The Board of Stewarts Care has accepted that HIQA reports on three of its residential centres describe unacceptable conditions, which did not meet the standards of care the charity expects of itself.
And it admits that an ambitious change programme embarked upon in light of earlier criticism by the watchdog, "is not without its difficulties as captured by... (today's) reports".
Two residential centres for people with disabilities operated by Stewarts Care Limited in west Dublin have continued to fail to provide a safe environment for residents despite being threatened with closure.
The Health Quality and Information Authority has ordered the charity to submit a governance improvement plan for all of its 17 centres and promises to closely monitor its implementation with a focus on the safety and quality of life of 300 residents.
Centres 1 and 5 on Stewarts Care's campus in Palmerston were home to 48 adults with disabilities when HIQA conducted unannounced inspections last October.
Following inspections last July, the centres had been served with notices of proposal to cancel their registration and Stewarts Care had submitted a plan of action to respond to the problems identified.
However both failed all nine tests applied during an unannounced inspection of each facility in October.
The Minister of State with special responsibility for disabilities has said he is concerned over the reports.
"The safety and quality of life of residents is of paramount importance. The failure to improve conditions in Centres 1 and 5 of the Palmerstown campus is of serious concern to me," Finian McGrath said in a statement.
"I understand that following these inspections, Stewarts Care submitted an Action Plan to HIQA outlining how they would address these problems. The majority of these actions were due to be completed by the end of March," he said.
"I have asked the HSE for an urgent update on progress to date. I have stressed to them the absolute necessity for radical improvements in the quality of care being delivered.
"While I understand the complexities of moving people from the old-style congregated settings into more appropriate community-style living, it is unacceptable to see these types of conditions persist. I have made this very clear to the HSE and I will be monitoring the situation very closely," he added.
Inspectors found governance and management systems were not effective in ensuring that the care provided to residents was safe.
In reports published today, inspectors say six incidents of abuse recorded in Centre 5 had not been responded to in line with policy.
Three related to peer-to-peer physical abuse, two to unexplained bruising on residents, and one to peer-to-peer verbal abuse.
A senior member of staff told inspectors that addressing incidents of unexplained bruising did not always involve safeguarding considerations.
Less than one in seven (13.3%) of the centre's staff had completed mandatory safeguarding training.
In Centre 1, inspectors saw one resident being locked in their apartment and staff and management said this was "the practice". But the resident's assessment of need stated that he/she needed an environment free from restriction.
Seven storage units in one resident's bedroom were locked although the risk identified related to the eventuality of that person's peer accessing one of them.
Inspectors were not assured that this practice had considered the impact on the first resident, whose access to his/her own personal possessions was limited by the lock-up.
The report says measures taken on foot of safeguarding concerns were not sufficient to protect residents and there was evidence of repeated peer-to-peer incidents.
It also criticises some staff members for failing to speak about residents with dignity and respect when discussing their care and behaviours.
In one area in Centre 1, there was food debris on sitting room chairs; toilet seats were not fitted in the area residents used most frequently and staff members were observed not to wash their hands with soap after providing intimate care to residents.
The report warns that adequate measures had not been taken in Centre 2 to safely evacuate residents in the event of fire. Nor were adequate arrangements in place for containing an outbreak.
Twenty-one staff had not completed fire drill training and it took an inspector 15 minutes to gain entry to the building at 7am despite two staff who were meant to be awake ("waking staff") being on duty.
Confessing that the HIQA documents are "difficult to read", the board's statement says that two of the centres, numbered one and five, "are the subject of a detailed and multifaceted response action plan that began last summer and is ongoing."
It recalls that Stewarts Care had produced the action plan on foot of last August's threat by HIQA to de-register both facilities.
It says the implementation of the plan "is accelerating the previously planned break-up of the congregated residential setting" on the site of the former Stewarts Hospital where its services had historically been provided.
The statement adds that the plan's implementation is "transitioning all residents into community settings".
The charity recalls that it used to provide care for 260 residents through six managers - with the title 'Person In Charge' - overseeing 15 centres.
But it says a new structure "is now coming in place with 29 persons in charge and 29 designated centres, each with its own staffing and dedicated governance and management structures".
The statement vows that "no more than four residents will share a home and no resident will share a bedroom."
"The scale of change required is extraordinary and unprecedented," the statement stresses.
"It involves providing new physical infrastructure as well as significant changes in structure and human resources. Critically the change prescribed requires investment beyond the resources ordinarily on hand to Stewarts Care."
The board says that each month, reports on delivery of the plan are being furnished to HIQA and "other key stakeholders".
"A number of senior appointments have been made to oversee and drive the change programme. We have to acknowledge however that it is not without its difficulties as captured by (today's HIQA) inspection reports," the board admits.
The statement says the challenges relate to:
- increased levels of front-line management and staffing
- new/changing staff familiarity with residents' complex care needs
- the availability of resources to assess and offset risk as a priority
- and the quality of physical infrastructure
The board says that, along with senior management, it is fully aware of those challenges and is committed to taking the steps required to secure the capital and human resource investment required to overcome them.
The statement concludes by accepting that the board and management cannot secure these key investments alone and promises to "continue to work with HIQA, the HSE, and other relevant stakeholders in that regard".