A nursing home in Waterford city has been criticised by HIQA for waking a number of residents before 6.30am despite them receiving sedatives the night before, while issues have been highlighted at two other facilities.
According to today's HIQA reports, the official watchdog made an unannounced inspection of Waterford Nursing Home in November after receiving an allegation that residents were being washed and dressed before day staff began duty at 8am.
Inspectors found four residents had been up since before 6.30am despite receiving sedatives the previous night.
One resident, who had received two different types of sedative, was washed, dressed and sitting in the day room at 6.10am.
Night staff told inspectors that management had asked them to wash and dress residents early to assist their day colleagues, but complained that there were "too many" to be attended to.
The report also said cleaning staff were washing and polishing floors mechanically at 6.30am and could be heard throughout the home's ground floor.
The home's records showed it had also overdosed a resident by 50% and HIQA was not assured that nurses were administering medications from prescription records.
An allegation of neglect was investigated when the person in charge told inspectors he had been alerted to a complaint that a resident's wound had been poorly cared for.
Inspectors discussed the allegation with staff and reviewed care plans and turning charts for a resident with pressure sores.
Today's report states that "based on this initial review of care, inspectors were not satisfied that wound care management was in accordance with evidence based practice".
Waterford Nursing Home is run by Mowlam Healthcare Services, which has over 1,500 clients in Ireland.
Unannounced night-time inspection in Dungarvan
In nearby Dungarvan, HIQA made an unannounced night-time inspection to the HSE-run Community Hospital late last September.
It focused on staffing, an area the nursing home had continuously failed in previous HIQA inspections.
On a sunny Friday autumn evening, inspectors found most of the 101 residents in bed and their curtains closed at 6.30pm.
A similar inspection late in July 2015 resulted in an immediate action plan being issued due to non-compliance with staffing standards, locks on doors and institutional practices.
However, the September inspection discovered that the exact same institutional practices were in place demonstrating "disregard for person-centred practice".
In fact, staffing levels in the evening and night time had deteriorated since July.
On three out of five units, the night nurse did the night-time medication round, leaving only one member of staff to give out evening drinks and assist residents to bed.
A statement from the Health Service Executive said: “The HSE has already taken steps to address these issues and continues to liaise with HIQA on the matter.
“Over the last number of years the HSE's capital investment programme has brought a number of its public long stay units to full HIQA infrastructural standards and will continue to invest in long stay units over the next number of years to meet the re-registration requirements to facilitate the continued delivery of these services.
“In relation to DCH [Dungarvan Community Hospital], in 2015 a number of units in the Hospital were significantly upgraded to ensure the environment for residents was compliant with HIQA regulations.
“The HSE is fully committed to residential care of the highest standards in Dungarvan and looks forward to that facility's excellent reputation for care giving continuing into the future,” the statement said.
The HSE also said it has completed a review of patients' choice of bedtimes in Dungarvan.
"Residents whose choice it is to go to bed at an earlier time are encouraged to watch television, are provided with one-to-one engagement or evening visiting [is] encouraged," the HSE said in a statement.
High incidence of falling in Limerick facility
A separate HIQA inspection of a County Limerick nursing home showed a high incidence of falling and pointed to possible hazards.
Cahermoyle House in Ardagh was home to 35 residents when it underwent an unannounced inspection last September.
Incident reporting records from January 2015 to 27 October 2015 showed 119 of 173 incidents related to residents falling.
The inspectors found that care plans relating to mobility needs were generic and did not outline the individual supports required for each resident.
Only two toilets were available for use by residents in the communal area.
Shower trays in every shower on the first floor of the 'West Wing' had a threshold step that residents had to negotiate to access the shower. "This posed a risk of falls," the report states.
The first floor bedrooms on the 'East Wing' were confined in terms of space and unsuitable for any resident who required assistive or adaptive mobility aids or appliances.
HIQA also found that screening in two double bedrooms remained inadequate as shower curtains were in place instead of more suitable screening.
And inspectors state that "poor skill mix of staff impacted the delivery of staff training, care planning, medication management and auditing of the quality and safety of the service".