HIQA’s Non-Compliant Findings Explained: The Regulations Putting Nursing Homes at Greatest Risk

Introduction

HCI conducted an in-depth review of 25 HIQA inspection reports for designated centres for older people, completed between June and September 2025 and published in December 2025 and January 2026. Our analysis found that the same regulations are being cited repeatedly as Not Compliant, often at Red or Orange levels. These findings are not isolated incidents,  they point to systemic weaknesses in how risk is identified, managed and controlled within services, increasing the likelihood of regulatory escalation if left unaddressed.

This article breaks down the key regulations most frequently associated with serious non-compliance, explains what inspectors are observing in practice, and highlights what these findings mean for providers seeking to reduce inspection risk and prevent escalation.

Regulation 23: Governance and Management 

Governance and management emerged as the most significant area of concern across the inspections reviewed. Where Regulation 23 was found non-compliant, inspectors consistently identified weaknesses that allowed other risks to persist undetected.

A recurring theme was the failure of audit systems to identify real risk. Internal audits often indicated compliance, yet inspectors observed unsafe practice on the day of inspection. Fire safety risks, infection prevention and control (IPC) breaches, and care delivery issues were frequently missed by internal audit programmes. In some cases, audits did not cover the very areas that became the focus of inspection findings.

Inspectors also identified weak organisational structures and unclear accountability. Roles and responsibilities between PICs, CNMs, ADONs and operational management were not clearly defined, leading to poor escalation of risk, particularly outside of core working hours. High turnover in management roles further destabilised oversight and continuity.

Incident and risk management systems were another area of concern. While risks were often documented, control measures were not consistently implemented or monitored, and trends in incidents such as falls or unexplained injuries did not lead to effective learning or improvement. In several cases, repeated findings indicated that action plans had not resulted in sustainable change.

Regulation 15 and 16: Staffing, Training and Supervision

Staffing and workforce management featured strongly in the inspections reviewed, with providers frequently found non-compliant with both staffing and training requirements.

Inspectors identified insufficient numbers and skill mix of staff to meet residents’ assessed needs, resulting in delays to care and compromised safety. In one centre, staffing levels for high-dependency units were not adhered to, and short-term absences were not replaced.

A particularly significant finding was the absence of risk assessment before reducing staffing levels. Staffing decisions were often driven by rosters rather than resident acuity, and gaps in shifts were not escalated or addressed.

Training and supervision failures compounded these risks. Mandatory training such as CPR and safeguarding was found to be out of date for some staff, while inspectors observed unsafe practices linked to inadequate supervision, including IPC breaches and inappropriate use of equipment.

Regulation 28: Fire Precautions 

Fire safety findings featured prominently among the most serious non-compliances identified. Inspectors focused in particular on evacuation capability, asking whether residents could be safely evacuated if a fire occurred.

Across inspections, evacuation drills were found to be unrealistic and insufficient. Drills often involved only two or three residents rather than full compartments, did not simulate worst-case scenarios, and were carried out using staffing levels that did not reflect reality. In one centre, the largest compartments had not been tested for evacuation in over two years, and recorded evacuation times were dangerously long.

Inadequate escape arrangements further increased risk. Inspectors identified unclear or incorrect signage, damaged or padlocked exit gates, and Personal Emergency Evacuation Plans (PEEPs) that lacked essential detail.

Regulation 9: Residents’ Rights

Residents’ rights featured prominently in the inspections reviewed, with HIQA identifying repeated failures in how services supported dignity, choice, privacy and meaningful engagement.

Inspectors observed limited or inconsistent activity programmes, with some residents spending long periods without stimulation, particularly when activities staff were redeployed to cover staffing shortages elsewhere. Dining experiences were compromised, with residents eating in unsuitable environments or without access to the same choice and dignity afforded to others.

Privacy concerns were also evident, including clinical handovers taking place in communal areas and personal information being openly displayed.

Regulation 17 and 18: Premises, Food and Nutrition

Premises and nutrition findings carried significant regulatory weight in the inspections reviewed.

Inspectors identified significant failures in heating and hot water provision, with residents’ bedrooms without heating during cold periods and no hot water available in clinical or domestic areas. These issues directly affected residents’ dignity, comfort and hygiene.

Food and nutrition findings focused on the mealtime experience. Menus did not always reflect what was served, modified diets were unavailable or poorly managed, and residents experienced rushed, undignified meal service. Staff distraction and lack of supervision further increased risk for residents with swallowing or nutritional needs.

What Providers Should Take From This?

The findings from recent inspections should prompt providers to reflect critically on their own systems. Key questions include:

• Do audits test real practice or documentation only?
• Would risks be identified out of hours or under pressure?
• Do incident trends lead to meaningful improvement?
• Are staffing decisions consistently risk-assessed?

Early recognition and control of risk is the most effective way to prevent escalation.

How HCI Supports Nursing Home Providers

HCI works with nursing homes to strengthen governance, assurance and compliance by:

• Reviewing governance and oversight frameworks
• Conducting Quality of Care Audit Programmes
• Best Practice Policies and Procedures utilising Cloda
• Supporting risk management and incident learning
• Implementing quality and safety management systems, including digital solutions that provide real-time assurance

Conclusion

Most providers do not fail inspections because they do not care. They fail where systems do not surface risk early enough. The recent HIQA findings offer a clear opportunity to act — before inspection, rather than because of it. If your nursing home requires regulatory, quality or resident safety support then contact HCI at +353 (0)1 6292559 or info@hci.care to find out how we can help you.