Summary of Health Information and Quality Authority (HIQA) Inspection Finding in Designated Centres for Older People

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 December 2021 to February 2022.

Summary of Findings

The review highlighted that Regulation 23: Governance and Management, Regulation 14: Persons in Charge, Regulation 15 Staffing 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 (30% Not Compliant Red and Orange)
  • The Registered Provider appointed a Person In Charge who did not have three years’ experience of nursing older persons within the previous six years and had not completed a post registration management qualification in health or a related field.
• Regulation 15: Staffing (37% Not Compliant Red and Orange)
  • There were insufficient staff resources in place at night to enable residents to be evacuated safely in a timely manner in the event of a fire.
  • Over a 1 week period, there was no day where the residential centre operated at full staffing capacity.
  • There was insufficient staff allocated to activities on a daily basis. On the day of the inspection, the activities coordinator was allocated to caring due to a deficit in care staff.
• Regulation 23: Governance and Management (55% Not Complaint Red and Orange)
  • Inspectors found that the Management Team resources were redeployed to the provision of direct resident care, and this detracted from implementing the systems to monitor, evaluate and improve the quality of the service provided to residents.
  • Analysis of information following regulatory inspections, management meetings or audits were not leading to the development of quality improvement plans or improved resident care.
  • Audit tools were not sufficiently robust or effective to identify findings that Inspectors found on the day of inspection.
  • Environmental and other audits of key areas of the service were not consistently followed up with clear time-bound action plans and follow-up reviews to ensure that the required improvement actions were completed.
• Regulation 17: Premises (54% Not Compliant Orange)
  • Ongoing preventative maintenance required improvement to ensure the premises was maintained to a high standard.
  • There were insufficient sanitary facilities. For example, sanitary facilities for 13 residents comprised of two toilets and one shower. When the shower was in use, there was only 1 toilet
    available for residents.
  • There was inadequate storage seen across the residential centre which impacted on resident’s rights and infection control.
• Regulation 27: Infection Control (67% Not Compliant Orange)
  • The nurse on duty was caring for both residents with confirmed COVID-19 and residents in whom COVID-19 had not been detected.
  • Staff practice did not reflect the World Health Organisation’s (WHO) five moments of hand hygiene and PPE was used inappropriately.
  • Available sinks designated for hand hygiene did not comply with current recommended specifications.
  • Resident’s used wash-water was emptied down hand wash sinks in resident’s rooms.
• Regulation 28: Fire Precautions (75% Not Compliant Red and Orange)
  • Fire drill records and night-time staff resources did not provide adequate assurances that the residents could be evacuated in a timely, safe and effective manner in the event of a fire at night.
  • While regular evacuation drills were being carried out, the Inspector noted the fire drills lacked detail.
  • There was no evidence of fire exit signage or emergency lighting fitted in external escape routes to indicate fire exits and to illuminate this area in the event of an evacuation.

Conclusion

This report illustrates the 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 Staffing, Governance and Management, Premises, Infection Control and Fire Precautions with many residential centres requiring improvements in key areas such as Individual Assessment and Care Planning, Protection and Risk Management.

Good practice was identified in relation to Insurance, Contract for the Provision of Services and visits.

Download the Report