A residential centre for more than 80 older people in Cork city accommodates more than half its residents in bedrooms with five or more beds, but has failed to use four single bedrooms for a number of years.
A HIQA inspection of the Health Service Executive-run centre failed it on 14 of the 18 tests applied and found that the overcrowded facility did not enable families to have private time with their dying relatives.
The HSE says that the four rooms are not part of the centre and are isolation areas for TB patients.
A report on the inspection published today says the centre's programme of activities was not sufficient to occupy residents meaningfully throughout any day and that many spent a considerable period of time either in bed or in a chair at their bedside.
The centre comprises five units in large institutional buildings dotted around the campus of St Finbarr's Hospital. While three are on the ground floor, two are at first-floor level.
At the time of last April's inspection, 46 of the 84 residents were accommodated in bedrooms of five or more beds.
A total of 69 were in multi-occupancy rooms which the report says did not support residents' privacy and dignity.
Inspectors were told that one dying resident's bed had to be moved to a sitting room at night so that relatives could spend time alone with their loved one.
The inspectors found that while residents' personal care and healthcare needs were met "to a good standard", their social care was deficient.
For instance, the preferences of relatives rather than the wishes of residents were sometimes used to determine whether a resident would sit out of their beds or spend time away from their bed space.
The report criticises the HSE for treating all of them as patients and for employing only two coordinators of activities who could not possibly provide enough stimulating activities to meet all residents' needs.
Inspectors noted that many residents spent a considerable period of time either in bed or sitting in a chair at their bedside and that they were at times left there, or in sitting rooms, unsupervised and unstimulated.
Criticising the HSE's under-resourcing of the facility, the watchdog found, not for the first time, that there was inadequate access to allied health services like physiotherapy and occupational therapy.
It says a number of residents had been referred for occupational therapy assessment approximately three months earlier but that appointments had not yet been secured.
The assessment was to focus on the suitability of the residents' seating arrangements because at least two of them spent each day in bed. The report says that the failure to assess the residents meant it was not possible to ascertain if they could comfortably spend time away from the bedroom.
Staff told inspectors that requests for low-cost items like comfortable seating for residents had been refused, as had a request for bedroom doors to be painted different colours to help dementia residents to identify their bedrooms.
The HSE admits that only one of the five units provides residents with access to secure outdoor space.
The HIQA report states: "Many residents spent a considerable period of time either in bed or sitting in a chair at their bedside. While staff stated that this was the preference of many of the residents, the inspectors were of the opinion that this was primarily as a result of institutional practices in the centre.
"For example, a recently admitted resident was observed to be in bed and had been in bed since admission. A member of staff had stated that the resident would spend the first few days in bed until they became familiar with their environment and would then perhaps sit out in a chair, again at their bedside, for a further few days.
"This would lead to residents becoming comfortable in the bedroom environment only, rather than availing of the communal space to mix with other residents, participating in group activities or having the opportunity to dine in the company of others rather than eating from a bedside table alone.
"Based on discussions with the (two) activities coordinators and a review of documentation, it was clear that the programme of activities was not sufficient to occupy residents meaningfully throughout the day."
It adds that, one day last March, only six of the 84 residents participated in group activities while the maximum number participating in a day's activities that month was 28.
The report laments that one resident's psychiatric assessment stated that "the resident presented with behavioural issues due to poor stimulation and insufficient activities".
The HSE has said that it has addressed ten of the 14 areas of non-compliance identified by HIQA.
In a statement,, it says that it has assigned one extra staff member to join the two who were already providing therapeutic activities for the 84 residents at the time of last April's inspection.
The HSE says this has been done to enhance the social model of care at the centre.
The statutory provider says it has also invested substantially in furniture and other comfort items for residents.
It explains that the four items which the HSE has not yet addressed relate to the centre's buildings.
"The current dated infrastructure occupied by St Finbarr's Residential Services for Older People is due to be replaced by a new purpose built unit on site by 2021," according to the the statement.
It adds that the project is part of a national Public Private Partnership process currently being progressed by the HSE's National Estates Office.
"A new building is the only way to address issues of privacy, storage space, space for visiting and space for activities," the statement concludes.