A Health Information and Quality Authority inspection of a Health Service Executive-run residential centre for adults on the autistic spectrum has found that it was understaffed and parts of it were in a poor state of repair while others appeared to contain faeces.
Three years ago Dunfirth Farm, near Johnstown in Co Meath, and two other similar centres were taken over by the HSE from the Irish Society for Autism following highly critical HIQA reports.
At the time, the HSE said the welfare of the residents was its main priority and that it had provided a range of additional supports to enhance the residents' quality of care.
But when inspectors arrived unannounced last May they found that Dunfirth Farm was non-compliant with 11 of the 13 standards reviewed.
The report, published today, recorded that in some areas they found what appeared to be faeces.
They also found broken glass in external communal areas and broken tiles in bathrooms.
A further area required urgent attention due to an unspecified risk it posed to staff and residents. After this was discussed with the HSE, interim measures were taken to ensure the zone was "safely contained".
The centre, which is on a large rural campus, comprises eight individual houses and six single unit apartments supporting both male and female adult residents. At the time of the inspection most of the 32 residents had been living there for more than 20 years.
The report said the HSE had brought another service provider, Inspire Wellbeing, to the facility to support local management with its day-to-day operations and to start putting systems in place to improve outcomes for all residents.
Today, 24 hours after publishing its report, HIQA said it should have clarified that the inspection it related to was the first to have been undertaken since the HSE contracted out the day-to-day running of the centre to Inspire Wellbeing.
A spokeswoman said that the inspection was the fourth since the HSE took over responsibility for the facility in 2016. She added that the HSE remains as the service provider and is solely responsible for the standard of care offered to residents.
A spokesman for Inspire Wellbeing said the May 2019 inspection on which yesterday's report by the regulator was based was conducted shortly after the company took over the day-to-day running of Dunfirth Farm.
He said a more recent HIQA inspection, carried out last month found that a number of non-compliance issues had been significantly addressed and that non-compliances remained in relation to three of the standards assessed. He concluded that an action plan is already being implemented to address these and to ensure that the facility is fully compliant.
HIQA said that the report on July's follow-up inspection is due to be published in the coming weeks.
Individual engagement
The report said that some residents told the inspectors they were happy in the centre and they appeared comfortable in the company of staff. However, many residents remained on the campus for much of the day "with limited opportunity to access the community individually".
A review of a number of activity records for a single month found that most activities were group based. Only twice during the month were residents supported on a one-to-one basis to engage in meaningful community-based activities and two residents were not recorded as having any such activities.
Staffing levels
The report stated that there were not enough staff to meet the assessed need of residents, adding that this was despite a concerted effort by the HSE to address the shortfall.
What is described as "a large number of agency staff" was hired to try and address the problem but the HSE was unclear if all such staff in the centre had appropriate Garda clearance. Following an alert by the HIQA inspectors, the HSE assured them after the inspection that clearance was in place.
The report called for the keeping of improved and accurate rosters.
In one case "for instance a staff member was documented as having worked within two separate parts of the designated centre simultaneously, it was therefore unclear if safe staffing levels were in place. Additionally, it was unclear which members of the management team were working and if they were due to work on site or off site."
Inspectors found that staff were respectful towards residents and generally appeared to understand their needs.
However, on one occasion they observed staff not following agreed protocols while managing a resident's assessed healthcare needs. Despite a staff member confirming to the person in charge that the protocol had been followed, the report says that it later transpired that this was not the case.
"The mismanagement of this adverse incident could have seriously impacted the resident. This was raised with the provider on the day of inspection and the provider committed to investigating the incident," the report continues.
"Overall the quality and safety of the service delivered to residents was adversely impacted by the poor adherence to organisational policies," it states.
It underlines that significant improvement is required in maintenance, safeguarding measures, access to appropriate allied healthcare professionals, fire containment measures and the opportunity for residents to engage in meaningful activities. It says the high levels of non compliance negatively impacted on residents.
Not all of them had access to occupational therapists, speech and language therapists and behaviour therapists on an ongoing basis when their assessed needs indicated any of these services was required.
The report says the provider had sourced allied health professionals to assess a number of residents but that these assessments had not been regularly reviewed or fully implemented.
For example, the inspectors reviewed records which demonstrated that one residents' healthcare plan, which related to nutrition and hydration needs, was not being fully implemented on a daily basis.
Restrictive practices
The report said there was evidence that restrictive practices in the centre were assessed and reviewed regularly and that some were being used less frequently with a number of residents since the May 2018 inspection.
"However, there were a number of restrictions in place which had not been identified and so were not notified in line with the requirements of the (statutory) regulations," the reports states.
Person-in-charge
Inspectors found that the centre was managed by a suitably qualified, skilled and experienced person with a good knowledge of the care and support requirements for residents.
"However, the person in charge was responsible for another designated centre and given the geographical size of this campus, the number of residents and the number of staff, inspectors found the person in charge did not have the capacity to be effectively engaged in the governance, operational management and administration of the centre," it said.
In the compliance plan issued in response to the inspection, the HSE said it would apply to HIQA to split the current centre in two and undertake to employ a full time person-in-charge for each of them. The appointees would have the skills and experience required to manage the needs and complexity of each facility, the HSE said.
"Within each proposed Designated Centre the PIC will be supported by a team of Team Leaders sufficient to support the role of the PIC and assist in an effective governance, operational management and administration of the Designated Centres," the HSE continued.
It said that subject to an agreed signed lease, applications for two separate designated centres will be submitted by next Friday.
