A HSE-owned residential centre with a capacity to accommodate 120 older people in Co Clare has been ordered to notify HIQA if it takes in more than 100 residents.
The watchdog said it was concerned about the temporary nature of some improvements to St Joseph's Hospital in Ennis that were implemented last year.
The improvements were made while the HSE was challenging in the courts HIQA's proposals to restrict further admissions in the interests of residents' privacy, dignity and quality of life.
St Joseph's aims to provides round-the-clock nursing care for long-term residents, as well as addressing short-term, respite, rehabilitation, palliative, and dementia care needs.
In August 2016, a HIQA inspection found that some residents were spending large parts of the day in bed and eating meals at their bedsides.
In today's overview report of three inspections conducted last year, the watchdog recalled that between 2012 and 2016, St Joseph's had consistently failed to comply with regulations resulting in residents being deprived of their rights to privacy and dignity and the opportunity to live active lives, free of institutional practices and regimes.
HIQA criticised the HSE for failing to proactively address the issues identified and to put a coherent and sustainable plan in place to improve residents' quality of life.
In January 2017, HIQA proposed to halt any further admissions until the HSE demonstrated that it was meeting the relevant rights of residents.
The HSE appealed the proposed restriction to Ennis District Court.
The case was adjourned for six months and today HIQA has published an overview of inspections conducted around that period, ending last November.
The watchdog found that by then the centre's culture had improved incrementally, most significantly as a direct result of the reduction in the number of residents accommodated on the Hazel and Alder units.
It also found that the centre had moved from a medical model grounded in institutional practices towards a social model of care.
The number and variety of social activities available had significantly increased, resulting in a rise in the number of residents who were participating in activities to enhance their quality of life.
Significant structural improvements were made in the Ash Unit, which were also impacting positively on their quality of life and more communal and dining space had been added throughout the centre.
HIQA has now ordered the HSE to notify its chief inspector within 72 hours if, at any time, the number of residents exceeds 100, or falls below 100.
It said it added this condition to the centre's registration because it was still concerned that the improved regulatory compliance may not be sustained in the event of occupancy levels increasing above 100.
A further condition is that "at all times and if the number of residents in the designated centre exceeds 100 residents", the HSE "shall ensure that such excess does not worsen regulatory compliance or compliance with all other conditions of registration and does not impact upon the lived experience and quality of life of the residents".
HIQA's report states this condition was attached because last November's inspection identified that a number of the improvements were temporary in nature, particularly regarding the availability of living space and dining space, and associated privacy and dignity issues.
"In the event of the occupancy of the centre increasing, the Chief Inspector needs to be assured that measures are in place to protect the privacy and dignity of resident's, ensure adequate living, dining and storage space for residents and an optimum working environment for staff," the watchdog ordered.