Summary of HIQA Inspection Finding in Designated Centres for Older People from November 2022 to January 2023

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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 five (25) randomly selected HIQA Inspection Reports. All inspections were completed by HIQA between November 2022 to January 2023.

Summary of Findings

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

• Regulation 21: Records (55% Not Compliant Orange)
  • Records contained gaps in the employment history of staff members with no satisfactory history for those gaps.
  • Not all records were stored in a safe and secure manner. Inspectors found files for residents and staff stored in a general storeroom that was in regular use.
• Regulation 23: Governance and Management (48% Not Compliant Orange)
  • There were no effective deputising arrangements in place. In the absence of the Person in Charge, the Inspectors did not have access to relevant information in respect of various aspects of the service.
  • Only one staff meeting had taken place since the last inspection. An action plan accompanied the minutes, but it was not time bound with no person identified with responsibility for the actions.
  • Disparities between the consistently high levels of compliance reported in the residential centre’s own audits did not reflect the Inspectors’ observations during the inspection.
• Regulation 5: Individual Assessment and Care Plan (29% Not Complaint Orange)
  • Many care plans referred to a female resident as he or a male resident as she throughout the care plans and it was obvious that these care plans were not person centered or specific to the resident.
  • A care plan was not developed for a resident with a history of seizures prior to admission. This meant that staff were unaware of this resident’s health risks and did not have up-to-date information regarding the care interventions this resident needed in the event of them having another seizure.
• Regulation 9: Residents Rights (32% Not Compliant Orange)
  • There was no evidence that issues raised at residents’ meetings were addressed either through the complaints process or any other avenue.
  • During the inspection 14 of the 28 residents in one unit were in bed by 17:20. This did not offer residents a choice of their bedtime.
  • Social activity in “pods” continued. Residents were divided into two groups. Each group remained in their bedrooms on alternate days. The burden of prolonged isolation on residents is considerable. There was no evidence that the infection prevention measures that restricted the liberty of residents had been balanced against a robust ethical justification.
• Regulation 17: Premises (43% Not Compliant Orange)
  • There was inadequate ventilation in a sluice room and a malodour was evident.
  • While the Inspectors were told that weekly temperature checks were completed in communal and bedroom areas, evidence of checks were not made available to the Inspectors and the environmental temperature in one resident sitting area was cooler than the rest of the residential centre and was not comfortable for residents.
• Regulation 27: Infection Control (33% Not Compliant Orange)
  • There were no guidelines available on the care of residents colonised with Multi-Drug Resistant Organisms (MDRO) including CPE and VRE.
  • Storage racks for the purpose for storing continence equipment to dry following decontamination was positioned directly over the hand washing sink in the sluice room and posed a risk of cross contamination from drip of residual liquids.
• Regulation 28: Fire Precautions (69% Not Compliant Orange and Red)
  • There were inadequate storage facilities and inappropriate storage practices in high-risk areas such as the residential centre’s attic space, gas boiler room and stairwells of fire escape routes required urgent action.
  • The Inspectors were not assured by the level of compartmentation and fire-rated construction enclosure to a laundry shaft as the doors that were fitted to the laundry lift were only FD30-rated and thus not sufficient to prevent the spread of fire and smoke.
  • Some external means of escape were unsuitable, as parked cars and an entrance canopy were obstructing them. Furthermore, some of the external routes had steps which would not be suitable for non-ambulant residents in the event of a fire emergency.
• Regulation 29: Medicines and Pharmaceutical Services (30% Not Compliant Orange)
  • Staff had transcribed medicines, in some situations, where there was no prescription record signed by the medical practitioner. Therefore, nurses were administering medications without a valid prescription and directions from the prescriber.
  • PRN medications did not have a maximum dose documented on the medication charts that could lead to a medication error.

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 Fire Precautions with many residential centres requiring improvements in key areas such as Records, Governance and Management, Individual Assessment and Care Plan, Resident Rights, Premises, Infection Control and Medicines and Pharmaceuticals.

Good practice was identified in relation to Insurance, Communication Difficulties, and Information for Residents.