I propose to take Questions Nos. 13, 42 and 52 together.
The Health Information and Quality Authority (HIQA) inspects Special Care Units annually under Section 69 of the Child Care Act 1991. HIQA undertook a full unannounced inspection of Ballydowd Special Care Unit on 3rd and 4th November 2011, as part of their annual inspection programme. The report of the findings from this inspection were published on 6th March last.
Inspectors found that there was a marked improvement in the standard of care in the unit since the last round of inspections in 2010. The main areas of improvement were in management, the delivery of care to the children and the overall presentation of the unit. The whole campus had been repainted and brought to a good overall standard. The safety concerns raised due to ongoing building works at the time had been well managed and risk assessed. The management of the unit had been strengthened by the introduction of good systems of accountability and clear lines of responsibility, which impacted positively on the day to day operations of the unit and the overall delivery of care to the children, staff practices and accountability. At the time of the inspection, a clinical team of child and adolescent psychiatry, child psychology and social work were available to the children in Ballydowd. Additionally, the inspectors also found that there were sufficient staffing to provide for optimal care for the children. Inspectors noted that all the children had an allocated social worker and were visited by social workers regularly. It was noted that social workers visited the children, met them privately and had access to their unit and bedrooms. Visits made by the children's Social Workers met the statutory requirements. Inspectors raised concerns regarding the impact of the building works on the space available to the children and the challenges posed by one child's complex needs.
HIQA inspected the unit against 40 standards and reported that 26 of these standards were met in full, 12 were partially met and 2 were not met. By way of comparison, in a July 2010 inspection, 6 out of 39 standards were met and 15 were not met. This clearly illustrates a marked improvement in findings during the most recent inspection. The 2 standards that were not met were in relation to "single separation" and "location and design".
It is very important that the facts of the care of one child in Ballydowd are clarified. There have been assumptions made that the care provided by the clinical and care staff Ballydowd to this young person fell below standards. Following this child's placement in Ballydowd, it became apparent that the child's full range of complex and demanding needs and behaviours could not be met in a Special Care Unit. Following a risk assessment by the clinical team and the acting director of the unit this child was cared for singly on their own in part of a Unit, whilst awaiting a specialist placement outside the country. This decision was approved by the clinical team, in conjunction with the placing social worker and team manager. The child had access to other children for limited periods, short periods in school and staff took the child on a range of outings. The decision on how to care for the child was reviewed by the clinical team on a weekly basis. There was no secrecy involved in the care programme for the child.
Inspectors expressed concerns in relation to this child on two matters. The first was the manner of recording the child being cared for in a separate part of the Unit. Inspectors considered the placement should have been recorded on a daily basis as a single separation. The HSE had taken the view that the child's placement was a single placement, and they would record as a single separation if the child was sent to his bedroom to be alone for a period. The second concern was the length of time the child was waiting for the specialist placement oversees. As this placement was outside this jurisdiction, and has many demands on its services, the social worker had limited influence to bring forward the child's date of admission. However I am glad to be able to say that shortly after the inspection, the child moved overseas to this specialist placement appropriate to his complex needs and continues to reside there.
There was no concern that a shortage of staff in the Unit influenced or impacted on the care of this child.
I welcome the findings of this report and the fact there are significant improvements since the inspections in 2010. My Department will continue to monitor the delivery special care services.
