A large HSE-run centre for highly dependent older people in Cork accommodates many of them in dormitories where beds are so close together that residents are unable to undertake personal activities in private or meet relatives in private.
HIQA, which made the finding, also criticises the failure to appropriately investigate a note on a resident's file recording bruising of unidentified origin until a relative made a complaint.
St Finbarr's Hospital's five units for older people are housed in large Victorian buildings scattered throughout a larger hospital campus in Cork city.
HIQA's announced inspection last May found that its 89 residents received a good standard of nursing and medical care but that significant improvements were required, most notably in the design and layout of the premises and in safeguarding practices.
HIQA says many residents are in multi-occupancy bedrooms, some of which have three, five and six beds, which are so close together that residents are unable to undertake personal activities in private or meet relatives in private.
Large structural support poles at some entrances made it impossible to use equipment such as hoists.
Three of the five units had only two toilets each and inspectors were not satisfied that bedroom accommodation was suitable for residents.
They also criticised the failure to appropriately investigate a note on a resident's file recording bruising of unidentified origin until a relative made a complaint.
A subsequent investigation concluded that the bruising may have been as a result of staff assisting the resident to the ground to protect him or her from being injured during a "near fall event".
A further allegation of abuse was made to HIQA during the inspection about the manner in which a staff member interacted with a resident.
This was brought to the HSE's attention and is pending investigation.
HIQA says these and some other failings have not been satisfactorily addressed by the HSE and the watchdog is considering further regulatory action.
A spokesman for the watchdog said it has not renewed St Finbarr's registration at this stage.
The HSE has welcomed HIQA's inspection report of its five elder-care units at St Finbarr's Hospital in Cork.
In a statement it said both incidents of alleged elder abuse mentioned by HIQA "were investigated in a timely manner" and "the investigations did not find any evidence of inappropriate care".