A Co Meath nursing home whose residents were severely affected by Covid-19 at the height of the crisis only complied with 7 out of the 19 regulations it was subsequently inspected for, a report by HIQA, the Health Information and Quality Authority, revealed today.
The June inspection of the nursing home, Silvergrove in Clonee, had been "triggered in response to the number of concerns that had been received by the Chief Inspector during and following the COVID-19 outbreak in April," the report said.
Silvergrove featured in a Prime Time report earlier this year when the family of a former resident, Charlie Bollard, complained that they believed he should been transferred to hospital when there was an outbreak at the home. Mr Bollard died of Covid-19 within days of being admitted by ambulance to Connolly Hospital in April this year.
At that time, the nursing home was being supported with additional HSE staff as it was trying to bring an outbreak under control.
Today's HIQA report found that, in an unannounced inspection on June 8th, Silvergrove was non-compliant with four key regulations on governance/management, staffing, record keeping and infection control. It was only partly or "substantially compliant" with a further eight regulations, including regulations relating to staff training, food and nutrition, end of life care, residents’ rights and their health care.
"This inspection found shortcomings in compliance with key regulations which underpin safe resident care including infection control, records, staffing, and food and nutrition. Improvements were also required in health care, risk management, end of life care and resident's rights."
The nursing home has not yet responded to a request for comment from Prime Time regarding today's report.
Background to inspection
In its report, HIQA explained the context in which its inspection took place following concerns raised about how an outbreak of Covid-19 had been handled at the home.
"During the course of the outbreak 14 residents contracted COVID-19 and six residents died with either a positive diagnosis of COVID-19 or a high suspicion of having contracted the virus. During this period the provider had assistance from the HSE Crisis Management Team."
"On the day of the inspection there were 17 residents accommodated in the designated centre. All residents had been tested for COVID-19 and the test results had been received more than 14 days prior to the inspection."
"Poor regulatory compliance was a repeated finding of inspections of Silvergrove Nursing Home in 2017 and 2018 resulting in a notice of decision to cancel the registration of the centre. "
However, the decision to close the nursing home was reversed when over 2019 the provider "took the required action to ensure the safety and well being of residents" and the HIQA found in inspections September and October 2019 that there had been a "significant improvement in regulatory compliance".
Today’s inspection report states that once again however "regulatory compliance had deteriorated".
Failure to comply with regulations on management and staffing
Inspectors found that while there were some improvements in the governance and management of the home since the last inspection, the home did not live up to the commitments it had made to HIQA in January 2020 on how it would be managed: "on the day of the inspection the management structure in the centre was significantly reduced; specifically the clinical nurse manager (CNM) hours had reduced."
This meant that, instead of having two full time clinical nurse managers and one part time, there was only one working, "with only 20% of that person's role committed to the management of the centre and the supervision of staff."
As a result, HIQA found that there was "inadequate supervision of staff delivering care to residents". It also found that "it was not clear who had responsibility for oversight of staff records" and "some files did not contain all of the required information".
Inspectors also found that "the centre was cluttered with boxes of PPE and other equipment which caused a risk to residents and staff mobilising around the centre and created an infection control risk". These risks had not been identified and addressed by senior staff and "it was not clear who had authority to resolve the significant risk posed."
On a related issue, HIQA found that staffing levels did not meet statutory regulations, which meant that they "were not sufficient to meet the needs of the residents or to ensure that the centre was cleaned to the required standard".
This had also had other impacts on residents. For example, the report describes how "Lunch for those residents who did not eat in the dining room was delivered off an unheated trolley by the three care staff". Given that it took up to 30 minutes for all meals to delivered to residents, this meant that "Those residents who were the last to have lunch did not receive a hot lunch."
There was inadequate numbers of house-keeping staff employed, which meant that "it was not possible for this number of staff to clean the centre to the required standard and do the required laundry."
"As a result the centre was not clean in all areas and the cleaning schedules required in the current Infection Prevention and Control guidance were not in place."
No comprehensive training plan
While the HIQA report found that the training of staff was "substantially compliant" and the required staff training had taken place prior to the Covid-19 outbreak, in June there was "no comprehensive training plan in place to bring all staff up to date with their mandatory training requirements."
In addition, the training plan was not available on the day of the inspection and the person in charge was not aware of those staff who needed updated training.
The report notes that "three staff who spoke with the inspectors did not demonstrate the required level of knowledge pertinent to the recognition of the symptoms of COVID-19" or public health guidelines required to identify and contain a second outbreak of the virus.
Infection control requirements not in compliance
HIQA found that Silvergrove had not ensured "that procedures, consistent with the standards for the prevention and control of healthcare associated infections were in place".
It also found that "There was no system in place to determine the requirement for PPE in the designated centre and for the return of surplus stock."
"Hoist slings were shared between residents…. Staff confirmed that it was the practice in the centre to use the same sling for more than one resident as long as the sling was of the correct size." Additionally, staff "were not clear about what schedule was in place for cleaning the slings that were in regular use".
Inspectors also found that not enough cleaning was being done. "The current numbers of housekeeping staff did not ensure that the cleaning schedules required…could be met at all times."
For example, although the large sitting room had been deep-cleaned on June 11, "the inspectors found the following the corners and edges of the floor were not clean and there were a number of cobwebs in the corners."
"Some staff did not adhere to good hand hygiene practise and were not seen to use hand sanitisers when they moved from one area to another around the designated centre."
Failure to keep proper records
HIQA also found that Silvergrove did not meet its statutory obligations on record keeping.
It states that it had in fact mixed up some resident’s records: "A review of residents care records found four entries relating to other residents in one care record and one entry for a female resident in the record of a male resident."
It also found gaps in files on staff, including a lack of references for two staff, a lack of evidence of vetting of another and "housekeeping records for deep cleaning schedules" were not accurate.
"Staff kind and respectful towards residents"
There were some positives highlighted in the report, the main one being that "inspectors observed that staff were kind and respectful towards the residents that they cared for."
"Staff knew the individual residents well and were able to tell the inspectors about each residents’ past life, family connections and their care needs."
Some improvements were recommended to ensure "that all staff used a person centred approach when delivering care".
However the report found that, overall, "the feedback from residents and their families was positive in relation to the care and services provided in the designated centre."