CHANCELLOR OF JUSTICE AS THE PREVENTIVE MECHANISM IX. PROVIDERS OF SPECIAL CARE SERVICES 1. General outline During the reporting period, there were six social welfare institutions in Estonia providing 24-hour special care services to persons placed in the institution upon a court ruling and in respect of whom the right of free movement may be restricted for the period of providing the service (i.e. a person is placed in a closed department). The Chancellor of Justice inspected three of the six of these establishments in 2010. The inspected establishments included Valkla Care Home (AS Hoolekandeteenused) (Inspection visit to Valkla Care Home (AS Hoolekandeteenused), case No 7-9/100019), nursing care and social welfare department of Viljandi Hospital Foundation (Inspection visit to the nursing care and social welfare department of Viljandi Hospital Foundation, case No 7-9/100490) and Võisiku Care Home (AS Hoolekandeteenused) (Inspection visit to Võisiku Care Home (AS Hoolekandeteenused), case No 7-9/100683). Previously, the Chancellor had inspected Valkla Care Home in 2001. Võisiku Care Home and the nursing care and social welfare department of Viljandi Hospital Foundation had not been inspected previously. The choice of the inspected institutions was based on the Chancellor’s work plan and the need to inspect institutions which had not been inspected at all or inspected a long time ago, and to verify whether the fundamental rights and freedoms of persons are guaranteed in the institutions. Petitions received by the Chancellor from service recipients (the number of petitions as well as the problems described in them) also affected the choice of the time and place of the inspections. All the above inspection visits were carried out without an advance notice. In comparison to previous visits, inspections carried out during the reporting period are characterised by more active involvement of experts and interviewing of service recipients and staff. In the inspection visit to the nursing care and social welfare department of Viljandi Hospital Foundation a general practitioner and a psychiatrist were involved as experts, and in the visit to Võisiku Care Home a general practitioner was involved. Experts examined the treatment documents of patients in these institutions in order to assess the conformity of general medical care and psychiatric care with the requirements. The experts did not find any violations of the requirements. However, some recommendations for improving the quality of health care were given. One of the main problems concerning both the undertaking AS Hoolekandeteenused and Viljandi Hospital Foundation was the absence or insufficiency of a register for recording incidents or seclusion. In the nursing care and social welfare department of Viljandi Hospital Foundation no separate register for recording the use of seclusion has been introduced. Therefore, advisers to the Chancellor could not verify the relevant information. In Võisiku Care Home, upon examination of the register of incidents of seclusion, decisions for placement of persons in a seclusion room and the relevant case descriptions, advisers to the Chancellor found that some cases of seclusion of persons receiving the service in the care home had not been recorded in the register of seclusion. The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) in its report on a visit to Estonia28 (which took place in 2003) in paragraph 103 has said: “every instance of the physical restraint of a patient/resident (manual control, use of instruments of physical restraint, seclusion) should be recorded in a specific register established for this purpose (as well as in the patient’s file). The entry should include the times at which the measure began and ended, the circumstances of the case, the reasons for resorting to the measure, the name of the doctor who ordered or approved it, and an account of any injuries sustained by patients or staff. This will greatly facilitate both the management of such incidents and the oversight of the extent of their occurrence.” In paragraph 52 of its standards,29 the CPT also emphasises the necessity of a register for recording incidents of restraint. 58 28 Available online: http://www.cpt.coe.int/documents/est/2005-06-inf-eng.pdf. 29 Available online page 52: hhttp://www.cpt.coe.int/en/documents/eng-standards.pdf.