A DAMNING INSPECTION report on a care centre for adults and children with a disability found residents were living “in a chaotic and fearful environment”.

Health Information and Quality Authority (Hiqa) inspectors who visited Ballytrim House in July last year expressed concern about the safety of residents, particularly children living at the centre. 

At the time, adults and children were sharing the living spaces in the centre, which provides both full-time and part-time residential care. 

On the day of the inspection, one of the children appeared fearful of an adult resident. 

“Inspectors heard her scream for help when this resident approached her and made a hitting gesture towards her,” the report stated.

After reviewing records and discussing the matter with staff, inspectors found this child had been hit or assaulted by this adult resident on a number of occasions. Staff said the child was an ‘easy target’ because she is in a wheelchair and was often hit by other residents. 

Incident reports also indicated that an adult male resident had ‘stripped naked’ in front of a female child resident in March 2019.

A safeguarding plan to protect the child was not put in place after this incident and the matter was not reported in line with Children First or the centre’s HSE child safeguarding statement. Therefore it was not investigated in line with these policies. 

In discussing this incident with staff and reviewing documentation in the centre inspectors found that this was not an isolated incident and had occurred previously whereby adults ‘stripped’ in front of children. Most staff spoken with highlighted this concern (and other concerns) to inspectors.

All staff who spoke with inspectors said residents and children were not safe in this centre. 

A serious incident took place in this centre in May 2019 that required garda intervention as staff were no longer able to manage the severity of the behaviours. This incident was reviewed and involved “very volatile, violent and aggressive behaviours that affected others living in the centre”.

This serious incident was witnessed by children living in the centre. A number of records seen by inspectors showed that some residents presented as “anxious and upset” because of the incidents they had witnessed.

Records also showed a pattern of incidents involving resident-to-resident violence and self injurious behaviour which has been sustained over a number of months. 

There was a significant impact on the residents which ranged from physical assault, hitting, slaps, pushes, to incidents of a safeguarding nature…

Staff members were also impacted with a number on leave due to occupational health injuries at the time of inspection.

Inspectors were sufficiently concerned about the children living in this centre that a referral was made to Tusla following this inspection. They also requested HSE senior management attend the centre and issued an urgent compliance plan in relation to the safeguarding and protection of children and adults.

The centre was found to be non-compliant with all 11 regulations inspected at the time. 

Follow-up inspection

Three months later the centre was inspected again and inspectors noted improvements had been made. 

Children were now living in a separate section of the designated centre, and a separate play area to which only the children had access was made available, although it was not yet furnished with play equipment.

Related Reads

Nursing home complaints: Allegations of abusive staff and unexplained injuries

What happened to the HSE's proposal for its own undercover investigations in care homes?

The living areas had been refurbished and repainted, and there was now “a homely feel to the centre, and a pleasant dining area was now available to residents”.

Since the previous inspection significant improvements had been made in monitoring and oversight, and agreed actions in the quality improvement plan submitted by the provider had been implemented for the most part.

There was evidence of a strong management presence in the centre and it was clear that the management arrangements were now responding in a timely way to issues which arose.

However the report said the centre ultimately remained “unsuitable for the current population of residents”. 

“There were incompatibility issues and the risk of incidents of violence and aggression remained.

“The management response to address this was not adequate as it was resulting in care practices which were not person centred and which were not sustainable in the longer term.”

HSE measures

In a statement, the HSE said it implemented a number of measures after the first inspection.

1. The number of residents availing at the centre was reduced to eight with a plan to further reduce this to seven in the coming months.
2. The layout of the Centre has been amended to allow for the physical separation of the young person and adults within the Centre with a dedicated staff team in place for both.
3. A new manager has been appointed for the centre.
4. Staffing at the centre has been increased to reflect the support needs of residents.
5. Increased Multi-disciplinary Support to include psychology has been provided to assist and support staff in the management of behaviours of concern.

After the second inspection in October, an additional action plan was developed and accepted by Hiqa. The HSE said this plan is under constant monitoring and review. 

“The HSE has liaised with all the families/guardians of the residents in Ballytrim prior to the publication of these reports to brief them on its contents and the work that has been undertaken to ensure a quality service is delivered within the centre.

“The HSE remains committed to respecting the rights and dignity of each resident in its care. We continue to work steadfastly to ensuring all designated centres are actively progressing to meet full compliance with regulations and national standards.”