The Health and Information and Quality Authority has issued several inspection reports into nursing homes in the country highlighting issues around staffing levels, fire safety, and infection control.

Significant issues remain at Co Mayo nursing home

A HIQA inspection of a private nursing home in Ballyhaunis, Co Mayo, has found that significant issues remain at the home and that staffing levels remained low and inconsistent.

It also found that there was insufficient infection control and the fire safety systems were not adequate.

Brookvale Manor Private Nursing Home was inspected on 9 November.

It is registered to provide long-term and short-term care for up to 57 adults over 18 and on the day of inspection there were 36 residents.

A previous inspection in June during a Covid-19 outbreak had found multiple non-compliance related to governance and management, staffing and infection control in the centre.

The latest inspection found that while some progress had been made significant further action was required.

On the week of the inspection, nursing hours reduced from two nurses during the day, supported by the assistant director of nursing and the person in charge, and one nurse at night on weekdays to one nurse both day and night at the weekends.

Staffing at the weekend was further reduced as the social care facilitator and the activity therapist were not rostered.

There was no provision to replace staff in the event of unplanned leave.

On the day of inspection, two staff members (one nurse and a member of the housekeeping staff) who were unable to attend work were not replaced.

Management at the home had previously committed to increase staffing levels and had recruited additional staff, but not enough to reach the levels promised.

Inspectors were concerned that the centre was not staffed to ensure that an outbreak of Covid-19 would be identified, managed, controlled and documented in a timely and effective manner.

They also found there was insufficient cleaning staff, that Covid-19 contingency plan lacked detail, there was inadequate access to appropriate hand hygiene sinks, poor management of clinical waste and stained and malodorous carpets throughout the centre.

There were also uncovered bins, poor cleaning records, no service contract in place for bedpan washer, no identification of clean and contaminated areas for storage and no cover for the laundry trolley.

These were a restated non-compliance from the previous inspection.

The inspectors also found that fire safety systems in place did not provide adequate assurance that residents were safe from the risk of fire. 

That maps and fire safety required review. For example, maps did not identify the route to evacuation assembly points, the location of fire fighting equipment, the location of fire doors or the identification of compartments required for emergency evacuation.

There were rooms in the centre with no fire detection equipment. There was one fire panel located in the nursing station.

The time taken to reach the panel from the most distant point in the centre had not been factored in to evacuation drill times in the event of an emergency.

There were damaged fire doors and fire doors held open with a chain and no release mechanism for automatic closure, in the event of a fire.

They also found the fire safety policy lacked detail.

Ineffective infection control measures at Ballina nursing unit

A HIQA inspection of a community nursing unit in Ballina in Co Mayo has found senior mangement did not properly support and oversee staff at the centre during a Covid-19 outbreak and there were ineffective infection control measures.

St Augustine's Community Nursing Unit on Cathedral Road in Ballina is operated by the HSE and provides nursing care to long stay and respite residents who have increasing physical frailty, some living with
dementia and others requiring assistance with mental health or palliative care needs.

HIQA inspectors visited the unit on 29 October 2020 following notification of a Covid-19 outbreak. At the time of the inspection 22 residents and 26 staff had tested positive for Covid-19. The infection outbreak was still active at the time of this inspection. This was the first outbreak of Covid-19 in the centre.

The inspectors found that governance and management arrangements in place during the outbreak were inadequate and did not ensure that the service delivered was adequately resourced, effectively managed
and appropriately monitored.

They reported that the lack of a consistent person in charge had impacted on the day-to-day operational management of the centre and contributed to some of the issues identified on the day of the inspection.

They found that senior management had failed to adequately oversee and support the staff on the ground to ensure the safety of the service during the Covid-19 outbreak.

They reported that sufficient staffing resources were not provided to ensure that the centre was cleaned to the standards required during a COVID-19 outbreak. 

They found there was not appropriate clinical supervision of nursing and care staff, evidenced by unsatisfactory oversight of care planning and residents records to ensure that residents needs were consistently documented and communicated to all nursing and care staff, particularly at a time when many staff on duty did not know the residents well and were not the regular staff in the centre.

They also noted that although the centre had been divided into two zones one of which was designated as Covid positive and the other other Covid free this was not effective as the boundary was consistently breached by staff.

The report says visitors were brought into the centre through the reception area which was in the Covid-19 positive zone and there was no cautionary signage alerting staff, residents or visitors to the Covid-19 positive areas. 

The inspectors found that the unit could not be effectively cleaned due to clutter such as boxes of personal protective equipment stored on the floor and several items of residents' assistive equipment that was not in use. There was no means of ventilating the nurse's station room located in the COVID positive zone and social distancing could not be maintained in the clinical room due to the layout and floor space available. 

Issues over fire precautions at Longford care centre

Elsewhere, a HIQA inspection of a care centre for mostly elderly residents in Longford also found issues over fire precautions, infection control and risk management.

St Joseph's Care Centre on the Dublin Road in Longford town is operated by the HSE and provides 24-hour nursing care for up to 68 residents who are predominantly over 65. 

Although the main evacuation pathways were unobstructed and clearly signposted, the inspectors were not assured that the fire procedures were clear, and that staff would be able to carry out a safe and effective evacuation of the residents in the event of fire. 

Also, on the day of the inspection inspectors observed that staff were following the appropriate procedures in relation to hand hygiene and use of PPE. However, records showed that not all staff working in the centre had completed the required infection prevention and control training. 

The inspectors also recommended a review of the laundry facility to ensure it supported a one-way system with a clear separation between the clean and dirty processes, improvement in the storage of supplies and equipment and a full review of all equipment to ensure it supported effective.