The Health Information and Quality Authority (HIQA) has today published a report on Coovagh House Special Care Unit. Special care units are secure residential units for children aged 11 years to 17 years. Children are placed in a special care unit by a court when their behaviour poses a risk of harm to their life, health, safety, development or welfare, and the placement is needed for the child’s care and protection. 

HIQA inspects against the Health Act 2007 (Care and Welfare of Children in Special Care units) Regulations 2017 and the National Standards for Special Care Units, which apply to special care units in Ireland. 

An unannounced risk-based inspection was carried out in June 2022. It took place in response to information received by the Chief Inspector that the provider intended to move two of the four children detained in the unit to an alternative, non-registered Tusla centre, to allow building work to the special care unit. The purpose of the inspection was to assess whether the special care unit could continue to comply with the regulations and could continue to safely operate in line with its conditions of registration and statement of purpose.

Overall, the centre was non-compliant with all of the regulations assessed. While there were governance systems and structures in place to support the delivery of service to children, significant shortfalls were identified in the effective management and oversight of the centre. There were acknowledged challenges in the previous six months in relation to staff recruitment and retention, an escalation in incidents of children’s challenging behaviour and physical decline of the building. Inspectors found that sufficient staffing resources were not always in place for the effective delivery of the childrens’ programme of special care.

At the time of the inspection, inspectors found that the physical environment could not provide safe living spaces for all four children. This posed significant risk to children’s safety and protection and while two of the four children were living off site at the time of the inspection, their substantive placement in the unit was maintained. However, inspectors were assured that this reduction in the capacity of the centre enabled the provider to provide safe care for the remaining two children.

Oversight and auditing processes in relation to the management of incidents, complaints and allegations concerning children in the unit were not effective. While there were systems in place for managerial oversight and review of individual incidents and significant events, these were not always strong enough. Furthermore, there was a systems failure as these monitoring processes did not alert managers or the provider to underreporting of child protection and welfare concerns in line with the requirements of Children’s First Act. The provider in charge had also failed to notify the Chief Inspector of several serious incidents in the special care unit relating to allegations of abuse made by children or serious injuries sustained by children.  

While this risk was known to the provider and some actions had been taken to mitigate against any immediate risk to the safety of children and staff, the centre’s risk management processes were ineffective at addressing risks at an earlier stage. Inspectors escalated specific urgent risks to the provider on the day of the inspection regarding fire safety precautions and the capacity of the unit and the provider took immediate steps to address these, including applying to vary the centre’s capacity from four to two children.

The provider has provided assurances in relation to the high-risk non-compliances relating to governance and management, risk management and the notification of incidents to the Chief Inspector. The provider has also submitted a plan outlining how it intends to come into full compliance.

The report and compliance plan are available at the link below.