8. Providers of nursing care services During the reporting year, the Chancellor inspected 12 institutions providing the nursing care service: - Hiiu Treatment Centre Foundation (case No 7-9/140310) - Põlva Hospital Ltd (case No 7-9/140419) - Tartu University Hospital Foundation (case No 7-9/140843) - Võnnu Hospital Foundation (case No 7-9/140842) - Vändra Health Centre Foundation (case No 7-9/140629) - Järva County Hospital Ltd (case No 7-9/140943) - Pärnu-Jaagupi Care Home Foundation (case No 7-9/140968) - Pärnu Hospital Foundation (case No 7-9/140969) - Kuressaare Hospital Foundation (case No 7-9/141290) - Narva Hospital Foundation (case No 7-9/150130) - Jõhvi Hospital Foundation (case No 7-9/150117) - Sillamäe Hospital Foundation (case No 7-9/141488) All the inspection visits were unannounced. A nursing care expert was involved in nine of the inspection visits to assess the quality of nursing care, signs of ill-treatment, compliance with the requirements for treatment documents of the patients, physical shape of the patients, skills of the staff, availability of the doctor, and the medical equipment and supplies of the institution. The most acute problems found concerned the provision of the nursing care service without a valid consent, shortcomings with the handling and administration of medications, and failure to ensure privacy. These issues are described in more detail below. In addition, problems with unfounded restriction of the fundamental right to liberty of the service recipients75, insufficient number of staff76, use of the nurse call system77, ensuring of human dignity78 and overcoming the language barrier79 were found at the providers of nursing care services during the reporting year. 8.1. Consent for the provision of nursing care services Similarly to 2013, during the reporting year the Chancellor paid more attention to the existence of a consent for the provision of nursing care services. Problems with documenting the consent were found in seven80 of the inspected institutions. In some cases, a consent of the patient or their legal representative was completely missing and on other occasions a signature confirming the consent or the name of the person signing was missing. In some cases, the carer or a social worker had given the consent on behalf of the patient instead of the legal representative. In addition, in some cases there was a suspicion that the consent for the provision of the service had been given by a dementia patient who was essentially unable to assess all the circumstances required for giving the consent. As on several occasions a written record of the consent for the provision of nursing care services was absent Narva Hospital, Põlva Hospital. Sillamäe Hospital, Jõhvi Hospital. 77 Vändra Health Centre, Kuressaare Hospital, Võnnu Hospital. 78 Järva County Hospital, Hiiu Treatment Centre. 79 Hiiu Treatment Centre. 80 Hiiu Treatment Centre, Järva County Hospital, Kuressaare Hospital, Pärnu-Jaagupi Care Home, Narva Hospital, Pärnu Hospital, Vändra Health Centre. 75 76 41