Summary of HIQA Inspection Findings in Nursing Homes during June 2020 to September 2020

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).

These legislative requirements are supported throughout the report by the National Standards for Residential Care Settings for Older People in Ireland (2016).

In light of the impact of COVID-19, certain reports also make reference to the application by residential homes of the following:

• National Standards for infection prevention and control (IPC) in community services (2018)
• HSE & HPSC Interim Public Health, Infection Prevention & Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities

HCI completed a review of twenty-three (23) randomly selected HIQA Inspection Reports. All inspections were completed by HIQA during June 2020 to September 2020.

Summary of Findings

The review highlighted that Regulation 15: Staffing, Regulation 23: Governance and Management, Regulation 17: Premises, Regulation 27: Infection Control and Regulation 28: Fire Precautions had findings that carried a Not Complaint Red Risk. Issues identified under these Regulations included:

• Regulation 15: Staffing 
  • Inadequate resources available for nursing care staff.
  • Hours for cleaning staff were inadequate as efficient cleaning was not taking place.
  • Staffing levels allocated did not ensure care was provided in a person centred manner.
• Regulation 23: Governance and Management 
  • Inadequate arrangements for ensuring compliance with legislation.
  • Failure to implement the Health Protection Surveillance Centre’s (HPSC) “Interim Public Health, Infection Prevention and Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities” guidance.
• Regulation 17: Premises
  • Premises required updating to ensure a safe and appropriate environment was in place.
• Regulation 27: Infection Control
  • Inaccurate recording of staff and resident temperatures.
  • Staff not wearing masks appropriately and not in line with HPSC guidance.
  • Review of environmental hygiene was required.
  • IPC processes were not in line with HIQA’s National Standards for Infection Prevention and Control in Community Services 2018 or HPSC guidance for residential care facilities.
• Regulation 28: Fire Precautions
  • The Registered Provider did not take adequate precautions against ensure the safe and effective evacuation of residents.
  • Fire doors had gaps between them making them ineffective to contain fire, smoke, and fumes.
  • Fire drills did not take place at night-time to ensure the residential centre can be evacuated safely with night-time staffing levels.

Other areas recognised as requiring improvement:

• Regulation 16: Training and Staff Development
  • Training provided was not adequate and did not ensure safe quality care was provided – staff are not aware of current good practice and how to implement it.
• Regulation 34: Complaints Procedure
  • The complaints policy and procedure were not updated to ensure relevant information regarding the requirement for a complaints officer.
  • Complaints were not adequately investigated and addressed.
• Regulation 25: Temporary Absence or Discharge of Residents
  • Necessary information, such as medical diagnosis and medications, were not always detailed in the transfer letter.
  • Comprehensive information was not provided to the receiving hospital.
• Regulation 12: Personal Possessions
  • Insufficient storage was used by residents to store their personal belongings.
  • Residents were required to limit the number of personal items they had where they were in a multi-occupancy room.
• Regulation 6: Healthcare
  • Appropriate medical and healthcare reviews were not completed in a timely manner for residents.
  • Wound care practices of nurses were found to be inconsistent.
  • Inconsistent records were retained to record if residents had been tested for COVID-19. No records were retained as to whether their results had been conveyed to them.
• Regulation 29: Medicines and Pharmaceutical
  • Gaps were identified in relation to signatures in the controlled drug record book.
  • Expired medications remained in the drug trolley.

The following Regulations were not inspected in the reports reviewed and were therefore not included in the analysis:

• Registration Regulation 6 (S.I.No. 61 of 2015) – Changes to Information Supplied for Registration Purposes.
• Regulation 30 (S.I.No. 415 of 2013) – Volunteers

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, Premises, Infection Control and Fire Precautions, with many residential centres requiring improvements in key areas such as Training and Staff Development, Complaints Procedures, Temporary Absence or Discharge for Residents, Personal Possessions, Healthcare and Medicines and Pharmaceutical Services.

Good practice was identified in relation to Persons In Charge, Directory of Residents, Notification of Absence, Communication Difficulties, and Information for Residents.

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