part of this annual review.

"This was an issue, given that understanding and managing residents' behaviours in the best way possible, was a key component in the care of each of the three residents. Extra staff were deployed to manage the challenging situation created by this cohort of residents living together," the report added.

"In some regards, this worked. However, it also had the impact of curtailing a resident's capacity for independence. For afternoon and evening hours, one to one staff was deployed for two residents and two to one for another resident. Indications were, that given the right environment, residents could increase their levels of independence. Again staff were aware of these possibilities.

"Some discussions had begun about alternative living arrangements. However, the matter was ongoing for many months and while it was managed day to day, there was limited progress with the provider effecting the changes required to deliver the
outcomes needed."

The inspector also stated: "There was much documentation available around the management of behaviours that challenge. However, the documentation was difficult to navigate and it was unclear what the most up to date practices were. For example, there were behaviour support plans dated 2018 and 2017. In addition,there was a guidance summary document dated 20th May 2019 and there were emails throughout 2020 indicating that support was needed around behavioural issues.

"The emails and documentation indicated aspects of the behavioural support plans weren't working. This included an email from February 2020 about a resident declining the use of a diary to schedule their activities, yet this was a key component of the behaviour support plan that was on file up to the date of this November 2020 inspection."

In so far as the inspector could establish, one plan gave the guidance for staff to 'not redirect' a resident if they were displaying specific behaviours, and for staff to 'focus on the other residen'.

"However, notes from an incident that occurred on November 17, 2020, indicated this was not the guidance that was followed."

A request had been made for behaviour support plans to be updated but updating the written plans was likely to take up to four months. This raised a question around the meaningfulness of multidisciplinary input and how it was incorporated into the annual review, the report said.

The inspector was informed personal plans were to be updated in December 2020 and would include families. However, as of
25 November 2020, no date was set for any of the three reviews.

Millbrook House was issued with a compliance plan outlining areas that need to be addressed to bring it into line with HIQA policy following this inspection. 

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