Visits to places of deprivation of liberty
change the fact that residents themselves were unable to open the door and leave the Home without
another person’s assistance. It also added that the definition of a secure ward in point 17 of Article 2 of
the ZDZdr stipulated that a secure ward was a ward which residents of the institution (and not only of an
individual ward) are unable to leave on their own accord. The NPM thus insisted on its recommendation
on due conduct when restricting residents’ liberty. During the visit to Metlika Retirement Home, we
noticed several examples of good practice. Among other things, we examined medical records of several
residents and examined the prescription of occasional medications. It was usually written at what time,
how many times a day and what dosage a resident may receive, which was certainly positive. The staff
are suitably trained to work with residents with advanced dementia. We commended the staff’s attitude
towards residents since friendliness and understanding are the most important if not the only form of
successful mutual communication with dementia patients.
On 27 February 2018, we visited Ljubljana Šiška Retirement Home where we were told that there was
no secure ward in the sense of point 17 of Article 2 of the Mental Health Act and that persons with
various stages of cognitive impairment (dementia) who are usually accommodated on secure wards
were staying on various wards in the Home. We nevertheless wanted to examine whether the right to
personal freedom was being restricted for the residents of the Home, particularly dementia patients. We
gave two (general) recommendations regarding the implementation of the Mental Health Act, and in the
response to the preliminary report, it was stated that both would be observed. We also proposed that in
cases when residents do not consent to be accommodated and are unable to leave the institution, the
Home immediately proposes to the court to issue a decision as per Article 75 of the Mental Health Act.
We also suggested that Article 29 of the Mental Health Act be observed consistently when using a belt
in a wheelchair in the case of simultaneous physical impairment of a resident (e.g. blockage of wheels
of a wheelchair) and their reduced higher nerve functions since the effect in the above case is the same
as when applying special protection measures.
On 5 March 2018, we paid a visit to Ormož Retirement Home. This was the first visit to this social
care institution where we proposed 18 recommendations, and after the response from the Home’s
management to the preliminary report of the NPM visit, we were pleased to discover that the majority
of them (12) had already been realised. These recommendations referred to the placement of suitable
signs on the doors of residents’ rooms to facilitate their orientation, installation of bedside reading
lights if the residents want them, organisation of activities also during weekends and holidays, and
monitoring the satisfaction of all three target groups (residents, relatives and staff). The Home also
realised recommendations which referred to a resident signing a statement on being accommodated
on a secure ward and understanding what they have signed, suitable supplementing of the relevant
statement with the legal caution and the possibility of revoking it, the observance of provisions
of the ZDZdr regarding special protection measures also in the case of a blockage of a wheelchair
and simultaneous installation of a pelvic belt or when tying down an arm when a nasogastric tube is
installed. They also realised recommendations about more suitable positioning of the collection box for
complaints, keeping a suitable record of complaints, updating the house rules and making data on the
representatives of persons with mental health disorders more visible. The Home had not yet managed
to realise individual recommendations, particularly those referring to exceeding capacity, reducing the
number of beds in individual rooms, ventilating and giving residents’ privacy when speaking on the phone
with a mobile receiver. The Home did not accept a recommendation relating to more appropriate recordkeeping of residents who require periodic check-ups with a psychiatrist. As a reason, the management
explained in the response to the preliminary report that the Home had been cooperating with the same
psychiatrist since its establishment in 2002 and the system of making appointments and the keeping
of records of regular check-ups had been agreed upon with the psychiatrist. These records were kept
manually in a special notebook, and it had not yet happened that a periodic check-up of a resident
would be overlooked. Together with the psychiatrist, they examined the recommendation and decided
to proceed with their present record-keeping system since the outpatient nurse and the psychiatrist
were used to it. We also noticed several things that were particularly commendable, i.e. the premises
of the ward and residents’ rooms were well-maintained, clean and light. We were pleasantly surprised
by the residents’ involvement, including those with severe mobility difficulties, into daily activities on
the ward organised throughout the day. A notice board is in the common area where it is written where
residents are located, and what time of the year and what day it is to facilitate orientation in time and
space. The staff informed us that they change information on this notice board every morning together
with the residents, which is commendable because this is also important for the residents who cannot
or are unable to read this information. An agreement was made with smokers on the dementia ward
that cigarettes and a lighter are stored by the nurse, and they get a key to the terrace after lunch where
they go to smoke. Such practice is considered positive since smoking is supervised and there is no
IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2018
NATIONAL PREVENTIVE MECHANISM UNDER THE OPTIONAL PROTOCOL TO THE UN CONVENTION AGAINST TORTURE AND OTHER CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT
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