A HIQA inspection of a residential service for people with disabilities in Dublin found it failed to ensure residents were protected from all forms of abuse.
The inspection by the Health Information and Quality Authority on a centre operated by Stewarts Care Ltd in west Dublin was carried out in November.
The findings are contained in one of 23 inspection reports on designated centres for people with disabilities, published this morning.
Non-compliance with regulations and standards were found during 14 inspections including at Stewarts Care Adult Services.
Designated Centre 28 run by Stewarts provides full time residential services to men with intellectual disabilities and high support needs.
Poor findings by HIQA inspectors at the centre resulted in it issuing the provider with a notice of a proposed decision to cancel the registration of the centre.
It found that practices and arrangements did not promote or uphold residents' rights in relation to respect, dignity, privacy, and freedom of choice and control in their daily lives.
The lead inspector was also not assured that all residents were protected from all forms of abuse.
The inspection report stated that staff were for the most part up-to-date with safeguarding training and while some safeguarding plans were in place, these were ineffective because the group of residents were not all suited to live together and "a compatibility issued remained".
It said the provider made a commitment not to have more than seven residents in any campus based setting, but a recent resident had increased the number to eight.
The report questions whether in the absence of an adequate compatibility assessment or assurances that the move of that resident into the centre was a good for all involved.
"It was evident that there were too many men living together all of whom had varying and complex needs", according to the report.
While safeguarding plans attempted to initiate some improvement with this incompatibility, the report said
measures involved keeping residents apart, which the inspectors observed was not occurring and "was also restrictive in nature".
Furthermore incidents of a safeguarding nature were not being documented.
The inspector concluded that the provider had not taken sufficient or effective steps to ensure that residents lived in a suitable environment that was free from distress and failed to
ensure their well-being was maintained.
The report says it was unclear if a referral had been made to the national safeguarding office".
The noise levels in the centre were at times loud and did not promote a relaxed or homely atmosphere.
Two residents spoke to inspectors and said they wanted to move out of the centre, due to the noise levels and to be able to partake in more activities.
Inspectors found that loud vocalisations exhibited by a resident caused distress to other residents.
"This on occasion had resulted in one resident requiring medication to help with their response to the noise, which would be considered chemical restraint", it said.
The administration of chemical PRN medication to the distressed resident was not in line with best practice according to the report and it was not demonstrated that every effort had been made to alleviate the cause of the resident's distress or if alternative measures had been considered before the PRN was administered.
'Institutional in nature'
The inspectors observed the layout and operation of the centre to be "institutional in nature".
Significant and concentrated cleaning and renovation was required throughout, and while the residents' bedrooms were personalised to their tastes and preferences, other areas of the centre were untidy, dirty, and damaged.
Despite those findings, Inspectors observed residents to be comfortable and happy in staff company.
Staff were "open and honest with inspectors" and expressed concern for the residents' well-being.
The inspectors found the staffing arrangements were not sufficient to meet the residents' needs. This was impinging on their rights to access their community and to engage in activities meaningful to them.
HIQA said it continues to engage with the provider and has completed a follow-up inspection, which found improvements had been made.
The proposal to cancel the registration has since been withdrawn, and the Health Information and Quality Authority says a follow-up report will be published in due course.
Inspection reports published
Another report on a centre operated by St Hilda's Services identified non-compliance in regulations such as governance and management, written policies and procedures, fire precautions, records, notification of incidents, and positive behavioural support.
Three inspection reports have also been published on centres operated by RehabCare.
In two of these centres, improvements were required in areas such as positive behavioural support and risk management procedures. An urgent action was issued to RehabCare at another centre due to inadequate fire precautions.
Non-compliance with fire precautions was found at centres separately operated by St John of God Community Services CLG, SOS Kilkenny Ltd and at a centre operated by The Cheshire Foundation in Ireland.
As part of a focused inspection programme carried out to assess infection prevention and control practices and procedures, three centres - operated by Peamount Healthcare, St Joseph's Foundation and Resilience Healthcare Limited CLG - were found to have insufficient measures in place to protect against infection.
Non-compliance was identified at a centre operated by Saint Patrick's Centre (Kilkenny) in the area of premises and measures to protect against infection.
At a centre operated by Praxis Care, non-compliance with medicines and pharmaceutical services was also recorded.
Examples of good practice were observed at a number of settings.
At a centre in Galway operated by RehabCare, a person-centred culture and a focus on residents' welfare was evident across the centre.
Residents were supported by staff to exercise their rights, and were involved in part-time and supported work prior to the pandemic restrictions.
HIQA said those residents enjoyed a range of activities and were encouraged to take part in interests, such as playing the guitar and writing poetry.
Inspectors were told by residents that they felt safe living at the centre and got on well with staff who supported them.
At a centre operated by St Hilda's Services in Westmeath, residents took part in a gardening project and had been involved in painting the garden’s furniture and shed, as well as growing vegetables and herbs which were used in cooking at the centre.
In Sligo, residents at a centre operated by The Cheshire Foundation were supported with their independence by staff, as well as their own personal assistants.
They had their own self-contained apartments which according to HIQA reflected their own needs and interests, and residents said they were happy with the support they received at the centre.
