Guidance on How to Prepare for a HIQA Inspection

Introduction

In the healthcare industry, maintaining high standards of care and safety is of paramount importance. For nursing homes in Ireland, the Health Information and Quality Authority (HIQA) plays a crucial role in ensuring that residents receive high quality of care, in a safe environment.

HIQA conducts various types of inspections to evaluate nursing homes in line with the regulations, National Standards, and best practice guidance. Preparing for a HIQA nursing home inspection is a vital part of maintaining regulatory compliance and ensuring the well-being of residents.

In this blog, we provide an overview of the types of inspections, as well as guidance on best practices for nursing homes to successfully prepare for a HIQA inspection.

Types of Inspections

Inspections are not just on-site events that take place in the residential home. They can also happen through the management and review of all information about the centre held or received by the Chief Inspector of Social Services. The Health Act 2007 (as amended) requires the Chief Inspector to register and inspect designated centres to check whether or not the Registered Provider is complying with the regulations and national standards.

On-site inspections are categorised as follows:

• Monitoring inspections
• Targeted (focused on risk) inspections
• Thematic inspections

There are various types of scheduling options for inspections, including planned announced inspections, short-notice announced inspections and unannounced inspections.

Planned Announced Inspections:

4 weeks advice notice is given to display poster informing residents and representatives of the inspection and ensure questionnaires completed in advance. Completed questionnaires may be returned to HIQA Regulatory Support Team or alternatively given to the Inspector on the day of the inspection. As part of the announcement of the inspection, Providers are also asked to submit certain information, such as their safeguarding policy and risk management policy.

Short-notice Announced Inspections:

These will only be used in exceptional circumstances. 24 to 48 hours notice is given in order to facilitate meetings.

Unannounced Inspections:

No advanced notice is given for unannounced HIQA inspections.

HIQA Inspection Checklist

When preparing for an announced HIQA inspection, focus on things that can be controlled including:

Staff Education

• Communicate with staff pre-inspection.
• Awareness of Inspection Date.
• Provide examples of inspection methods.
• Advise staff on Inspector engagement – open, but only answer questions asked. Never belligerent.
• Give reassurance to staff – work to approved processes.
• Always focus on person-centred care.
• Ensure mandatory training requirements for staff are up to date.
• Ensure staff know how to access P&P’s and are confident in the application of the processes.

Resident Involvement

• HIQA will speak with the residents as part of their inspection process.
• Communicate the upcoming inspection with residents / representatives in advance of inspection via resident representative groups, posters, one to one communication.
• Circulate HIQA questionnaires.
• Identify residents / representatives who may wish to be involved.
• Inform Inspectors of residents that wish to be involved on day of inspection.

Documentation

• Documents to have ready include: All policies and procedures, governance policies, recruitment policy, risk management policy, Incident Management Policy and log, Meeting Minutes (samples), resident register, complaints log book, evidence of audits, staff personnel files, resident records, controlled drug register, training plans, maintenance and service records.
• Ensure that documentation is in a clear, accessible format and well organised.
• Ensure that confidentiality is maintained.
• Ensure that documentation is reflective of your service and processes.
• Ensure that staff are aware of the documentation.  
• Avoid using old, out of date documentation and poorly photocopied/reproduced information.

Management Involvement

• Prepare opening presentation to include:
  • Introduction and Welcome.
  • Overview of Centre – size, number of service users, services provided, occupancy levels etc.
  • Details of Management Structure.
  • Actions taken on previous HIQA Inspection findings / Changes since previous inspection.
  • Activities which will occur for residents on that day.

• Be familiar with relevant documents, SI’s and Standards.
  • Make sure previous non-compliances have been addressed.
  • Keep any information about how resident views the service and any improvements made as a result.
• Have a list of key information:
  • Resident Involvement mechanisms
  • Continuous Improvement examples
  • Environment maintenance
  • Dealing with complaints
  • Protection from Abuse
  • Care Planning
  • Staffing and Recruitment

Environment & equipment

• Ensure fire exits are clear.
• Ensure service/maintenance records are available for all equipment.
• Provide evidence of Health & Safety Assessments.
• Resident Absconsion Prevention Systems.
• Call Bells – Use and Maintenance.
• Hygiene and Infection Control including posters, information for staff and evidence of hand washing.

Logistics

• Have a private room available for the Inspector to use.
• Sign for Door.
• Remove all confidential information.
• Access to paper, pens etc.
• Have documentation available.
• Water and refreshments on arrival and throughout the day.
• Identify key link person.
• Have introduction presentation ready and set up.

Tips on how to prepare for an unannounced HIQA Inspection

Unannounced Inspections provide a more objective picture of the actual standards and level of compliance of a service. In cases where the inspection is unannounced, the service is subject to an assessment of what the quality and safety of care is today. It is argued that this approach is more reflective of the actual service provided.

Below are some tips on preparing for an unannounced HIQA inspection.

• Plan for unannounced inspections – Consider the development on an “Unannounced inspection Policy and Procedure”.
• Ensure staff are trained on what to do should an unannounced inspection arise.
• Complete drills to assess the service’s responses to an unannounced inspection. Where possible, get an independent entity to complete this process.
• Ensure policies and procedures are up to date with regulatory requirements.
• Ensure any open incidents and complaints logged are under review and being actioned.
• Keep up to date with external reporting to HIQA.
• Keep up to date with your internal audit schedule and be responsive to findings.
• Ensure any findings from previous HIQA inspections are closed or being appropriately managed.
• Ensure care records are completed as care is provided.
• Ensure mandatory staff training is completed as required.
• Have a process in place that allows you to view the key metrics of the service so that significant slippage does not occur.
• Predict the focus of inspections: Be aware of “what’s hot right now” – research what are the key areas of focus for Inspectors, due to changes in regulation, or high levels of NC’s in other services.

Conclusion

Preparing for a HIQA inspection in a nursing home is a comprehensive and ongoing process that involves careful planning, self-assessment, staff training, and a commitment to maintaining high-quality care and safety standards. By adhering to the regulations, National Standards, and best practice guidance, maintaining accurate records, and continuously improving your nursing home’s operations, you will support your regulatory compliance.

HCI has been working with health and social care organisations for almost two decades, supporting them to make intelligence driven decisions to attain, manage and improve quality, safety and regulatory compliance. HCI supports nursing homes in achieving compliance with regulations and best practice guidance. We provide practical, hands-on support, helping nursing homes to build comprehensive Quality and Safety Management Systems that assure the quality and safety of the care provided. We offer support in the development of policies and procedures, provide education and training, conduct independent quality audits and support governance and management teams in preparing for a regulatory inspection from HIQA.

For more information on HCI’s HIQA Regulatory Compliance Support for nursing homes contact HCI at 01 629 2559 or info@hci.care.