The first five years of regulation of Ireland's disability sector has had a positive impact on the lives of residents in its services, according to HIQA.
But the Health Information and Quality Authority has warned that better protections need to be put in place to safeguard residents from abuse and to extend the protections offered by regulation to other vulnerable people.
The review says that levels of compliance with regulations have risen from 59% in the year 2013/14 to 76% in the year ending last October.
From 1 November 2013 to 31 October 2018, inspectors conducted 3,829 inspections of designated centres for people with disabilities, the report states.
By 31 October 2018, there were 1,183 centres for people with disabilities registered with HIQA, providing 8,894 residential places for adults and children.
By last winter, the average occupancy of a centre was 7.5 people. Some campuses have more than one centre.
HIQA's Director of Regulation and Chief Inspector of Social Services Mary Dunnion said the watchdog's findings in the first few years indicated that the sector was not prepared for regulation, with some services emerging well from inspections but poor practice and low levels of compliance evident in others.
She said that over the five year period, regulation had driven improvements in residential services through monitoring, inspections and enforcement action.
In a statement, she emphasised that inspection findings showed that residents' rights and dignity are now better promoted, and that their social care needs are being met "in most cases".
She said: "Residents regularly tell us how these improvements have positively impacted their lives. For example, moving to houses nearer their families, going on holidays or to concerts, working in their local communities and having more control over what they do on a daily basis."
But she cautioned that significant challenges remain regarding the management and oversight of services, addressing infrastructural deficits and the safeguarding of vulnerable people.
Ms Dunnion said the governance arrangements in some centres have continually failed to ensure that there is adequate oversight of the quality and safety of the service.
She also highlighted "ongoing challenges for some providers in achieving a safe and high-quality living environment for residents".
Inspection reports over the past five years have criticised some HSE-run centres for failing to adequately adapt or to replace old buildings which have been judged unfit for purpose.
Ms Dunnion said that while regulation has brought about increased awareness of the rights of people with disabilities, safeguarding issues continue to be regularly raised by HIQA inspectors.
She added that better protections need to be put in place to safeguard residents from abuse and to extend the protections offered by regulation to other vulnerable people.
She said HIQA is awaiting the Minister for Health's approval of the National Standards for Adult Safeguarding, developed by HIQA and the Mental Health Commission.
She also noted the introduction of specific legislation would ensure there was a legal basis to safeguard people who live in residential care.