Summary of HIQA Nursing Home Inspection Reports identifies Non-Compliance Issues in areas such as Governance and Management, Fire Precautions and Complaints

Introduction

HCI completed a review of thirty-six (36) randomly selected Health Information and Quality Authority (HIQA) Inspection Reports for residential care settings for older people. This review highlights the trends in non-compliance as detailed by HIQA in the inspection reports. All nursing home inspections were completed by HIQA between November 2023 and January 2024.

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Summary of Findings

In HCI’s review, the high-risk areas with non-compliance included Governance and Management, Complaints, Fire Precautions, Infection Control, Residents Rights, Staffing and Protection.

Some of the key findings under the related regulations include:

Regulation 23 Governance and Management:

• The registered provider did not operate the centre in line with its conditions of registration as a number of communal areas dedicated for residents’ use had been re-purposed without agreement with the Chief Inspector in advance.
• Recent changes in the provider’s senior management team did not ensure that the lines of authority and accountability were clear. As a result, a recent complaint including the safeguarding concerns had not been followed up as directed by the provider.
• The annual review of the quality and safety of care did not adequately assess if the care delivered was in accordance with relevant standards, nor was there evidence that the report was prepared in consultation with residents and their families.
• The Registered Provider has not put in place effective management systems and processes to ensure it is competent to provide a service to residents that is safe, appropriate, consistent and effectively monitored.
  • A number of audits were not scored, tracked, trended to monitor progress and drive improvements in resident care.
  • The centres governance meeting minutes were not robust to drive quality improvement. Records of governance meetings did not show evident of actions required from audits being discussed.
  • There were inconsistent and poorly defined systems in place to escalate risks to the senior management.

Regulation 34 Complaints:

• The registered provider failed to meet regulation requirements in relation to the management of complaints. For example;
  • the detail of the complaints were not fully recorded.
  • complaints were closed out without any evidence of investigation or actions taken as a result of the complaint.
  • the satisfaction level of the complainant was not always recorded.
  • opportunities for learning and quality improvement were not identified and communicated to staff.
• The provider had recorded one complaint since the last inspection and the complaint had not been followed up in line with the centre’s own complaints procedure.
• There was no provision for the access to advocacy services to assist with the making of a complaint or reference to an external complaints process, such as the ombudsman.

Regulation 21 Records:

• While policies and procedures as required by Schedule 5 of the regulations were available, they were poorly organised, difficult to review, and not easily accessible.
• One staff member had commenced employment two weeks prior to the staff member’s garda vetting being received.
• The roster was not an accurate reflection of all persons working at the designated centre or a record of whether the roster was actually worked.

Regulation 15 Staffing:

• Inspectors were not assured that there were sufficient numbers of staff available to meet all the needs of the residents as on the day of the inspection.
• On review of the staffing rosters, it was identified that staff nurses were working 96 hours over a two week period to cover the vacancies with one nurse working 102 hours. This is not sustainable.
• This inspection found that there was not sufficient staff on duty to meet the needs of the residents.

Regulation 28 Fire Precautions:

• There were inconsistencies and a lack of clarity in respect of the fire evacuation strategy. Differences were identified between the local policy, evacuation plans displayed on the wall, staff training and knowledge, and completed evacuation drills.
• A courtyard area which was a designated means of escape had a padlock on the gate. This was in direct contradiction with the fire safety certificate which stated that it should be unobstructed and free from fastenings.
• Residents’ documentation displayed on their wardrobe doors, detailing their personal emergency evacuation procedures were not always kept up to date.
• Records showed that one fire drill have been completed in 2023. This was against provider’s own local policy which stated that monthly fire drills should be completed.

Regulation 9 Residents Rights:

• Residents had restricted access to the dining room, oratory and two visitor rooms. On the day of inspection these rooms were observed to be locked at various times of the day.
• There was no documented evidence that activities took place for residents for 3 days of the week.
• The residents survey results highlighted a dissatisfaction amongst residents relating to the overall care provided, communication, services and recreation. However, the registered provider had failed to respond to resident feedback survey results.

Regulation 27 Infection Control:

• The registered provider did not have adequate oversight of cleaning. For example:
  • The dining room was visible unclean during the premises walk in the morning.
  • Access to cleaning rooms was not readily available on the day of the inspection and inspectors were told that oversight of these areas was not completed by the registered provider.
• Mop heads were not changed between the cleaning of residents’ bedrooms and their en-suites.
• Hand gel receptacles were observed to be stained and contained excess amount of dried hand gel.

Regulation 8 Protection:

• The records of accidents and incidents reviewed identified a potential safeguarding risk that was not investigated and managed in line with the centre’s own safeguarding policy.
• Action was required to ensure that all staff were familiar with what constitutes abuse and the actions to be taken to detect, prevent and respond to abuse. Staff spoken with did not identify the presence of unexplained bruising as a potential safeguarding concern.
• Records reviewed by the inspector showed that 17% of the current staffing complement did not have up-to-date training in safeguarding of vulnerable adults.

Regulation 6 Health Care:

• 1 resident who was admitted to the designated centre two months prior to the inspection had not been seen by their nominated GP.
• 1 resident who had been residing in the centre for many years had not been seen by their nominated GP in 17 months.
• 1 out of the 4 GP’s attending residents in the centre, did not have oversight and did not take responsibility of residents end-of-life care needs.

Regulation 7 Managing Behaviour that is Challenging:

• Inspectors were not assured that the least restrictive methods were being used in relation to restrictive practices. For example, records did not set out when PRN medication should be administered to residents. Where there were changes to this type of medication, records did not clearly set out the rational for that change.
• The restraint register completed by the management team did not cover all types of restriction in use in the centre. While it did cover environmental restraints, it did not cover chemical restraints.

Conclusion

This review 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 Governance and Management with many residential centres requiring improvements in key areas such as Fire Precautions, Complaints, Records, Resident Rights, Infection Control, Premises, Protection, and Staffing.

HCI’s expertise in quality improvement, resident safety and regulatory compliance uniquely positions us to assist your nursing home in overcoming the issues identified in the recent HIQA inspections. By integrating HCI’s comprehensive services, including governance reviews, quality of care audits, and best practice policies and procedures, you can enhance your nursing home’s operational effectiveness and ensure compliance with regulatory requirements, National Standards and best practice.

If you would like further information on HCI’s HIQA Regulatory Compliance support offerings for nursing homes, contact HCI at +353 (0)1 629 2559 or email info@hci.care.