HCI has completed a review of seventeen randomly selected HIQA Inspection Reports of Designated Centres for Older People. All inspections were completed during March 2019 to June 2019.
The report by HCI highlights the trends in inspection findings, those being ‘Compliant’ and ‘Not Compliant’ as detailed by the Health Information and Quality Authority (HIQA) in reports for residential care settings for older people. The inspections were against the requirements as outlined in the following:
- Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I.No. 415 of 2013).
- Health Act 2007 (Registration of Designated Centres for Older People) Regulation 2015 (S.I.No. 61 of 2015).
Summary of Findings
The review highlighted that Regulation 21: Records, Regulation 23: Governance and Management and Regulation 28: Fire Precautions had findings that carried a Not Compliant Red Risk.
Issues identified under these Regulations included:
- Regulation 21: Records (58% of Services Not Compliant of the 12 assessed against the Regulation). Issues included:
- Failure to ensure all staff had a vetting disclosure in accordance with the National Vetting Bureau (Children and Vulnerable Person Act 2012 and 2016).
- Regulation 23: Governance and Management (76% of Services Not Compliant of the 17 assessed against the Regulation). Issues included:
- Inspectors were not assured that the appropriate management systems were in place to ensure the service provided was safe appropriate to the needs of residents and effectively monitored by the Registered Provider.
- The fire safety strategy was not implemented, and management were not knowledgeable in relation to it.
- Regulation 28: Fire Precautions (59% of Services Not Compliant of the 17 assessed against the Regulation). Issues included:
- The Registered Provider did not take adequate precautions against the risk of fire or ensure that adequate systems were in place to ensure the safe and effective evacuation of residents.
- Break glass units were located 1.5m above floor level.
- Fire safety management plans was not up to date.
- No signage was available to alert staff and residents to the use of oxygen in bedrooms.
Additional key areas requiring improvement included:
- Regulation 17: Premises (82% of Services Not Compliant of the 17 assessed against the Regulation). Issues included:
- The layout and design of the residential centre was not fit for purpose.
- General maintenance of the premises was required.
- Inadequate storage facilities for residents.
- Regulation 19: Directory of Residents (80% of Services Not Compliant of the 5 assessed against the Regulation). Issues included:
- The Directory of Residents had not been updated to reflect all admissions and transfers.
- The Directory of Residents was not available for review during the inspection.
- Regulation 26: Risk Management (77% of Services Not Compliant of the 13 assessed against the Regulation). Issues included:
- Risk management policy and procedure did not contain the necessary information as detailed within the Regulations.
- There were inadequate arrangements to identify, assess, mitigate, monitor and report all risks.
- Risks were not assessed and managed appropriately.
- The Risk Register was not updated and reviewed on a regular basis.
Summary of Findings from Restrictive Practice Thematic Inspection Reports
HIQA commenced restrictive practices thematic inspections in designated centres for older people in 2019. Thematic inspections are performed by HIQA to drive quality improvement within designated centres. Restrictive practices inspections completed by HIQA focus on assessing physical and environmental restraint among other types of restrictive practices. Chemical restraint is not inspected as part of the thematic inspection programme. A summary review was completed of 14 thematic inspection reports released within the period from May 2019 to June 2019. Key findings included:
- The use of a restrictive practice was not recorded on the Restrictive Practice Register.
- Restrictive practices in the residential centre were not always supported by appropriate assessments. Practices include external doors that were secured with keypad locking devices were not identified as a restrictive practice and did not have accompanying risk assessments completed.
- Reviews of care plans did not provide sufficient detail to ensure residents were consulted with in relation to the continued use of the particular restraint.
- Pre-admission assessments were not routinely signed or dated by the assessor.
- A small number of staff informed the Inspector that there were occasions when family members insist on the use of bedrails. This required further information sessions to ensure all staff were fully informed of, and operating in line with, national guidelines on the use of physical restraints.