Failure to address poor governance and oversight arrangements in HSE Disability Services in the northwest could lead to safeguarding issues in the future, according to HIQA.
The Health Information and Quality Authority inspected disability centres in the area following concerns over how they were managed by the Health Service Executive.
The inspections follow publication of the Brandon Report Executive Summary last year, which found that adults with learning difficulties had been subjected to sustained sexual abuse by another resident at a HSE-run facility in Donegal for over 15 years.
It also emerged late last year, that a resident at another centre had accessed material of child exploitation online and a delay in reporting this to HIQA, led it to question the HSE’s fitness as a registered provider of centres for people with disabilities.
In January, HIQA inspectors went to the northwest to asses compliance with regulations on governance and management, protection and positive behavioural support; and the impact on the quality and safety of care for residents living in centres.
Inspections of CHO1 - which includes Donegal, Sligo, Leitrim, Cavan and Monaghan - focused on centres in Donegal and Sligo.
The HSE is the largest provider of direct services to people with disabilities in CHO1.
Under the governance and management regulation, the centres were found to be 'not compliant'.
The inspections found shortcomings in the oversight of centres and poor supervision and support arrangements for persons in charge.
These shortcomings increased the risks of safeguarding issues.
Inspectors found that poor quality surveillance of centres by the HSE had resulted in issues of concern not being identified in a timely manner and responded to appropriately.
The provider was heavily dependent on the ability and discretion of the person in charge and on inspection activity by HIQA to identify when things went wrong in centres.
During the January inspections, inspectors met with each of the persons in charge and reviewed how they were managing their centres.
Overall, the report says the persons in charge were found to be competent, knowledgeable and experienced, however, inspectors found that supervision of them by their managers was informal and inconsistent.
There was a heavy reliance on the person in charge to recognise, identify and escalate any issues or concerns within the centre to them.
Apart from an annual personal development plan meeting with their manager, inspectors found there were no formal supervision meetings for persons in charge to review their performance or the quality of service, or where persons in charge had protected time with their manager to discuss their centres.
HIQA says a review of safeguarding arrangements in each of the centre was a key focus and it reviewed this under its protection regulation. Again, centres were found to be non compliant.
Inspectors found gaps in the safeguarding arrangements, which HIQA says the HSE needs to address to ensure proper oversight and response to issues that may arise in the future.
When inspectors reviewed the National Incident Management System (NIMS), which they used for escalating significant safeguarding risks, they found that, in general, safeguarding incidents were being categorised as the lowest risk - category 3.
This meant that the frequency of incidents of a safeguarding nature were not always captured or escalated to senior management according to the report.
In order to proactively protect residents, the HSE is required to ensure its policies and procedures are implemented by all staff, according to HIQA.
The HSE is also required to ensure that persons in charge are provided with clear guidance regarding the reporting arrangements and thresholds for reporting.
Despite this, inspectors did not identify any current safeguarding concerns that were not being managed and responded to in line with the provider’s safeguarding policy.
As a result, the Chief Inspector did not need to escalate any safeguarding concerns over the course of this inspection programme.
However, the report recommends that the HSE review its auditing and oversight arrangements to ensure that risk is identified and to ensure that it is proactive in quality improvement to evaluate the effectiveness of protection measures.
There was good news regarding the regulation which oversees positive behaviour support which is about the management of the behaviours of residents. Here, the centres were found to be substantially compliant.
In all cases, inspectors found that staff responded to residents in a kind, respectful and considerate manner to residents.
Behaviour support plans were examined and overall, residents had support plans that recognised their support needs and these were being reviewed regularly.
Inspectors saw evidence of staff implementing strategies to support residents to manage their own behaviours where possible, and were identifying and managing potential behaviour triggers for residents.
At the end of the report, there is an outline of discussions inspectors had with 69 residents at the facilities and their lived experiences.
Overall, residents said that they were happy in their homes, were happy with staff and with the service that they received.
In addition, most residents said that they liked their homes and that they felt safe. Some residents spoke with inspectors about how they were looking forward to moving to new homes in the future.
The report notes that at one centre, residents continued to live in an institutional setting and HIQA noted that the poor physical environment for residents had been identified in previous inspections.
In two centres, residents demonstrated their unhappiness at living together by the manner in which they interacted with each other and the inspectors could clearly see that there were significant compatibility issues.
The provider had arrangements to manage behavioural issues and had plans for residents to move to new homes.
However, the report notes that progress on this has been slow and residents continued to live in a very challenging environment that impacted on their quality of life.
Overall, inspectors found that residents were generally content and comfortable in their homes, and that their care needs and choices were being responded to and respected by staff.
Minister considers findings of report
Meanwhile, a spokesperson for the Minister of State for Disability Anne Rabbitte has said that Minister Rabbitte is considering the findings of the HIQA report.
He said the Minister "has been clear and consistent that an independent review of safeguarding is required in Donegal to ensure the highest standards are being met and that service users and their families are assured of this".
He added that an independent review would also clarify what additional resources may be needed to further support the HSE and whether there are wider policy implications to be considered.
"Minister Rabbitte is working with officials in the Department of Health and the Department of Children, Equality, Disability, Integration and Youth, to finalise the terms of reference for such a review," he said.
IASW calls for adult safeguarding legislation
The Irish Association of Social Workers has said the HIQA report shows that despite assurances that 'very strong processes' were introduced by the HSE to allow staff escalate safeguarding concerns, this is not happening.
In a statement the IASW said that despite the lessons of of Aras Attracta, the Grace case, the Brandon case, and the recent safeguarding failures in CHO1, the fact that the HSE requires the intervention of, and such intensive support from HIQA to bring the "serious failings" to light is "deeply concerning".
Its Chairperson Vivian Geiran said that the Brandon report highlighted how the HSE "ignored safeguarding social work guidance and expertise and the continued absence of social work at senior decision making at strategic and operational level continues to limit HSE safeguarding responses".
He said people with disabilities in Donegal "are living in services in which the HSE repeatedly fail to learn the same lessons and in which the regulator repeatedly flags concerns, without meaningful change or reform".
The IASW has called for urgent introduction of adult safeguarding legislation with establishment of an independent safeguarding authority in adult safeguarding.
