Inverness care home for adults with learning difficulties criticised by Scotland’s Care Inspectorate for the way it confines and punishes distressed residents
Inspectors have raised “significant concerns” over how an Inverness care home uses confinement and other punishments for adult residents with learning difficulties.
The Care Inspectorate concluded Mayfield Lodge used "seclusion, removal of possessions and punitive responses" without "a clear understanding about how to best support people's physical, mental and emotional wellbeing".
The Scottish care industry watchdog also highlighted how such restrictive practices were being used "without appropriate documentation or consents".
Seclusion within care settings is usually defined as the supervised confinement of a resident in a room from which they are prevented from leaving, sometimes to prevent harm to themselves or others. It can involve and element of physical restraint.
The report also said internal CCTV cameras used on the premises "infringed on people's right to privacy".
In all, the Care Inspectorate rated Mayfield Lodge’s care home service “weak” in three of five areas evaluated, with the other two areas of service classed as “adequate”.
There was also praise within the report of how staff cared for and interacted with the home’s 12 residents, noting strong relationships between them and a strong sense of belonging within a “warm and homely” environment.
Mayfield Lodge, registered as a care home since August, 2005, is a single-storey house within garden grounds on Mayfield Road, between Culduthel and Southside roads.
It consists of 12 bedrooms with en-suite wash basins, two communal lounges, a kitchen and dining area and three bathrooms.
Three inspectors carried out an unannounced inspection between March 18 and 26 this year, spending time with residents, relatives, visiting professionals, staff and management, as well as reviewing documents.
The report stated: “We had significant concerns about how people were supported when they experienced stress and distress.
“The current quality assurance processes in place were not robust or effective. Staff had not received regular reflective supervision.
“Care and support plans were not outcome focused and did not contain the necessary assessments or documentation.”
An assessment of how the service supported people’s well-being was designated “weak”, the second lowest grading from one to six.
The report said: “During the inspection, we raised serious concerns about the culture and responses to people living in Mayfield Lodge who had experienced stress and distress.
“This included the use of seclusion, removal of possessions, and punitive responses which had escalated situations further.
“There was not a clear understanding in the service about how to best support people's physical, mental, and emotional wellbeing.
“The management team was responsive to our feedback and expressed their commitment to improve the culture, and… develop appropriate strategies to support people experiencing stress and distress.”
The report found seclusion was being used in the service without the appropriate documentation or consents.
It added: “This included the use of devices such as door sensors, alarms, and internal CCTV cameras, some of these were installed for security purposes, but infringed on people's right to privacy.
“We asked the provider to switch off the internal CCTV cameras and review the use of any restrictive practice in the service.”
There was further praise for the home’s good communication with healthcare professionals and positive approach to supporting residents’ best interests.
It was said to provide “appetising meals”.
But Mayfield Lodge’s management has been ordered to address various issues of concern by May 9 this year to ensure they meet Health and Social Care Standards (HSCS).
Although staff and relatives of residents said management were supportive, approachable, and responsive, there was criticism of “significant gaps” in how such feedback was used to improve the service.
It added: “Language used in (care plans) was often punitive and outdated from current best practice guidance.
“Where people are likely to experience stress and distress, we would expect to see a detailed positive behaviour support plan to inform staff of how best to respond proactively and reduce the risk of stress and distress.”
“Risk assessments… lacked detailed information around the risks identified and measures staff should take, for example, …if somebody was at risk of choking.”
In response to the report’s criticisms, a spokeswoman for Mayfield Lodge said: “Our primary aim is the well-being of the residents and we’re working with NHS Highland to deliver the required improvements.”
