Summary of HIQA Inspection Findings in Nursing Homes during July 2021 to September 2021

Introduction

This 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).

HCI completed a review of twenty (20) randomly selected HIQA Inspection Reports. All inspections were completed by HIQA between July 2021 to September 2021.

Summary of Findings

The review highlighted that Regulation 23: Governance and Management, Regulation 9: Residents’ Rights, Regulation 17: Premises, Regulation 27: Infection Control and Regulation 28: Fire Precautions, all had findings that carried a Not Compliant Red Risk.

Some of the key findings under the related dimensions and regulations include:

• Regulation 14: Persons In Charge (10% of Services Not Complaint Orange)
  • There was no Person in Charge of the residential centre on the day of the inspection. The previous Person in Charge had resigned 6 months prior to the inspection.
• Regulation 16: Training and Staff Development (26% Not Compliant Orange)
  • Training records did not provide evidence that all staff had received or were up to date with mandatory training.
• Regulation 21: Records (28% Not Compliant Orange)
  • Records required in Schedules 2 and 3 were not maintained in line with the regulation.
  • Some staff records did not contain all the necessary information such as, evidence of qualification, employment history, references and An Garda Siochana vetting disclosures.
• Regulation 23: Governance and Management (70% Not Compliant Orange and Red)
  • The system of governance and management in place for the residential centre at the time of the inspection did not provide adequate oversight to ensure the effective delivery of a safe, appropriate, and consistent service.
  • There was no clearly defined management structure with adequate supports in place to support the Person in Charge in the day-to-day management of the residential centre.
  • There was little evidence of ongoing auditing of the service and of the quality of care and experience of residents during 2020.
• Regulation 31: Notification of Incidents (23% Not Compliant Orange)
  • Notifications in relation to suspected or confirmed incidences of COVID-19 and allegations of abuse to a resident in the residential centre were not submitted to the Chief Inspector.
  • Notifications submitted to the Chief Inspector did not include all occasions when restraint was used.
• Regulation 5: Individual Assessment and Care Plan (25% Not Compliant Orange)
  • Individual assessments were not always completed four monthly.
  • Some residents did not have a care plan initiated within 48 hours from admission to the residential centre.
  • Residents were not always involved in the care planning process.
• Regulation 9: Residents’ Rights (20% Not Compliant Orange and Red)
  • Inspectors were not assured that residents’ rights to undertake personal activities in private were respected.
  • There were gaps seen in access to activities at the weekend.
  • Residents were unable to freely access some communal areas in the residential centre due to locked doors that staff had to open for them.
• Regulation 17: Premises (44% Not Compliant Orange and Red)
  • There was inappropriate storage seen across the residential centre.
  • The premises was in a poor state of repair including worn and damaged skirting boards, grabrails, doors, tiles and walls rendering them difficult to clean.
• Regulation 27: Infection Control (45% Not Compliant Orange and Red)
  • Residents were at risk of infection as a result of the Registered Provider failing to ensure that procedures were implemented by staff.
  • The residential centre did not demonstrate adherence to ‘Interim Public Health, Infection Prevention & Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units’.
  • Some staff were not adhering to the correct use of face masks and not abiding by the uniform policy.
  • Rooms were not cleaned to a high standard and deep cleaning was not completed as per the residentials centre’s cleaning schedule.
• Regulation 28: Fire Precautions (78% Not Compliant Orange and Red)
  • Simulations of evacuations of compartments were not completed cognisant of night duty staff levels.
  • It was apparent that fire drills generally only composed of single room/half compartment evacuation, rather than an entire compartment.
  • Emergency floor plans were not sufficient and could potentially cause delay to emergency evacuations.

Conclusion

This report illustrates the new layout of the HIQA inspection reports and details the continuing trends in HIQA findings in relation to residential care settings for older people in meeting the relevant requirements.

The trends show that high risk findings are still evident in the areas of Fire Precautions, Governance and Management, Infection Control, Premises, Residents’ Rights, and Medication Management with many residential centres requiring improvements in key areas such as Training and Staff Development, Records, and Individual Assessment and Care Plan.

Good practice was identified in relation to End of Life, Communication Difficulties, and Directory of Residents.

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