Unsuitable staffing, overcrowded rooms and a lack of respect for residents' dignity and privacy have been highlighted in reports on a number of centres for older people across Ireland.
Health Information and Quality Authority (HIQA) inspections carried out across Ireland in late 2017 found evidence of "major non-compliance" in areas such as health, safeguarding, governance and suitable staffing in six centres for older people in Killarney, Kells, Ratoath, Dublin, Cavan and Ballinamore.
The latest Hiqa reports, published on Monday, warned that in six of the 14 centres examined, older people’s needs were “not always met in line with the regulations and standards of these centres”.
An unannounced “triggered” inspection of the St Colomcille’s Nursing Home in Kells, Co Meath, which was carried out over two days in December 2017, reported a “major” non-compliance in the area of staffing.
The inspection was carried out after the health body received an “unsolicited” concern regarding inadequate staffing and poor quality of care for residents in the centre. This latest inspection at St Colomcille’s was the second such “triggered” inspection of the home in 2017.
While the centre was reported as “homely” and “comfortable”, Hiqa found the number of nurses was being reduced from two to one between 4pm and 8am every day.
Dependency
There were 35 residents living in the centre, of whom 27 were assessed as having “high to maximum dependency needs”. The inspector was told by staff that residents with this level of dependency generally required assistance from two staff members working in pairs.
Hiqa found that aside from providing care to all residents in the centre, the night time nurse also had many other duties to carry out, including visitor queries, answering phone calls from pharmacies/GPs and conducting the evening medication round.
The majority of staff highlighted that the lack of staff greatly impacted the night nurse’s ability to carry out his/her role effectively and meet the residents’ needs. The inspection noted “warm interactions” between staff and residents, while residents also spoke positively of staff and indicated that they were treated with respect and dignity.
A similar concern was raised regarding staffing numbers at the St Colomcille Nursing Home in June 2017 when inspectors found that only one nurse was available between 6pm-8am each day.
Hiqa also noted “moderate” non-compliance of governance and management at the centre, medication management and the health and social care needs of residents. The inspector warned that the centre had recruited nurses with “limited experience in older person care and no training in dementia care or challenging behaviours” and underlined issues with infection prevention and control.
Major non-compliance
An announced inspection of the Killarney Community Hospital - Fuschia, Hawthorn and Heather wards - in mid-November 2017 reported "major" non- compliance in the provision of a safe and suitable premises for residents.
The Hiqa inspector found that bedrooms in the Heather, Hawthorn and Fuschia units of the hospital were “unsuitable in design and layout to protect the privacy and dignity of the residents” and that the room design meant residents were unable to “undertake personal activities in private” or to meet with visitors in a private area in their bedroom. It found in many cases there was not enough room to place a visitor chair beside the bed and that wardrobe space did not meet residents’ storage needs.
The overall storage of wheelchairs, hoists and commodes in the wards was labelled “inadequate”, while there were “insufficient numbers of toilets and showers” in close proximity to bedrooms in the Hawthorn and Heather units. The inspection added that there was no evidence of regular servicing of beds.
The November inspection of the Killarney Community Hospital also recorded moderate non-compliances in the area of health, safety and risk management; residents’ rights, dignity and consultation; residents’ clothing, personal property and possessions and suitable staffing. While it found residents were addressed by staff in a “respectful” manner, a number of residents said they would like more storage space and complained about noise levels in the six-bedroom unit at night.
Inspectors also found that the location of some toilets and showers meant residents had to travel through a whole ward in their night wear to use a shower or toilet which in turn led to a greater reliance on commodes and affected the privacy, dignity and quality of life of residents.
