Summary of HIQA Inspection Findings in Nursing Homes during April 2021 to June 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-four (24) randomly selected HIQA Inspection Reports. All inspections were completed by HIQA between April 2021 and June 2021.

Summary of Findings

The review highlighted that Regulation 15: Staffing, Regulation 9: Residents’ Rights 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 15: Staffing (4% Not Compliant Red))
  • Residential centre did not ensure adequate staffing levels were in place to meet the needs of residents or for the size and layout of the residential centre.
• Regulation 21: Records (30% Not Compliant Orange)
  • Records for newly recruited staff members required review as not all the required documentation was available.
  • Do Not Resuscitate (DNR) orders were not clearly documented.
  • Staff rosters in the residential centre did not identify the role of the staff member.
• Regulation 23: Governance and Management (29% Not Compliant Orange))
  • Roles and responsibilities of the senior management team were not clearly defined.
  • Inadequate supervision and oversight of housekeeping staff.
  • Organisation structure required review as it was not in line with the residential centre’s Statement of Purpose.
  • Some audits completed did not contain a time bound action plan.
• Regulation 34: Complaints Procedure (14% Not Compliant Orange)
  • The residential centre’s complaints policy required review as complaints were not recorded in line with regulatory requirements.
  • The documentation of complaints was inconsistent and did not consistently record the investigation outcome, the learning identified or the satisfaction of the complainant.
• Regulation 9: Residents’ Rights (17% Not Compliant Red and Orange)
  • The residential centre failed to risk assess a resident’s psychosocial well-being and to develop a professional, appropriate and personcentred care plan.
  • The residential centre failed to communicate effectively with residents in relation to opportunities for activity and social engagement.
  • Resident meetings were required to be held more frequently.
  • The residential centre was required to ensure all residents had access to facilities for occupation and recreation.
• Regulation 17: Premises (23% Not Compliant Orange)
  • In multi-occupancy rooms, there was inadequate space for residents to sit in a chair beside their beds.
  • The building required upgrading, repair and repainting.
  • No call bell available in a quiet room.
• Regulation 27: Infection Control (21% Not Compliant Orange)
  • The designated isolation rooms in use were not effective and were not in line with the HPSC guidance for the Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities.
  • Cleaning procedures utilised by staff in the residential centre were inconsistent.
  • No clinical waste bins inside or outside the designated isolation rooms.
  • Sluice room was not clean.
  • No clinical waste bins inside or outside the designated isolation rooms.
• Regulation 28: Fire Precautions (26% Not Compliant Red and Orange)
  • No recorded evidence of simulated full compartment evacuation drills.
  • Personal Evacuation Plans for residents were not easily accessible in the event of an emergency.
  • Fire doors required review as gaps were identified.
• Regulation 29: Medicines and Pharmaceutical Services (28% Not Compliant Orange)
  • Staff in the residential centre were not adhering to medication management guidance as set out by the Nursing and Midwifery Board of Ireland.

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 area of Staffing, Governance and Management, Infection Control, Fire Precautions and Medicines and Pharmaceutical Services with many residential centres requiring improvements in key areas such as Records, Complaints, and Premises.

Good practice was identified in relation to Insurance, Notification of Absence, Notification of Procedures and Arrangements for periods when Person In Charge is absent, Communication Difficulties, Visits and End of Life.

Download the report