HIQA reports critical of a number of nursing homesSaturday 09 January 2016 19.09
The Health Information and Quality Authority has published a number of reports on unannounced inspections carried out at nursing homes in counties Mayo, Limerick, Cork and Waterford.
The watchdog found that allegations of reported abuse at Marymount University Hospital and Hospice in Curraheen, Co Cork, were not investigated appropriately.
Inspectors found that staff did not have up-to-date training in the protection of vulnerable adults.
While issues at the facility were dealt with in a timely manner, it was found that complaints were not recognised as possible allegations of abuse, even though one issue of neglect had been raised by a social worker.
The nursing home was also found to have "virtually no care plans" in place to direct or inform the treatment of patients admitted for long-term care or respite care.
Following a separate inspection, HIQA raised concerns about the handling of abuse allegations by a Limerick nursing home.
The unannounced inspection was carried out in Cahermoyle Nursing Home in Ardagh, Co Limerick, last October.
It found that all reasonable measures were not taken to protect residents from abuse.
It also found that appropriate actions were not been taken following an allegation of abuse to prevent similar incidents happening in the future.
Evidence was found that staff had observed three incidents of potential abuse that had not been reported immediately.
Inspectors said they were not satisfied that the staff understood the nature of the abuse nor were they aware of their responsibilities in preventing, detecting and reporting such behaviour.
Major non-compliance was also found in relation to the safe moving and handling of patients with mobility issues.
HIQA found that the centre did not have suitable equipment to support residents with restricted mobility to bathes and showers.
A separate inspection of the Dungarvan Community Hospital, Co Waterford, found that staffing in the evenings and at night was inadequate and was a continuing area of non-compliance after repeated inspections.
It found that this led to institutional practices which were not patient-centred such as patients being put in bed or in night attire before 6.30pm.
One nurse on duty to care for 47 residents
An inspection on Tí Aire nursing home in Co Mayo found the night nurse on duty was caring for 47 residents, almost half of whom were of maximum dependency, and two of whom were dying.
The inspection also found that Tí Aire in Belmullet had insufficient clinical oversight of residents.
The unannounced two-day inspection took place in October following a tip-off to the watchdog.
HIQA said the needs of residents were not adequately met because only one nurse was on duty from 6pm until 8am the following morning. Most of the 47 residents were maximum or highly-dependant.
It said the nurse was responsible for "administering a significant amount of medications, supervising care delivery and responding to residents' healthcare needs when required".
The inspection report stated that staff and management interacted with residents in a respectful and caring manner.
However, the person-in-charge of the nursing home no longer worked full time in this role due to staff shortages.
HIQA found that clinical oversight was insufficient, some medication and wound management was inappropriate and there was no updated plan to address the end-of-life care needs of one resident.
The nursing home told HIQA an extra nurse was due to start work within a few weeks of the inspection.
However, the report said a significant number of the actions required to be taken following a previous inspection in March had not been adequately addressed five months later.
For example, residents who had choked on sausage skins were still at risk of doing so because the home had failed to implement an agreement with HIQA to use skinless sausages.
One day nurse on duty to care for 43 residents
Meanwhile a separate inspection on a Co Roscommon nursing home found that the one nurse that was on duty during the day was to care for 43 residents, most of whom were regarded as high dependancy.
The inspection of Ferna Manor Nursing Home in Castlerea, Roscommon, also found evidence of other staff working long hours, including one who worked a 24-hour shift.
During the unannounced inspection in August, investigators found that on 30 July 2015, one staff nurse worked from 8am-1pm and was responsible for administering medicine and caring for the medical needs of 43 patients.
It said this had impacted on patient care as normally two staff nurses carried out this work.
It also found that on the same week, one care worker worked an "excessive" 101 hours in a fortnight doing a 24-hour shift having just completed a 44-hour week.
Staff told an inspector that long hours were a regular practise at the home.
Staff in Limerick nursing home never trained in fire safety - report
A separate inspection carried out on a Co Limerick nursing home found it to be majorly non-compliant with fire safety and safe medication practices.
During an inspection last September, HIQA found that the Good Counsel Nursing Home in Kilmallock was found to be non-compliant in eight out of 10 areas inspected.
Inspectors said a smell of smoke permeated the centre and burn marks on a bedding indicated that residents were smoking in their rooms.
It said four staff who regularly worked overnight had never been trained in fire safety or taken part in a drill.
Inspectors also found unsafe medicines management including medicines not being administered at the time and frequency required, medicines being kept in an unlocked fridge and no recording of when medicines were opened and if they had expired.
A number of deficiencies were also noted in relation to the use of restraints, the carrying out of assessments and the making of care plans for patients.
In one case records showed that a nurse had made a decision on a Do Not Attempt to Resusitate (DNAR) order in consultation with the patient's family instead of with a consultant, hospital registrar or GP as guidelines required.
The home has since submitted a report saying that a number of changes to practices have been implemented following the inspection.