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St Catherine’s Ward, St Finbarr’s Hospital Inspection Report 2020 PROMOTING QUALITY, SAFETY AND HUMAN RIGHTS IN MENTAL HEALTH ST CATHERINE’S WARD, ST FINBARR’S HOSPITAL St Catherine’s Ward, St Finbarr’s Hospital Douglas Road, Cork Date of Publication: Thursday 04 March 2021 ID Number: AC0162 2020 Approved Centre Inspection Report (Mental Health Act 2001) Approved Centre Type: Continuing Mental Health Care/Long Stay Psychiatry of Later Life Mental Health Rehabilitation Most Recent Registration Date: 17 May 2019 Conditions Attached: Yes Inspection Team: Martin McMenamin, Lead Inspector Noeleen Byrne Susan O’Neill Registered Proprietor: HSE Registered Proprietor Nominee: Mr Kevin Morrison, General Manager, Mental Health Services, Cork Kerry Community Healthcare Inspection Date: 18 – 21 February 2020 The Inspector of Mental Health Services: Dr Susan Finnerty MCRN009711 Previous Inspection Date: 18 – 21 June 2019 Inspection Type: Unannounced Annual Inspection 2020 COMPLIANCE RATINGS 21 REGULATIONS RULES AND PART OF THE MENTAL HEALTH ACT 2001 Compliant CODES OF PRACTICE Non-Compliant Not applicable RATINGS SUMMARY 2016 – 2020 Compliance ratings across all 39 areas of inspection are summarised in the chart below CHART – COMPARISON OF OVERALL COMPLIANCE RATINGS 2016 – 2020 45 40 35 13 30 21 20 13 12 7 18 21 11 10 10 25 20 19 15 10 2016 2017 2018 Not applicable 2019 Non-compliant 2020 Compliant Where non-compliance is determined, the risk level of the non-compliance will be assessed Risk ratings across all non-compliant areas are summarised in the chart below CHART – COMPARISON OF OVERALL RISK RATINGS 2016 – 2020 20 18 16 14 12 10 11 6 4 2016 2017 2018 Low AC0162 St Catherine’s Ward, St Finbarr’s Hospital Moderate 2019 High 1 2020 Critical Approved Centre Inspection Report 2020 Page of 81 Contents 1.0 Inspector of Mental Health Services – Review of Findings Conditions to registration Responsiveness to residents’ needs 2.0 Quality Initiatives 10 3.0 Overview of the Approved Centre 11 3.1 Description of approved centre 11 3.2 Governance 11 3.3 Reporting on the National Clinical Guidelines 15 4.0 Compliance 16 4.1 Non-compliant areas on this inspection 16 4.2 Areas of compliance rated “excellent” on this inspection 16 4.3 Areas that were not applicable on this inspection 16 5.0 Service-user Experience 18 6.0 Feedback Meeting 19 7.0 Inspection Findings – Regulations 20 8.0 Inspection Findings – Rules 65 9.0 Inspection Findings – Mental Health Act 2001 66 10.0 Inspection Findings – Codes of Practice 67 Appendix 1: Corrective and Preventative Action Plan 69 Appendix 2: Background to the inspection process 78 AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 1.0 Inspector of Mental Health Services – Review of Findings Inspector of Mental Health Services Dr Susan Finnerty In brief The approved centre St Catherine’s Ward was located on the grounds of St Finbarr’s Hospital, Douglas Road in Cork city It provided continuing care for people with mental health difficulties All six General Adult teams and both Psychiatry of Later Life clinical teams from South Lee could admit to St Catherine’s Ward Following admission, responsibility for the residents care was usually undertaken by a dedicated Consultant Psychiatrist The needs of the residents extended between continuing care and rehabilitation although rehabilitation was not directly available to the residents The age ranged from residents in the midspan of life to those in later life Compliance Summary 2016 2017 2018 2019 2020 % Compliance 41% 62% 63% 62% 72% Regulations Rated Excellent Conditions to registration There were three conditions attached to the registration of this approved centre at the time of inspection Condition 1: To ensure adherence to Regulation 15: Individual Care Plan, the approved centre shall audit their individual care plans on a monthly basis The approved centre shall provide a report on the results of the audits to the Mental Health Commission in a form and frequency prescribed by the Commission Finding on this inspection: The approved centre was not in breach of this condition and was in compliance with Regulation 15: Individual Care Plan Condition 2: To ensure adherence to Regulation 26(4): Staffing the approved centre shall implement a plan to ensure all healthcare professionals working in the approved centre are up-to-date in mandatory training areas The approved centre shall provide a progress update on staff training to the Mental Health Commission in a form and frequency prescribed by the Commission AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 Finding on this inspection: The approved centre was not in breach of this condition but was non-compliant with Regulation 26: Staffing Condition : To ensure adherence to Regulation 26: Staffing, the approved centre shall ensure that residents of the approved centre have access a suitably qualified speech and language therapist, and dietitian, in accordance with their assessed needs as documented in their individual care plan, by no later than 31 August 2019 Finding on this inspection: At the time of inspection, the residents in the approved centre had emergency access only to a speech and language therapist and a dietitian Safety in the approved centre • • • Ligature points were minimised to the lowest practicable level within the approved centre Medication was ordered and stored in a safe manner Hazards were reduced to a minimum However: • • • There were discrepancies in the prescribing and administration of medication Cleaning products and dry food products were stored within the same storage room Not all healthcare professionals were up to date with the required mandatory training in Basic Life Support, fire safety, the management of violence and aggression and the Mental Health Act 2001 Appropriate care and treatment of residents • • • • Each resident had a multi-disciplinary Individual Care Plan that reflected the resident’s goals There were therapeutic services and programmes that met the needs of the residents Each resident had a comprehensive six-monthly general health assessment Residents on antipsychotic medication had an annual assessment of their glucose regulation, blood lipids, and an electrocardiogram Adequate arrangement were in place for residents to access general health services A number of staff vacancies exist in relation to an Occupational Therapist, Speech and Language Therapist and a Dietitian However, in the absence of these personnel, a contingency plan for urgent access had been put in place However: • The residents whose needs reflected either continuing care or enduring mental health needs for which a specialist rehabilitation team would be appropriate, were all under the care of a general adult consultant AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 Respect for residents’ privacy, dignity and autonomy • • All bathrooms, showers, and toilets had locks on the inside of the door Bed screening in shared rooms ensured that the residents’ privacy was not compromised All observation panels on doors of treatment rooms and bedrooms were fitted with blinds, curtains, or opaque glass Generally, the approved centre was maintained in a good state of repair, and internally the approved centre was clean and hygienic However: • • • • • Not all residents’ personal property and possessions were sufficiently safeguarded when the approved centre assumed responsibility for them For one resident, the amount recorded in the cash log did not correspond to the amount present in the resident’s wallet in the safe The access to and use of resident monies was not overseen by two members of staff and the resident or their representative Where possible, the resident signed the transaction log with a nurse However, where this was not possible, only one member of staff signed the log All residents were required to vacate their bedrooms in the morning The bedroom area was locked during the day and not opened again until around 21:30, when residents went to bed This restrictive practice prevented residents from sleeping or resting during the day in their rooms Externally, the courtyard area was littered with numerous cigarette butts and pieces of litter on the ground There was a hole in the wall and chipped paintwork in one of the bedrooms and there was an area in which there was a smell of cigarette smoke and the floor and a plastic chair displayed burn marks There was no programme of general maintenance, decorative maintenance, cleaning, decontamination, and repair of assistive equipment There were no curtains in place on the windows in a number of bedrooms Responsiveness to residents’ needs • • • Residents had at least two choices for meals and were provided with a variety of wholesome and nutritious food Activities in St Catherine’s Ward included reading books, watching television, and movies, while group activities included: gardening, aqua aerobics, social outings, exercise groups, crossword groups, walking groups, bingo, therapy dog groups, current affairs sessions, cookery groups and mind groups Residents were provided with written and verbal information on diagnosis, medication, and details about the approved centre AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 Governance of the approved centre • • • • • • • The approved centre was part of the HSE’s former Community Healthcare Organisation (CHO4) area and spanned counties Cork and Kerry An Executive Management (EMT) teams was in place for each service area, with the Cork Mental Health Area Management Team providing clinical and management oversight of St Catherine’s Ward There was an organisational chart to identify the leadership and management structure and lines of authority and accountability in the approved centre Feedback from suggestion boxes, complaints and compliments were standing agenda items on the Local Management Team Meeting The approved centre had access to the service’s Risk & Patient Safety Advisor who provided a quarterly report to the approved centre The risk register was reviewed monthly at the unit management meeting Risks escalated up to the Area Management Risk Register where indicated There was an annual audit schedule in place and key performance indicators were measured centrally Although St Catherine’s had a comprehensive suite of audits, most of which were in reality checklists, however they served a key function in ensuring practice matches policy Heads of discipline had identified strategic aims for their departments and there was clear evidence that changes had occurred since the previous inspection, all of which impacted positively on the approved centre Staff have been encouraged to complete mandatory training as a priority over all other training This has greatly contributed to the service almost achieving 100% compliance with mandatory training requirements Support for continuing education programmes was available AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page of 81 2.0 Quality Initiatives The following quality initiatives were identified on this inspection: A Nutrition and Hydration committee comprising representation of a Dietitian and a Speech and Language Therapist has commenced supported by other multi-disciplinary team members The development of Standard Operating Procedures for The Apartment at St Catherine’s has been initiated This will offer a recovery centred practice to bridge the continuum of care from residential support to community living A Risk Register & Quality and Patient Safety (QPS) Oversight Structure has been instigated This has provided a structure to oversee quality and safety appropriately within St Catherine’s AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 10 of 81 10.0 Inspection Findings – Codes of Practice EVIDENCE OF COMPLIANCE WITH CODES OF PRACTICE – MENTAL HEALTH ACT 2001 SECTION 51 (iii) Section 33(3)(e) of the Mental Health Act 2001 requires the Commission to: “prepare and review periodically, after consultation with such bodies as it considers appropriate, a code or codes of practice for the guidance of persons working in the mental health services” The Mental Health Act, 2001 (“the Act”) does not impose a legal duty on persons working in the mental health services to comply with codes of practice, except where a legal provision from primary legislation, regulations or rules is directly referred to in the code Best practice however requires that codes of practice be followed to ensure that the Act is implemented consistently by persons working in the mental health services A failure to implement or follow this Code could be referred to during the course of legal proceedings Please refer to the Mental Health Commission Codes of Practice, for further guidance for compliance in relation to each code AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 67 of 81 Admission, Transfer and Discharge NON-COMPLIANT Risk Rating Please refer to the Mental Health Commission Code of Practice on Admission, Transfer and Discharge to and from an Approved Centre, for further guidance for compliance in relation to this practice INSPECTION FINDINGS Processes: The approved centre had a policy in relation to admission, transfer, and discharge Admission: The admission policy, which was last reviewed in July 2018, included all of the policy-related criteria for this code of practice Transfer: The transfer policy, which was last reviewed in July, included all of the policy-related criteria for this code of practice Discharge: The discharge policy, which was last reviewed in July 2018, included all of the policy-related criteria for this code of practice Training and Education: There was documentary evidence that relevant staff had read and understood the admission, transfer, and discharge policy Monitoring: Audits had been completed on the implementation of and adherence to the admission, transfer, and discharge policy Evidence of Implementation: Admission: The clinical file of one resident was inspected in relation to the admission process The admission on the basis of mental illness or mental disorder and an admission assessment was completed The assessment included the presenting problem, past psychiatric history, family history, medical history, current and historic medication, social and housing circumstances, a current mental health state, a risk assessment, full physical examination, and any other relevant information The resident’s family member, carer, or advocate involved in the admission process, with the resident’s consent A key worker system was in place within the approved centre Transfer: The approved centre did not comply with Regulation 18: Transfer of Residents Discharge: There had been no discharges from the approved centre since the last inspection The approved centre was non-compliant with this code of practice because it not comply with Regulation 18: Transfer of Residents, 30.1 AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 68 of 81 Appendix 1: Corrective and Preventative Action Plan Regulation 6: Food Safety Reason ID : 10001258 Corrective Action Preventative Action The registered proprietor did not ensure that proper facilities for the storage of food was maintained to support food safety requirements, 6(4)4 Measurable Achievable/Realistic Time-bound Post-Holder(s) On the spot checks Achieved 01/08/2020 ADON, CNM2 and wil be conducted by Domestic Supervisor the CNM2 Specific Discuss with domestic supervisor/staff to reiterate correct storage of food Remove any food products and place in correct storage facility Signage fixed to store room door indicating storage facility 6/12 audit against JSF monthly audits (MHC, 2018) Regulation to improve compliance achievable 31/12/2020 ADON, CNM2 and Domestic Supervisor Regulation 8: Residents' Personal Property and Possessions Reason ID : 10001259 Corrective Action Preventative Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital The registered proprietor did not ensure that an accurate record was maintained of each resident's money: cash balances did not always correspond with the balance recorded in available records, (3) Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) Cash was balanced to 3/12 audit against JSF Complete 01/08/2020 ADON, CNM2 and correctly correspond (MHC, 2018) Nursing Staff with records A new Regulation to cash record was improve compliance initiated indicating signature columns for two staff members and the service user At the end of each 3/12 audit against JSF achievable 30/11/2020 ADON, CNM2 and shift the signature (MHC, 2018) Nursing Staff sheet is checked for Regulation to any omissions or cash improve compliance imbalances The cash balance is checked at the end of the shift pass Approved Centre Inspection Report 2020 Page 70 of 81 Regulation 18: Transfer of Residents Reason ID : 10001257 Corrective Action Preventative Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital The approved centre did not ensure that all relevant information about the resident was provided to the receiving facility upon transfer, 18(1) Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) Meeting with medical Review and monitor Achievable 30/09/2020 ADON, CNM2, Medical team and nursing transfers in the Team staff to ensure all approved centre relevant specifically on documentation is documentation is provided to receiving correctly handed hospital over to the receiving hospital 3/12 audit against JSF monthly audits Achievable 30/09/2020 ADON, CNM2 and (MHC, 2018) Medical Team Regulation 18 to improve compliance Approved Centre Inspection Report 2020 Page 71 of 81 Regulation 21: Privacy Reason ID : 10001255 Corrective Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital The bedroom area was locked from early morning until approximately 21:30; a restrictive practice that was not conducive to resident privacy and dignity Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) The role of the HCA is Management will fill Achievable Interview held 31/01/2021 DON, ADON, General to compliment the the approved HCA week of 23.11.2020 Manager, HR existing staff skill mix posts Introduction in allowing staff keep of the Healthcare the downstairs assistant role to bedroom area open support the patients during the day and staff of St Controlled swipe Catherine's access has been Additional swipe added to non access controls added bedroom areas The to non-patient role was advertised designated areas and interviewed however the campaign was not successful in that the identified post holders no longer wished to take up the posts offered A Cork Kerry Community Healthcare recruitment campaign was undertaken and interviews were scheduled for the week of 23.11.2020 It is anticipated that Approved Centre Inspection Report 2020 Page 72 of 81 Preventative Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital the successful candidates will be available to comence in post by 31.01.2020 The role of the HCA is Introduction of the Achievable Interview held to compliment the Healthcare assistant week of 23.11.2020 existing staff skill mix role to support the in allowing staff keep patients and staff of the downstairs St Catherine's bedroom area open Additional swipe during the day access controls added Controlled swipe to non-patient access has been designated areas added to non bedroom areas The role was advertised and interviewed however the campaign was not successful in that the identified post holders no longer wished to take up the posts offered A Cork Kerry Community Healthcare recruitment campaign was undertaken and interviews were scheduled for the week of 23.11.2020 It is anticipated that Approved Centre Inspection Report 2020 Page 73 of 81 31/01/2021 ADON, Area Administrator the successful candidates will be available to comence in post by 31.01.2020 AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 74 of 81 Regulation 22: Premises Reason ID : 10001249 Corrective Action Preventative Action Reason ID : 10001250 Corrective Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital The physical structure of the approved centre was not maintained with due regard to the safety and well-being of residents as ligature points had not been minimised, 22(3) Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) Updated Ligature This has been used to Program of Works has been 21/08/2020 ADON, Area Audit undertaken in develop program of costed by maintenance Administrator January 20 associated works to department with works now Maintenance reduce ligature commenced Department points and provide direction for maintenance department Bi-monthly inspection Records will be This is both Achievable and 01/07/2020 ADON, Area to be undertaken on maintained for Realistic It will also assist Administrator the units by crossinspections and audit with Budget preparation and Maintenance functional team from accessing funds to progress Department Nursing, Area works in a planned and coAdministrator and ordinated manner Maintenance Dept There was no programme of general or decorative maintenance, 22(1)(c) The external courtyard area was littered with cigarette butts and other rubbish, 22(1)(a) Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) To initiate and review Create a folder which Each time staff issue a 21/08/2020 ADON Maintenance current programme will be kept in the maintenance request this Department for decorative CNM2 office which will be logged in the folder maintenance To will indicate along with a copy of the keep courtyard free maintenance email request Cleaning staff from cigarette butts requests and will sweep the courtyard and rubbish programmes To daily and service users will monitor courtyard for be reminded to use rubbish and cigarette appropriate waste facilities butts Approved Centre Inspection Report 2020 Page 75 of 81 Preventative Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital To continue and The maintenance Achievable & Realistic review the folder will be maintenance updated and programme and to reviewed following monitor courtyard for completed cigarette butts and maintenance work rubbish Bi-monthly and planned inspection to be decorative works will undertaken on the be evident in the units by crossfolder There will be functional team from a cleaning log for the Nursing, Area courtyard 3/12 audit Administrator and against JSF (MHC, Maintenance Dept 2018) Regulation 22 to Approved Centre Inspection Report 2020 Page 76 of 81 31/07/2020 ADON Maintenance Department Area Administrator Regulation 23: Ordering, Prescribing, Storing and Administration of Medicines Reason ID : 10001260 Corrective Action Preventative Action AC0162 St Catherine’s Ward, St Finbarr’s Hospital One MPAR did not record the date of discontinuation of each medication, 23(1) One MPAR did not record the date of initiation for each medication 23(1) Six MPARs did not record all medications administered to the resident, 23(1) Specific Measurable Achievable/Realistic Time-bound Post-Holder(s) Liaise with the 3/12 audit against JSF Achievable 30/09/2020 medical team, ADON, medical team to (MHC, 2018) CNM2 and Nursing Staff discuss the omission Regulation 23 to on the MPAR and to improve compliance discuss with nursing staff Audit results are to be inlcuded in audit reviews by the South Lee Audit Group to assit with training and learning outcomes Audit members to sit on the widened audit committee At the end of each 3/12 audit against JSF achievable 30/09/2020 Medical Team, ADON, shift the nurse (MHC, 2018) CNM2 and Nursing Staff allocated to the Regulation 23 to medication round will improve compliance also check all MPARs for omissions Audit results are to be inlcuded in audit reviews by the South Lee Audit Group to assit with training and learning outcomes Approved Centre Inspection Report 2020 Page 77 of 81 Regulation 26: Staffing Reason ID : 10001263 The numbers and skill mix of staff was not appropriate to the assessed needs of the resident, 26(2) The numbers and skill mix of staff was not appropriate to the assessed needs of the residents and to facilitate the bedroom area being accessible to the residents as appropriate, 26(2) The approved centre did not provide an acceptable CAPA for Regulation 26: Stafing in time for the publication of this report Appendix 2: Background to the inspection process The principal functions of the Mental Health Commission are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres The Commission strives to ensure its principal legislative functions are achieved through the registration and inspection of approved centres The process for determination of the compliance level of approved centres against the statutory regulations, rules, Mental Health Act 2001 and codes of practice shall be transparent and standardised Section 51(1)(a) of the Mental Health Act 2001 (the 2001 Act) states that the principal function of the Inspector shall be to “visit and inspect every approved centre at least once a year in which the commencement of this section falls and to visit and inspect any other premises where mental health services are being provided as he or she thinks appropriate” Section 52 of the 2001 Act states that, when making an inspection under section 51, the Inspector shall a) See every resident (within the meaning of Part 5) whom he or she has been requested to examine by the resident himself or herself or by any other person b) See every patient the propriety of whose detention he or she has reason to doubt c) Ascertain whether or not due regard is being had, in the carrying on of an approved centre or other premises where mental health services are being provided, to this Act and the provisions made thereunder d) Ascertain whether any regulations made under section 66, any rules made under section 59 and 60 and the provision of Part are being complied with Each approved centre will be assessed against all regulations, rules, codes of practice, and Part of the 2001 Act as applicable, at least once on an annual basis Inspectors will use the triangulation process of documentation review, observation and interview to assess compliance with the requirements Where noncompliance is determined, the risk level of the non-compliance will be assessed The Inspector will also assess the quality of services provided against the criteria of the Judgement Support Framework As the requirements for the rules, codes of practice and Part of the 2001 Act are set out exhaustively, the Inspector will not undertake a separate quality assessment Similarly, due to the nature of Regulations 28, 33 and 34 a quality assessment is not required COMPLIANCE, QUALITY AND RISK RATINGS The following ratings are assigned to areas inspected: Following the inspection of an approved centre, the Inspector prepares a report on the findings of the inspection A draft of the inspection including provisional COMPLIANCE RATINGS are report, given for all areas inspected.compliance ratings, risk ratings and quality assessments, is provided the registered proprietor of the approved centre Areas of inspection are QUALITY RATINGStoare generally given for all regulations, except for 28, 33 and 34 are givenorfor any area thatand is deemed non-compliant.risk is rated as low, moderate, deemed RISK to beRATINGS either compliant non-compliant where non-compliant, high or critical COMPLIANCE RATING QUALITY RATING RISK RATING EXCELLENT COMPLIANT NONCOMPLIANT SATISFACTORY LOW REQUIRES IMPROVEMENT MODERATE INADEQUATE HIGH CRITICAL The registered proprietor is given an opportunity to review the draft report and comment on any of the content or findings The Inspector will take into account the comments by the registered proprietor and amend the report as appropriate The registered proprietor is requested to provide a Corrective and Preventative Action (CAPA) plan for each finding of non-compliance in the draft report Corrective actions address the specific non-compliance(s) Preventative actions mitigate the risk of the non-compliance reoccurring CAPAs must be specific, measurable, achievable, realistic, and time-bound (SMART) The approved centre’s CAPAs are included in the published inspection report, as submitted The Commission monitors the implementation of the CAPAs on an ongoing basis and requests further information and action as necessary If at any point the Commission determines that the approved centre’s plan to address an area of noncompliance is unacceptable, enforcement action may be taken In circumstances where the registered proprietor fails to comply with the requirements of the 2001 Act, Mental Health Act 2001 (Approved Centres) Regulations 2006 and Rules made under the 2001 Act, the Commission has the authority to initiate escalating enforcement actions up to, and including, removal of an approved centre from the register and the prosecution of the registered proprietor AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 80 of 81 AC0162 St Catherine’s Ward, St Finbarr’s Hospital Approved Centre Inspection Report 2020 Page 81 of 81
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