The latest Health Information and Quality Authority (HIQA) inspection report on Louth nursing home Dealgan House – in which 22 residents died during the initial outbreak of the Covid pandemic – shows that the home was fully compliant with just 9 out of 22 statutory regulations for which it was inspected over two days on May 27th and 28th.

The announced inspection took place over 10 days after the Royal College of Surgeons Hospital group, which had temporarily taken over management of the home after a Covid-19 outbreak in April, had handed back its governance to the owners.

The regulator of nursing homes found that it was non-compliant with seven key statutory regulations, including staffing, management and infection control, and only partly or substantially compliant with a further six regulations. On the positive side, the inspection report noted that "Feedback from residents and their families was overwhelmingly positive in relation to the care and services provided by staff working in the designated centre.

"The inspectors observed that staff demonstrated genuine warmth and respect in their dealings with the residents they cared for."

Dealgan House had a Covid-19 outbreak in April resulting in the deaths of 22 residents, and which led to the Royal College of Surgeons taking over management of the nursing home to bring it under control.

Non-compliance

HIQA found Dealgan House to be non-compliant in relation to aspects of management at the home.

It states: "Although the COVID-19 pandemic was an unprecedented event, inspectors found that the COVID contingency plan in place in the designated centre [Dealgan House] did not work, which significantly compromised the delivery of care and services for residents, and created high levels of anxieties and distress for their families."

It found that in mid-April "more than 60% of all staff, including 70% of the nursing staff, were unable to work due to contracting COVID-19."

"The management team was reduced to the assistant director of nursing (ADON). As there were no administration staff to support nursing and care staff during the outbreak, telephones were not answered and communication with families broke down as a result. This created high levels of anxiety and distress as families did not receive accurate information about their loved ones."

Although the HIQA inspection took place after the Royal College of Surgeons had taken over control of the nursing home for almost one month, it found in relation to infection prevention and control (Regulation 27) the home was non-compliant when it visited in late May. 

This inspection found a number of infection control risks "which required the inspectors to issue an urgent action plan to the provider."

The following issues were identified: "not all staff had attended up-to-date training" in infection prevention and control in line with HPSC guidance. There was "inadequate oversight of staff practices in infection control, for example staff travelling to work in their uniforms, staff gathering in the foyer the entrance and not adhering to social distancing guidelines, not all staff checked their temperatures on arrival for work and again during the working day in line with HPSC guidance."

While the in-house housekeeping staff were found to be knowledgeable and compliant "the external contract cleaners did not have adequate knowledge and expertise …There was no system in place for cleaning the shower chairs in the main area of the building and some of these were visibly dirty."

There was also "no clear protocol in place to ensure that all staff knew what to do in the event of a suspected case of COVID-19" occurring at the home.

While HIQA found that Dealgan House "was adequately resourced to promote good infection prevention and control practices" and PPE was available, inspectors also found "there was poor oversight of staff training needs and infection control practices, which did not provide the required assurances that infection control procedures were in line with best standards and available guidance."

Staffing

In relation to staffing, Regulation 15, HIQA found that on staffing the nursing home "had not ensured that the number and skill-mix of the staff team was appropriate."

The housekeeping team was supplemented by staff employed by an outside cleaning agency. "Inspectors found that these staff did not have the required training and knowledge for their role. In addition, there was no continuity of staff supply and as a result the housekeeping supervisor spent much of their time training new agency staff who did not consistently return to work in the designated centre."

With regard to nursing staff the report found that, although the centre had been divided in line with HSE public health guidance into three distinct staffing areas at the time of the inspection, "Rosters showed that on some night shifts, only two registered nurses were on duty which meant that nursing staff were potentially moving across and between the units which was not in line with the public health infection control."

In relation to staff training and development regulation 16, HIQA found "the person in charge had not ensured that all staff working in the centre had attended all of the required additional COVID-19 infection prevention and control training."

Observations made by the inspectors on the second day of the inspection found that "staff were not adhering to Interim Public Health, Infection Prevention & Control Guidelines" on Covid-19 oubreaks. "For example, inspectors observed staff arriving at work already with their uniforms on, and not adhering to social distancing rules when checking having their temperatures checked." Inspectors also found arrangements at the home were "were not sufficient to ensure that staff had adequate support and supervision out of hours."

In relation to the keeping of records, the home was found to be "substantially compliant".

"While the recent records appeared largely well-maintained, inspectors found gaps and discrepancies in respect of the documentary evidence for the period of outbreak in the centre. Specifically, in relation to some of the resident’s care and medication administration records, which were all kept in electronic format on a password protected device.

"For example, while a daily care record stated that all medication was administered as prescribed, the corresponding medication administration sheet stated that the resident had declined the medication. As a result, it was often unclear and difficult to establish the exact level of care some of the residents received during the outbreak."

In relation to Health care, the home was also "not compliant".

The inspectors found that Health Protection and Surveillance Centre (HPSC) guidelines in relation to Covid-19 were not being followed. The inspectors "were not assured that residents were being monitored twice daily in order to detect signs and symptoms of potential COVID-19 infections early".

"The provider was issued with an immediate action plan to correct this non-compliance."

Positives

The inspection report found Dealgan House to be compliant with a number of key regulations.

"Residents who had contracted the virus and had recovered told the inspectors how well staff had looked after them when they were unwell and that 'they could not have done more for me'," the report said.

A representative of the families of the former Dealgan House residents, Roisin Duffy, stated that they were "shocked and saddened" by many of the findings in the HIQA inspection report that has been published today.

She says that the families "will be raising many of the issues with Minister Stephen Donnelly when they meet with him next week."

"The report galvanises our calls for a public inquiry into Dealgan House Nursing Home. It is clear that this report will only add to the questions that we have about what exactly happened to our loved ones. We believe that by examining what happened at Dealgan House Nursing Home, the wider lessons that are so badly needed by the health authorities can be learned and implemented in full to avert a similar tragedy ever happening again."

Eoin Farrelly, the director of Dealgan House, said today that he welcomed the HIQA report, pointing to the recognition given to the dedication of the nursing home staff, who faced significant pressure during the height of the outbreak.

He noted that, in a follow-up inspection, Dealgan House was deemed compliant with all residential care-related regulations. Mr Farrelly said the home would continue to take all possible steps to protect its residents and staff during the pandemic.