Following publications in the press regarding an incident of serious injury of a patient in a Care and Protection Facility for Children with Disabilities of the Region of Central Macedonia and his subsequent death in hospital, a mixed team of Auditors- Inspectors of the National Transparency Authority (NTA) and experts, doctors and social workers, during the period from January 2022 to November 2022 conducted an ex officio audit in the specific structure, with the purpose, as far as the incident is concerned, to control the incident management actions of the administration of the institution and in general the quality and adequacy of the facilities, equipment and services provided by the audited institution.
Findings of the team during the on-site inspection:
- There is no Operating Organization of the audited entity resulting in dysfunction and inefficiency at all levels.
- The audited facility provides for the admission of juveniles with multiple disabilities and their stay until the age of 25. However, eighty-one (81) residents are accommodated, of which only nine (9) are minors.
- Minors are living with adults without provision for spatial separation and special treatment. A large number of residents were found living in the wards.
- Persons with autistic spectrum disorders are admitted to this establishment, by decision of the Public Prosecutor's Office. Particularly in these cases, it is necessary to provide special programmes of special therapies, speech therapy and special education, which are lacking.
- There are very few cases of fostering and adoption of care recipients.
- The main shortcomings of the structure are the lack of human resources and the absence of systematic and specialised training of staff. There are persistent and serious shortages of specialised staff, particularly care staff, which, combined with the seriousness and complexity of the situation of the recipients, do not ensure safe living conditions, quality of services and make it difficult to provide a personalised approach/care for the recipients. Burnout was observed among existing staff.
- In some cases, auxiliary nursing/care staff provide their services in double shifts with 16 hours of continuous work, in violation of the legislation in force
- Casual workers do not provide services to the patients/employees for whom they are employed but substitute for care staff.
- In November 2021, an incident occurred resulting in the serious injury of a carer who died in the hospital where he was being treated. With regard to the relevant actions taken by management to hold the incident to account, it was noted that an employee was referred to the Disciplinary Board out of time. The case is being investigated by the public prosecutor in the context of a preliminary examination.
- In December 2021, an incident between inmates resulted in the serious injury of one of them and his hospitalization for a month in an Intensive Care Unit (ICU). After his discharge from the ICU, the inmate returned to the controlled facility where he passed away in two days. Doubts were raised as to the management of the case, which was not reported to the control team even though the caregiver had died five days prior to the mixed team's visit. Furthermore, the incident and the death of the patient were not reported to the competent authorities as required by the relevant provisions.
- The medical care is provided under fixed-term service contracts. In private agreements of the institution with three (3) private physicians, the hours of their employment were not specified and the terms of the private agreement were not complied with, as two (2) of them were paid in excess of the specified amount. The doctors' attendance book was not kept in order to confirm their visits to the audited body.
- The operation of a 'Quiet Room' (reduced stimulation/seclusion area) was found, but this is not provided for in the existing provisions for the organisation and operation of the audited body.
- The facility does not have a Fire Safety Certificate.
In view of the above, the NTA made proposals, inter alia, regarding:
- The institutionalisation of scientific supervision and the definition of specifications (standards) for the case of mandatory certification of all child protection service providers.
- strengthening the institution of professional fostering in the case of minors and adults with disabilities.
The report was forwarded:
- To the Deputy Minister of Labour and Social Affairs with responsibility for welfare issues, to implement the recommendations and seek accountability of the President and members of the Board of Directors (BoD) of the audited body.
- To the Board of Directors of the body for the implementation of the proposals.
- To the prosecuting authorities for the criminal assessment of the findings in the audit report.
- To the Labour Inspectorate for investigation of any breaches of labour legislation.