The Health Information and Quality Authority (HIQA) has today published a report on Ballydowd 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 special care units against the Health Act 2007 (Care and Welfare of Children in Special Care units) Regulations 2017 and the National Standards for Special Care Units.

An announced inspection of Ballydowd Special Care Unit was carried out between 30 June 2020 and 2 July 2020. This inspection was carried out in response to a cluster of serious incidents and allegations of misconduct against staff members, and the lack of assurances provided by the service on how these incidents and allegations were being managed. This was the second risk-based inspection of this service within a 16-week period. It was carried out to measure progress in relation to managing absconding behaviour, which was the focus of the previous risk-based inspection in February 2020.

Overall, children had positive experiences of care in the special care unit, but significant improvements were required in the service’s quality and safety of care. The welfare and safety of children placed in the centre, prior to and at the time of the inspection, could not be guaranteed. The children who met with inspectors did not raise concerns about their immediate safety, but they were not always confident that staff could safeguard them from risks posed by other children placed in the unit. 

The governance and management arrangements in place were not adequate and practice by a small number of staff was not well managed. Furthermore, risk management systems were not strong enough, and the procedures in place to manage allegations of misconduct against staff members, in particular where their behaviour posed a potential risk to children, were not always implemented in a safe or well informed way. As a result, the service could not pre-empt and potentially prevent some of the incidents which occurred. Reports of these concerns to Tusla social work lacked essential detail, and did not ensure timely notification of concerns to An Garda Síochána or the sharing of appropriate information.  

The special care unit was not adequately resourced with a full complement of qualified and experienced staff, which potentially compromised the quality and safety of the service. Vacant management posts were filled on an interim or temporary contract basis by staff members who were inexperienced and untrained in management roles. This led to poor supervision of social care workers, some of whom were equally inexperienced in their role as direct care givers to vulnerable children. 

Following this inspection, HIQA escalated in writing to the CEO of Tusla, who is the registered provider of this designated centre, areas of non-compliance and associated key risks, which required immediate assurances by way of a written plan of action. Immediate actions were put in place by the provider to ensure children placed in the service at that time were safe, to address the key risks and to strengthen reporting and monitoring systems. These immediate actions and the provider’s capacity to bring this unit into compliance and ensure that an effective and sustainable programme of care is delivered, will continue to be closely monitored by HIQA and determine regulatory action going forward.

The special care unit provided a plan to address the non-compliances identified in this inspection report, along with timelines for implementation. The report and compliance plan can be found on www.hiqa.ie.