A report by the Health Information and Quality Authority into a special care unit for teenagers in Limerick has highlighted concern over the use of medication to restrain a resident.
HIQA carried out a full announced inspection of Coovagh House in Limerick, one of three special care units in Ireland, on 8 and 9 September this year.
Children are detained in special care under a High Court detention order on the basis that they pose a serious risk to themselves or others
Coovagh House has capacity for short-term care for up to four children aged between 11 and 17.
There were three children resident at the centre during the time of the inspection.
HIQA inspectors found that of 30 standards assessed by the health watchdog, the centre exceeded one of those standards and met 18.
Improvement was required in eight areas, and significant risks were identified in relation to three standards assessed.
The report highlighted concern over what it described as the monitoring, recording and reviewing of medication prescribed to one child to help with behaviours despite no psychiatric reason being present.
HIQA inspectors determined that the medication prescribed met the criteria under the authority's definition of chemical restraint.
The report found safeguarding practices were actively promoted by the centre which protected children from self-harm and abuse.
It found a child-centred approach was taken in the promotion of children's rights and supporting children to participate in decision making processes.
The report found operational practices reflected the rights of children to privacy and dignity generally, however it said that some improvements were required.
It identified that some building maintenance issues were outstanding since the last inspection.
Infection control practices were found to be inadequate and required improvements.
The report also found food preparation areas and inside storage presses were sticky and greasy, with residual grime in areas.
HIQA inspectors also reviewed an incident in August of this year required the assistance of gardaí, during which force was used.
Gardaí said the incident had been notified to the Garda Síochána Ombudsman Office, and said the particular use of force was deemed the lowest level of force based on their assessment of the situation on the night in question.
The child was offered the opportunity to make a complaint about this, but declined.
HIQA inspectors found the response to the incident was significant and not child-friendly.
A statutory child in care review took place for this child at the end of the second day of the HIQA inspection, during which the incident was to be reviewed to assess the actions taken.
The report also found there was no provision for psychiatric assessment and ongoing psychiatric review available to the centre.
The report noted there had been 16 instances of physical intervention involving five children and 14 physical restraints involving six children in the 12 months prior to the inspection.
Inspectors found they were carried out appropriately, in line with policy and procedure, for the shortest time frames and in response to behaviours that challenged.
The report found there had been five missing from care episodes from the centre in the 12 months prior to the inspection.
A security alert was raised at Coovagh House earlier this month, when two male youths who were residents of the centre climbed on to the roof of an adjoining building in the St Joseph's Psychiatric Hospital campus.
The young people were safely returned to the unit.
Action plan published in response to report
Coovagh House has published an action plan in response to the report which outlines the measures being taken to address concerns identified by HIQA.
Responding to the finding in relation to the chemical restraint of a child, the centre said unit staff would adhere to the Policy on Restrictive Practices and this policy would be expanded to include the administration of medication as defined as "chemical restraint".
The centre said that the unit had received a written treatment plan from a Consultant Psychiatrist, which would provide guidance and direction on the benefits and/or side effects of the medication.
It said unit staff would adhere to this treatment plan.
In relation to the finding that staff did not have the capacity to manage one child's behaviour, the centre said that a strategy meeting had taken place, which included the gardaí, to review the management of the child's behaviour.
A Significant Event Review Group was also convened which reviewed incidents whereby gardaí assistance was required.
It said the learning and outcomes from this group had been documented and discussed at debriefings, clinical and staff team meetings.
The centre said that due to the physical size and profile of the young person it was impossible for staff to safely manage this young person at all times.
It said staff would continue to make immediate assessments of the situation and if risk is present to the young person and others, staff would request assistance of Gardaí if required.
The plan also noted that a National Significant Event Review Group was due to be established by the end of January to ensure external governance of incidents.
In relation to the provision for psychiatric assessment available to the centre, Coovagh House said the issue had been escalated to senior management level and there were ongoing discussions on the matter.
On the maintenance of the property and hygiene issues, the centre stated that damage to property observed on a previous inspection had been repaired.
It said infection control measures had been reviewed, and a deep clean had been carried out in the kitchen which would continue on a monthly basis.
Tusla, the Child and Family Agency have said it notes the findings of HIQA's inspection report.
