Summary of HIQA Inspection Finding in Nursing Homes during March to May 2022

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 March 2022 to May 2022.

Summary of Findings

The review highlighted that Regulation 23: Governance and Management, Regulation 15 Staffing, Regulation 21: Records, Regulation 9 Residents’ Rights, Regulation 27: Infection Control 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 23: Governance and Management (90% Not Compliant Red and Orange)
  • The management and oversight systems in place to ensure compliance with Regulations were not effective. This was evidenced by:
    • Systems to ensure effective allocation of staffing resources were not in place and did not ensure the effective delivery of care in accordance with the residential centre’s Statement of Purpose.
    • Risk was not appropriately managed and resulted in a culture of over restrictive and institutional practices which were negatively impacting on residents’ quality of life, positive risk taking, rights and well-being.
  • Key Performance Indications (KPIs) such as falls, restraints, weight loss, pressure ulcers, infections and indwelling catheters were monitored weekly; however, these KPIs did not reflect the clinical findings of the inspection and therefor failed to provide clinical oversight of how the service was performing and analysing the information to improve outcomes for residents.
  • Audit tools were not sufficiently robust or effective to identify findings that inspectors found on the day of inspection.
• Regulation 15: Staffing (30% Not Compliant Red and Orange)
  • The allocation of staff in the residential centre did not ensure there was adequate numbers of staff with appropriate skills to ensure that residents’ individual support, choice and social activity needs were met.
  • There were six vacant day shifts on the day of inspection. Inspectors observed that residents had to wait for staff assistance including access to meals.
  • The Person in Charge did not have any additional managerial support in running the residential centre on a day-to-day basis. The senior staff nurse was working as a staff nurse without any managerial hours allocated to their duties.
• Regulation 21: Records (36% Not Complaint Red and Orange)
  • Significant improvements were required in relation to record management. Of a sample of four staff files reviewed, two did not have a Garda vetting disclosure in accordance with the National Vetting Bureau (Children and Vulnerable Persons) Act 2012.
  • Inspectors observed that residents records were not stored safely on two occasions during the inspection.
  • The record of a resident’s transfer to hospital, the name of the hospital and date of transferred was not recorded as required by Schedule 3 of the regulations.
• Regulation 9: Resident’s Rights (40% Not Compliant Red and Orange)
  • Residents’ right to exercise choice in how and where they spent their day was not respected. Resident’s daily routines were largely determined by the established routines of staff working in the residential centre and did not reflect individual resident preferences of flexible routines determined by the resident on a daily basis.
  • Male and female residents were segregated by locked doors on the corridors between two units. This was a well-established practice in the residential centre and did not reflect the current needs of the residents or their preferences.
• Regulation 27: Infection Control (65% Not Compliant Red and Orange)
  • There was no COVID-19 contingency plan seen on the day of inspection.
  • Resident equipment, such as unclean wheelchairs and hoists slings, was stored in the same room as sterile dressings and supplies.
  • Many of the gloves in the residential centre were vinyl gloves rather than nitrile. Vinyl gloves are not recommended for healthcare as they do not offer adequate protection against blood and body fluids.
• Regulation 28: Fire Precautions (67% Not Compliant Red and Orange)
  • The Inspector saw that a number of serious findings, highlighted in an external report on fire safety in the residential centre from 2021, had not ben addressed.
  • The basement area of the building contained large volumes of combustible storage.
  • There was damage to some fire safe doors, some doors were not capable of being closed properly due to broken locks of had gaps around the fire safe door.
  • The procedures to follow in the event of a fire emergency were not displayed at appropriate locations around the residential centre.

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, Residents’ Rights, Infection Control and Fire Precautions with many residential centres requiring improvements in key areas such as Staff Training and Development, Managing Behaviour that is Challenging, Premises and Medicines and Pharmaceuticals.

Good practice was identified in relation to Persons in Charge, Directory of Residents, Volunteers and End of Life.

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