HIQA questions quality and safety of care at nursing home

Residents with dementia were ordered to sit down, had their cigarettes confiscated and were fed from behind by staff who were found to be ‘disrespectful and inappropriate’ in a litany of adverse findings during an unannounced re-inspection at Corrandulla Nursing Home.

Inspectors from the Health Information and Quality Association (HIQA) visited the home last September following concerns raised to the Office of the Chief Inspector about the capabilities of the management team that were having a direct negative impact on the quality and safety of care.

Inspectors were not satisfied that there were sufficient measures in place to protect the 23 residents living in the home from being harmed or suffering abuse.

“Evidence found during this inspection did substantiate these concerns. Inspectors found that there were inadequate governance and management systems and poor oversight arrangements in place to ensure that the service provided to residents was safe, appropriate, consistent and met regulatory requirements. There continued to be repeated regulatory non-compliances from the previous inspection dated January 2019,” the report stated.

A judgment of “major non-compliance” was found in six of the eight outcomes inspected, which focused on the care and welfare of residents who had dementia. An urgent action plan was issued to the nursing home owner in relation to fire precautions with “immediate and sustained improvements” needed in the other areas to meet the requirements of the Health Act 2007.

The interaction between staff and residents makes for uncomfortable reading.

A resident was told to ‘sit down’ in a tone of voice described as ‘inappropriate’.

Following an altercation between two residents, a staff member asked the resident ‘are you five?’.

One resident had their cigarette supply restricted, even though the person became agitate when they could not smoke.

Residents were assisted with their meals “in an inappropriate, unsafe and disrespectful manner”, the report found.

“Inspectors observed a member of staff assisting a resident with their meal. The resident was lying on their side facing the opposite direction. The resident could not see the person who was feeding them. The only conversation heard by the inspector was the direction ‘open your mouth’.”

During meal times there was minimal interaction by care staff who offered no choice to residents.

“Staff stood in front of residents while assisting them with their meals, rather than sitting next to them. The radio was played at a high volume and was not conducive to a relaxed and social dining experience. Residents were not consulted in relation to what they wished to listen to.”

HIQA criticised the fact there were no activities schedule in place for residents who wished to remain in their bedrooms.

There was a failure to ensure and uphold residents rights’ to privacy and dignity by using CCTV in the communal rooms where residents interacted with their visitors.

Inspectors found staff were not administering medicines in line with guidelines, with doses of prescribed antibiotics omitted and oxygen and fluids given without a valid prescription.

A sample of six residents’ files found that clinical risk assessments had not been completed. Nutritional assessments were calculated using incorrect measurements. One resident who was assessed to be at high risk of developing pressure wounds did not have a skin integrity care plan in place. Another who was reviewed by a dietitian following weight loss did not have the recommendations of the dietitian documented in the nutritional care plan or communicated to the catering team.

Following a meeting, management of the home had agreed to review and update care plans for all residents. They said they had increased staffing levels by 50% which would continue.

Fire training was updated and policy and procedures were reviewed with drill techniques practised on site.

The inspectors found the location of fire equipment was not indicated on the fire floor plans and the fire exit from the unit had moss and no hand rails would could cause a delay in the event of an emergency.

The nursing home was given until the end of December 2019 to address all the issues and will be inspected again to ensure full compliance with the regulations.