Concern at standard of care at children’s unit

ASSAULTS on staff and a high use of physical restraint has led to a call for a total review of behaviour management in a unit for troubled children.

Inspectors from the Social Services Inspectorate (ISSI), who visited the high support residential unit in Cork in April said they had “serious concerns about some aspects of the standard of care provided to the young people in the unit.”

They found that “in spite of all the effort, patience and commitment of the staff” there had been serious difficulties in the management of behaviour in the unit over the three months prior to the inspection.

The inspectors warned the situation, which had led to high levels of physical restraints, use of sanctions, and assaults on staff, was not acceptable and had led to poor staff morale.

“At times, owing to the fact that the young people were beyond the staff’s control and regular routines were disrupted, the quality of primary care was compromised by unpredictability regarding the organisation of meals and insecurity at bedtimes,” the report said.

“There were difficulties in establishing appropriate boundaries, and inspectors found that the approaches to managing behaviour in the unit did not provide a sound structure for staff to develop confidence in tackling difficult behaviour consistently and to establish a culture of safety for the young people and themselves.”

The inspectors were critical of the support systems put in place by the Southern Health Board (SHB) to respond to violence against staff.

“Support systems within the unit, such as super-vision, were not as regular as described in the unit’s policy.”

The inspectors recommended the board carry out a total review of the management of behaviour in the unit “to improve the quality of primary care and the quality of interaction between staff and the young people.”

Vetting procedures for staff at the five-bed unit for boys aged 12-15 were also criticised.

At the date the inspection was announced there were three boys aged 12-14 years in the unit, which had 24 staff.

However, not all complied with Department of Health guidelines on vetting, which require staff to have garda clearance and three references before commencing employment.

Twenty-one out of 24 of the staff had garda clearances and one of those commenced employment before the clearance was received. Five staff had three references, 15 had two, three had one, and one member of staff had none.

Of the 48 references, 43 were received before staff started working in the unit.

“Inspectors are concerned that the board’s vetting procedures have not become more rigorous, given that the guidelines from the DoHC have been in place for nearly ten years and recommendations regarding vetting have been made in inspection reports of other SHB children’s centres,” the inspectors said.

On a more positive note, the inspectors commended standards of education, health and accommodation and the commitment and professionalism of staff.

However, it warned the overall standard of care had to improve. Inspectors intend to carry out a follow-up inspection of the unit in six months’ time to assess the progress made in fulfilling the recommendations.

Yesterday a spokesperson for the SHB said they hoped to have most of the recommendations implemented by mid-October. She said a number of measures had already been taken, including training staff in therapeutic crisis intervention. Each recommendation has been given an individual timeframe for implementation.