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Major non-compliance found at four disability centres

The Health Information and Quality Authority has published 11 reports on residential services
The Health Information and Quality Authority has published 11 reports on residential services

The Health Information and Quality Authority has published 11 reports on residential services for people with disabilities. 

It found major non-compliant issues at four centres ranging from inadequate food and nutrition to medication not being administered on time and accusations of abuse not being dealt with appropriately.

The reports relate to centres that are provided by the Health Service Executive. 

In relation to five of these centres, inspectors found evidence of a good quality of life for residents. 

The HSE has welcomed the reports and in a statement said they wish to "reassure residents and their families that a comprehensive programme of work is underway to address these issues as quickly as possible."

The statement added that action plans have been agreed with HIQA to address issues at individual centres.

St Raphael's, Cork

Unannounced inspections were carried out in May and June of this year at St Raphael's in Cork.

Inspectors found one resident was not provided with adequate food and nutrition for a period in excess of 18 hours.

Staff told inspectors that this was due to inadequate numbers of staff available at that time to assist the resident to get out of bed.

The person in charge outlined that since she started in February 2016 she did not have a copy of the night duty roster despite requesting this on a number of occasions.

One resident's healthcare record had a care plan relating to dementia. However, there was no definitive diagnosis of dementia recorded in this resident's healthcare file.

There were two significant allegations of abuse submitted to the Chief Inspector since January 2016. Since the last inspection HIQA was in receipt of unsolicited information in relation to an allegation of abuse.

For one resident there were 15 recorded incidents between 26 October 2015 and 16 November 2015 where the resident was noted as alleging that someone "had hit me".

There was no evidence of "screening" of these specific allegations of abuse to establish if an abusive act could have occurred and if there were reasonable grounds for concern.

Seven staff had not received training in protecting vulnerable adults.

HIQA was notified in April 2016 that four residents had lapbelts in place as a restraint.

Some residents were observed spending long periods of time not engaged in any meaningful activities throughout their day.

Inspectors observed unsafe medicines administration practices.

On the second day of the inspection, inspectors intervened at 10.30am as an antimicrobial medicine that was due to be administered at 8am had not yet been administered.

"Due to the potentially catastrophic and fatal impact of delayed administration of antimicrobials and the mis-administration of 'rescue' medicines in the management of epileptic seizures on the vulnerable residents living in this centre, the inspector deemed this to be at a level of major non-compliance."

Ard Greine in Donegal

In March an announced inspection took place at Ard Greine in Donegal where HIQA found seven major non-compliant issues.

This inspection identified significant risks to the safety and welfare of residents in this centre. As a result the registration inspection was postponed and a specific safeguarding and risk management inspection was carried out instead.

Inspectors identified several allegations of abuse that had not been appropriately reported to management or properly investigated.

In one instance a resident was not believed by staff when they reported an allegation of abuse.

In January 2016 two female residents had been physically assaulted by a male resident while being transported in the car.

A number of staff informed inspectors that when they raised safeguarding concerns with the person in charge, they were either not listened to or felt they were seen as "troublemakers".

Inspectors were deeply concerned by the categorical denial of the person in charge and another person participating in the management of the centre that there had been any allegations, incidents or suspicions of abuse, something which was clearly not the case.

In one house two male staff members were required to be present as a risk management control measure.

However, on review of staff rosters, inspectors found that female staff were regularly left on their own to supervise residents.

In one instance; inspectors were informed that a male resident had to be physically and chemically restrained following an aggressive outburst when female staff were left alone in the house.

Chemical restraint was frequently used in this centre. Inspectors were told that it was used as a form of therapeutic intervention. In one case chemical restraint had been administered to one resident, 44 times in a two month period.

One resident had fallen eleven times from May to December 2015.

"Inspectors did not have confidence in the fitness of the person in charge to manage the centre."

There was evidence of a very high sickness absence rate and inadequate management of the staffing resources available in this centre.

A follow-up inspection was carried out in May at Ard Greine where HIQA found staff remained unclear as to what constituted abuse and the procedure to be followed and residents were often left unsupervised due to low staff numbers.

Millmount, Westmeath

During an unannounced inspection in March at Millmount in Westmeath HIQA found the governance systems in the centre were inadequate, ineffective and did not ensure the service provided was safe, appropriate to residents' needs, consistent and effectively monitored.

It also discovered that every weekend a single staff member worked from Saturday morning until Monday morning.

Our Lady's Centre, Kilkenny

During an unannounced inspection 4in May at Our Lady's Centre in Kilkenny, which was transferred from St Patrick Centre to the HSE in October 2015, HIQA found residents' needs could not be met due to lack of assistive equipment in the centre.

The inspector had significant concerns regarding the lack of suitable governance and management arrangements to oversee the quality and safety of care provided to residents.

Incidents of peer-to-peer abuse not being reported to the Chief Inspector as required.

A resident with significant visual impairment was observed to sit unoccupied for hours at a time. The resident was observed to sit against a wall on a dining room chair with a table in front of them for most of the inspection. 

In a statement HIQA says it is continuing to monitor these centres closely, and will take further regulatory action if required.