HIQA has criticised a Co Limerick residential centre for adults with intellectual disabilities for continuing to use face-down restraint.
The independent watchdog says it presents a risk to residents' health and safety.
Inspectors also found that the Group D centre had continued to use a form of chemical restraint on a resident despite being told by a consultant psychiatrist that its use under one particular circumstance was inappropriate.
The centre provides high-support residential accommodation for seven people with intellectual disabilities.
It is run by the Daughters of Charity Disability Support Services on its Lisnagry campus near Limerick city, and shares a building with a number of similar residences.
The unannounced inspection described in today's report was conducted last July, following a separate HIQA inspection in November 2016 when the centre had been issued notices of a proposal to refuse and cancel its registration.
Despite receiving a subsequent representation from the Daughters of Charity Disability Support Services at the end of last year, HIQA has refused to issue the facility a certificate of registration.
July's inspection was designed firstly to follow up on an allegation that had been submitted in recent months that a resident's human rights - and particularly their right to liberty - had been breached.
Secondly, inspectors monitored the grounds for the earlier proposal to cancel registration.
One key ground was the use by the centre of face-down restraint.
The report says that although it had only been used once in the first seven months of this year, marking a "significant decrease from previous years", and despite the safeguards the centre had in place, "the ongoing use of such a high-risk technique coupled with the difficulties (in) examining residents following any such episode … continued to present a risk to resident's health and safety".
The report also says "the recording around the use of chemical restraint required improvement".
The November inspection report had recommended that the psychiatrist who, on a weekly basis monitored residents' records relating to medications which are exclusively taken as the need arises, was not provided with adequate records of adverse effects.
The inspection found that the centre was continuing to fail to keep relevant records in a way that ensured that the prescriber could monitor the efficacy of the medication when carrying out reviews.
Inspectors also found that the centre had continued to use a form of chemical restraint on a resident despite being told by its consultant psychiatrist that its use under one particular circumstance was inappropriate.
The report recalls that an inspector discussed the matter with the centre's management who, by the end of the day-long inspection, had arranged for a clinical meeting to take place to further review the centre's practices.
The report records that November's inspection had found that the centre had failed to provide a premises that afforded adequate privacy and dignity for residents and fire safety protection in the event of a fire.
It states that, with respect to fire safety, adequate steps had been taken by the service provider to mitigate against any immediate risk to residents. However, inspectors found that "to date it had failed to submit a funded, costed and time-bound plan to HIQA to satisfactorily address the cited failings".
The report praises the warm and well-informed relationships between staff and residents that was evident during the inspection.
It states that the service provider had responded to failings highlighted by November's inspection by arranging for the completion of two independent external reviews of the service provided in one part of the centre and by implementing or pursuing the reviews' recommendations.
However, inspectors criticised the failure to put in place a funded plan to ensure that individual residents would not be subjected to restrictions due to the centre's environment.
The report says that the provider confirmed that it was exploring specific options and was in the process of submitting a business case to the Health Service Executive to address this failing.
And it says key failings remained largely unchanged since the previous inspection.
For example, individual residents were restricted to using wheelchairs to go for a walk, despite being fully mobile and they had limited access to adequate outdoor space.
Most of the centre had limited natural light and private and communal space provided for residents was unsatisfactory.
And an apartment annexed to the main part of the centre is described as having been "particularly unsatisfactory ... bleak and institutional in nature with limited access to outdoor space".