Health Information and Quality Authority (HIQA) inspectors found the safety and wellbeing of intellectually disabled people at centres run by the Western Care Association were at risk, because the provider did not have adequate oversight.
A report published by HIQA followed inspections that were carried out on centres in Co Mayo, in response to contacts made to HIQA's Concerns Helpdesk last year, relating to "the deteriorating quality" of service.
Sixteen centres were examined between November 2022 and February 2023 and "a concerning deterioration" in the level of compliance was discovered.
This led HIQA's chief inspector to request inspections of the remaining centres over a two-week period.
The report published this morning, set out the overall findings of the inspection programme undertaken since November 2022 and the outcomes of the inspections undertaken over the course of two weeks in March 2023.
Between 13 and 21 March 2023, inspectors met with 54 residents and 74 staff members, including persons in charge. They also spoke with middle and senior management in Western Care Association.
Overall, inspectors found that in each residential centre, persons in charge and staff were committed to meeting the needs of residents and engaged with residents in a respectful and kind manner.
However they also found that the provider had "inadequate oversight and support arrangements" for persons in charge and staff and this was having "a negative impact" on the provider’s ability to deliver consistent, good quality support to people with disabilities who lived in the centres.
When it came to safeguarding, inspectors found that although staff had a good understanding of what constituted a safeguarding concern, gaps in the provider's safeguarding arrangements increased the risk that there would not be an appropriate and timely response to issues that may arise.
While significant instances of abuse were not identified, there were situations where the actions of some residents were impacting on the safety and quality of life of other residents through peer-to-peer interactions.
Inadequate auditing
While the provider had a safeguarding policy to direct staff in their response to concerns, the policy was not being implemented in a range of centres.
The inspection report said not all safeguarding concerns were investigated in line with the policy and incidents were not referred to the chief inspector as required by the regulations.
In addition, where safeguarding concerns had been notified, the provider had not completed a subsequent internal investigation to find out if improvement was required to their own processes to ensure effective safeguarding in the future.
Where preliminary screening and interim safeguarding plans had been developed, inspectors found an inconsistency in approach across the organisation.
In one centre a recommendation for psychological support had been identified in December 2021 and was not provided until May 2022.
Inspectors found that there was inadequate auditing and oversight of safeguarding arrangements by the provider and the report said this was particularly evident in safeguarding plans across a number of centres.
Following the inspection, Western Care Association assessed the structure of the senior management team and appointed a Head of Quality, Safety and Service Improvement, an Interim Head of Clinical and Community Supports and a Head of Properties and Facilities to ensure "a clearly defined governance arrangement for consistent and effective oversight for distinct aspects of service delivery".
It committed to ensure that arrangements for responding to safeguarding concerns "are consistently implemented across all service locations in a timely manner" to ensure safeguarding of all residents and that the regulator is notified as required.
In addition to the HSE online safeguarding training, the association also said that the safeguarding training module had been reviewed and was "actively being delivered" through face-to-face learning events by trained designated officers employed by the provider.
Substantial progress
In a statement Western Care Association said substantial progress had been made in addressing issues highlighted in the HIQA report.
As part of its new governance arrangements, it said a number of additional practitioners such as Assistant Psychologists and Behaviour Support Specialists had been employed.
These practitioners will provide support, guidance and advice to team members directly working with people with intellectual disabilities and autism.
Western Care Association said additional training was being provided to team members in areas such as neurodiversity, safeguarding, and incident and risk management.
"The organisation has communicated with people supported, families and staff at its services. Anyone with concerns should contact their Area Manager. Western Care Association remains fully committed to meeting the ongoing needs of the people it supports," it said.
