The Health Information and Quality Authority has told the Health Service Executive it will move next February to close the controversial Áras Attracta facility in Co Mayo unless repeated failures to upgrade the service are rectified.
The watchdog says the HSE has failed over a two-year period to implement promises, including an undertaking to move dozens of residents to community-based housing.
It welcomes improvements experienced by a minority of the scores of residents of the centre.
The threat to close the HSE-run Áras Attracta is made in today's 50-page HIQA report on 14 inspections of the Swinford facility over two years up to last May when the facility was home to 86 adults with intellectual disabilities and complex health needs.
The report says some residents also have mental health needs and/or challenging behaviours.
Respite services were also being provided to temporary residents not included in the figure of 86.
The report recalls that the RTÉ Investigations Unit's 2014 report of "disturbing and abusive practices" in Bungalow Three prompted the HSE to submit to HIQA a detailed, three-year, time-bound improvement plan for the campus.
The report says the submission was personally supervised by the executive's National Director of Social Care, Pat Healy.
But HIQA has concluded that, despite the allocation of "significant additional resources", overall improvement was limited.
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The watchdog criticised the HSE for failing to implement an undertaking to move more than two dozen residents to community-based housing last year and again this year.
It says that while there were 89 residents on campus in the summer of 2015, by last May, the total had decreased by only three.
The overview report states that the HSE has consistently failed to appropriately address its own institutional and centralised care practices on the campus, as well as safeguarding issues involving peer-on-peer abuse.
The lack of personal development and growth opportunities for residents on campus is also highlighted.
The report reveals that, in September, it told the HSE it would propose the cancellation of the facility's registration.
The HSE availed of its legal entitlement to respond with another written improvement plan.
HIQA says a series of unannounced inspections will inform its final decision on registration by next February.
In a statement, the HSE said it welcomed the report and that the watchdog had made very valid findings. It said it is optimistic that it will be able to meet HIQA's standards by February.
The executive said that central to resolving the issues highlighted was to moving residents to community-based housing as recommended, but this has been slowed by challenges in the housing market over the past 18 months.
It said that 16 residents will have moved to their own homes by the end of the year and a further 20 should be moved next year.
The HSE also said that HIQA had noted progress has been made at Áras Attracta, particularly that staff are caring and respectful and the general health and well-being of residents is being met.
Tonight, a spokesperson for Minister Finian McGrath said that by 2019 the HSE plans to have moved off campus all those assessed as being capable of living more independently in houses in the community.