A proposed notice to cancel the registration of a community residential centre for people with disabilities has been issued by HIQA to its operator after faecal matter on bedsheets, in bathrooms and on toilet seats were discovered during an unannounced inspection in February.
The inspection report on the centre which is run by Avista CLG - formerly the Daughters of Charity - is one of 25 reports on designated centres for people with disabilities published this morning.
Six of the reports relate to centres run by Avista CLG.
The original purpose of the inspection in question was to monitor compliance with Infection Prevention and Control standards.
However, due to the concerning findings identified on the first day, an immediate action was issued to the provider in relation to infection prevention and control.
The report outlines how the inspectors took the "unusual but necessary step" of returning for a second day of inspection to ensure that the actions issued by HIQA had been acted upon by the provider.
Overall, the inspection found that governance and management systems did not effectively ensure that care was provided in a clean, safe and suitable environment.
The condition of the centre did not promote the dignity of the residents living in the designated centre according to HIQA, nor did it demonstrate that effective oversight and governance arrangements were in place.
In the residents' bedrooms, the inspectors observed a stained mattress protector with faecal matter and a heavily stained bed sheet.
One resident's en-suite bathroom presented with a strong malodour of urine, faecal matter on tissues, rusting pipes, stained flooring on the resident's bath and a thick layer of dust or dirt on the windows.
In another resident's en-suite, which was vacant at the time of the inspection, the inspectors noted a heavily stained floor around the toilet and shower area.
In addition, the inspectors found the shared bathrooms to be unclean - faecal matter was observed on the toilet seat and toilet bowel in the downstairs bathroom.
In the upstairs bathroom, shared between three residents, the inspectors identified that hand soap, paper towels and toilet paper were not readily available.
The inspectors met with the residents and asked one if they liked living in their home and they responded no, adding that their peer shouted a lot.
Another resident was asked if they liked their room and they responded no also, but did not elaborate further.
Some residents spoke with the inspectors of their interest in music, local GAA and where they were from. Other residents had limited verbal communication abilities.
As such, the report notes that it was not possible for the inspectors to directly obtain these residents' views of the service that they received while living in the centre.
A notice of a proposed decision to cancel the centre's registration was issued to the provider following the inspection.
The provider has since made representation setting out further planned improvements, as is its right under the Health Act 2007, as amended.
HIQA says it is continuing to closely monitor the centre.
Inclusion Ireland has said the watchdog should not have to consider elements such as a basically clean environment in centres for people with disabilities.
CEO Derval McDonagh said it should be the absolute minimum expected, regardless of the residential setting or how much support they require.
"We have to think about the individuals living in circumstances like this. We need to demand better for people, far beyond basics like cleanliness and safety. We must support people as rights holders to have choice and control about where and how they live and for people to have the support they need every single day to live a good life," said Ms McDonagh.
The organisation said of significant concern was the voice of the resident who stated that they did not like living there as "their peer shouted a lot".
Inclusion Ireland has said that in no other walk of life would it be acceptable for people to be forced to stay living together if they were unhappy with their circumstances.
Ms McDonagh said: "We cannot ignore that voice. Where are the options for people to move out if they are unhappy and distressed? Ultimately, we need institutional type living to end and a shift to where rights are the basis for all support."
Two other Avista CLG centres required improvements in areas such as staffing, training, positive behaviour support and governance.
At three other centres operated by the same provider, improvements were required in areas such as fire safety and the submission of notifications to HIQA.
Five inspection reports have been published on centres operated by Brothers of Charity Services Ireland CLG.
One centre was found to be non-compliant in areas such as staffing and governance and the use of restrictive practices.
Given the failure of the provider to adequately address these issues over a series of inspections, it was issued with a notice of proposal to cancel the registration of the centre.
In line with the Health Act 2007, as amended, the provider made representation and also confirmed that they had received funding to improve the quality of care and support for residents.
Inspectors are continuing to monitor this centre also, to verify that the actions of the provider are having a positive outcome for residents.
Four other centres operated by Brothers of Charity Services Ireland CLG required improvements in fire safety, infection control, governance, and notification of incidents and restrictive practices to HIQA.
Two inspection reports have been published on centres operated by Ability West.
At one centre, a resident’s right to privacy and dignity was not being adequately safeguarded.
Furthermore, the condition of the building at another centre did not ensure appropriate infection control measures were in place according to HIQA.
At a centre operated by Camphill Communities of Ireland, improvements were required in the governance of the centre to ensure agreed practices were followed, appropriate infection control arrangements were in place, and to ensure the premises was appropriate to the needs of residents.
Examples of good practice observed by inspectors included a centre in Galway also operated by Ability West, where residents enjoyed participating in a range of activities.
One resident spoke about music concerts they were looking forward to attend, including one in Dublin.
Residents were involved in cooking meals and decided upon the weekly menu.
They had also recently purchased a coffee machine and spoke about how they enjoyed coffee and the different types that they preferred.
Residents at a centre in Waterford operated by Brothers of Charity Services Ireland CLG spoke with the inspector about their recent holidays, their families and their interests, such as music.
The centre’s routine reflected residents’ needs and choices, such as having a morning lie in or the attendance at day services.
Residents were further supported to access a range of activities in their local community, as well as drives to a local seaside village for refreshments.
At a centre operated by Camphill Communities of Ireland in Wexford, residents spoke about changes to their home and how they liked the new furniture and decoration.
Residents also enjoyed going out for coffee and participating in projects such as writing and art.