Residents were not adequately protected from peer-to-peer abuse at a psychiatric facility in Castlebar, Co Mayo, according to an inspectors' report.
Representatives from the Mental Health Commission found critical or high risks across seven areas including food safety, premises and staffing during an unannounced two-day inspection at the Teach Aisling centre in October.
The issue of assaults between residents was of most concern to inspectors, who noted a lack of precautions in place at the 10-person facility to control and prevent such incidents.
A number of instances of peer-to-peer aggression had occurred prior to the inspection. Processes to mitigate the risk of further assaults occurring were inadequate, according to the report published Thursday.
As a result, vulnerable adults were not adequately protected from the possibility of attacks by other residents.
Arrangements to respond to emergencies at the centre were inadequate and personal alarms tended to be broken, including one which was in pieces on the ground at the time of the Mental Health Commission visit.
Staff passed on the contact details of those responsible for oversight of risk management and health and safety procedures in the facility. However when inspectors got in touch with the named individuals they denied having any responsibility for the areas.
Examinations on residents were carried out in a visitors room as the centre’s two dedicated consultancy rooms were instead used as offices, it was found, while presses in the kitchenette were unclean and bathroom floors were badly stained.
Responding to concerns about resident safety, management at Teach Aisling promised to review the control measures in place for preventing assaults.
Elsewhere, a number of non-compliances were recorded during an unannounced four-day visit to Highfield Hospital in Dublin in September.
High-risk practices were observed in the area of medication management after inspectors witnessed unlocked drugs cabinets and fridges.
In one incident, a pot of custard was left in a fridge where medication was stored, while resident property was stowed in a controlled drugs press.
Keys were left in the lock of a drugs press on another unit despite inspectors alerting staff to the breach earlier in the day. Inspectors were later told that this was “routine practice”.
Nurses were found to have administered medications without checking the expiry dates first, and the registration numbers of prescribing doctors were missing from medication labels.
Serious breaches in standards were also identified in a number of other psychiatric units at St Brigid's Hospital in Ardee, the An Coillín centre in Mayo and Cappahard Lodge in Clare.