Summary of HIQA Inspection Findings in Nursing Homes during December 2020 to March 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 December 2020 to March 2021.

Summary of Findings

The review highlighted that Regulation 15: Staffing, Regulation 16: Training and Staff Development, Regulation 23: Governance and Management, Regulation 27 Infection Control, Regulation 28: Fire Precautions and Regulation 29: Medicines and Pharmaceutical Services, all had findings that carried a Not Compliant Red Risk.

Issues identified under these regulations include:

• Regulation 15: Staffing (33% Not Compliant Red and Orange)
  • Insufficient number of nurses available to allow for unprecedented demands of COVID-19.
• Regulation 16: Training and Staff Development (33% Not Compliant Red and Orange)
  • Training records illustrated gaps in mandatory training requirements.
  • Staff were not adhering to the designated centre’s policies and procedures such as Infection Prevention and Control.
  • Staff with responsibility for completing audits had not received any audit training.
• Regulation 23: Governance and Management (50% Not Compliant Red and Orange)
  • The Registered Provider abdicated its responsibility and was failing in accountability, as required by the Health Act 2007.
  • A lack of clearly defined management structure that identified the lines of authority and accountability, specifies roles and details the responsibilities.
  • Supernumerary hours were not in place for senior staff.
• Regulation 27: Infection Control (46% Not Compliant Red and Orange)
  • Infection prevention and control practices and protocols in the designated centre 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.
  • Insufficient oversight of staff’s infection control practices.
  • Not all staff had attended up to date training and refresher courses in IPC and a lack of knowledge was evident in practices observed.
• Regulation 28: Fire Precautions (75% Not Compliant Red and Orange)
  • The Inspector found staff were insufficiently trained or experienced to manage their roles and responsibilities in relation to fire safety.
  • Inspector not assured that the largest compartment could be evacuated in a timely manner.
  • Simulated fire drills with nighttime staffing conditions evidenced poor evacuation times.
• Regulation 29: Medicines and Pharmaceutical Services (28% Not Compliant Red and Orange)
  • Staff administered medication without a prescription.
  • A number of medicines were found to have been transcribed without authorisation, were not transcribed correctly, were not signed by the transcriber or did not detail what route the medicine was to be administered.

Additional key areas requiring improvement included:

• Regulation 34: Complaints Procedure (19% Not Compliant Orange)
  • Policies and procedures did not comply with legislative requirements for complaints.
  • No evidence of follow up or evidence that the Complainant was satisfied with outcome.
• Regulation 17: Premises (59% Not Compliant Orange)
  • The Registered Provider was not providing a premises which conformed to the matters set out in Schedule 6 of the Regulations. The major impact was on daily experience for residents living in the designated centre, for example, the lack of privacy to perform basic care, noise, risk of infection and fire evacuation risks.

Good practice was identified in relation to Communication Difficulties and End of Life.

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, Training and Staff Development, 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, Personal
Possessions and Premises.

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