Eight areas of non-compliance with regulations reported following HIQA inspection at nursing home
AN unannounced inspection by the health watchdog HIQA reported eight areas of non-compliance with regulations in a nursing home in Sligo.
The report, published on the Health Information and Quality Authority website earlier this week related to an inspection at Sonas Ard na Gréine in Enniscrone which took place on October 11, 2022.
Sonas Ard na Gréine is a purpose-built nursing home providing 24-hour long term, convalescent and respite care for both male and female residents. There were 49 residents in the centre at the time of the unannounced inspection. Some of the findings included the failure on the day of inspection to find a person in charge in place who met the requirements of the regulations, a lack of a clear management structure, inadequate numbers of staff with the required knowledge and skills to meet residents’ needs. The inspectors found management of medicines and pharmaceutical services required a number of actions to ensure that this service was safe and effectively monitored.
A smoke alarm had been covered over while gaps and breaks in fire stopping in a number of areas had not been identified and addressed. A member of staff had been appointed without an appropriate Garda Vetting in place. Controlled drugs were not consistently administered in line with best practice professional guidelines. The practice of double-checking controlled drugs at the start of each shift and prior to administration, was not always adhered to. The report also noted that a series of remedial actions had been taken by the nursing home management to address the areas of non-compliance found by inspectors.
Since the inspection, the provider has made several improvements including promoting a Staff Nurse to Senior Staff Nurse with specific responsibilities.
All recruitment records, including garda vetting, are saved in the staff members files and all of these are now up-to-date. The risk register has been updated to all identified risks. Further training for the new management team will be incorporated into their team development.
All nursing staff have completed medication management training to ensure they are up to date with best practices and guidelines. A weekly review is also taking place of medication trolleys, fridges and medication storage has been implemented to ensure that medication is appropriately managed.
Overall, inspectors found that residents were content living in the centre and that they were satisfied with the care and service provided. General feedback from residents was positive regarding their quality of life and the levels of support that they received.
Residents told inspectors that they felt safe in the centre, were well cared for and that their meals were of a good standard. The inspector observed that residents were comfortable in the company of staff and that staff were attentive to the residents' needs for assistance and support. Staff interactions with residents were observed to be caring, gentle and respectful.
The registered provider for this designated centre is Sonas Asset Holdings Limited. There was no person in charge in place at the time of the inspection. The registered provider had submitted a plan to appoint a suitable person in charge who met the requirements of the regulations by mid November 2022.
At the time of this inspection, according to the 31-page report, the management team consisted of a director of the company who was supported by a quality and governance coordinator. The director of the company was based in the designated centre on a day-to-day basis.
The remainder of the staff team consisted of two clinical nurse managers (CNM), a team of staff nurses, health care assistants, household, catering, maintenance and administration staff. Inspectors found that the CNMs were working 60% of their time as a nurse on duty and as a result their protected management hours were not sufficient to oversee the quality and safety of care for the residents.
At the time of the inspection there were a number of staff vacancies, and the registered provider was in the process of recruiting four health care assistants, an activity coordinator, a part-time physiotherapist, a housekeeper and one catering staff.
In terms of quality and safety of care the report said overall, the quality and safety of care provided to residents were found to be satisfactory. Residents reported that they felt safe and well cared for.
However, inspectors found that increased oversight was required to ensure that the quality and safety of care being delivered to residents was consistently managed, to ensure the best possible outcome for residents. Actions were needed to bring Regulation 28 Fire Safety, Regulation 8 Protection, Regulation 27 Infection Prevention and Control, Regulation 5 Assessment and Care Planning and Regulation 9 Residents' Rights into full compliance. Residents had access to appropriate health and medical care services. There was a general practitioner (GP) available to residents.
Furthermore, residents were supported by a team of allied health care professionals including a dietitian, physiotherapist, optician, and an occupational therapist. A community palliative care and a psychiatry of later life team also formed part of the multi-disciplinary support for residents. The recommendations made by the allied health care professionals were incorporated into the residents' care plans.
Resident care records were maintained on an electronic nursing documentation system. Inspectors found that assessment and care planning required improvement to ensure each resident's health and social care needs were identified and the care interventions that staff must complete were clearly described.
The inspectors reviewed a sample of residents' care documentation and found that some preadmission assessments did not contain sufficient information and therefore there was a risk that some of the residents' care needs would not be identified. Additionally, there were some inconsistencies in the care planning documentation as outlined under Regulation 5: Individualised assessment and care plan.
There were measures in place to protect residents against the risk of fire. These included regular checks of means of escape to ensure they were not obstructed and checks to ensure that equipment was accessible and functioning. However, inspectors found that supervision of staff and oversight of fire safety risk was not robust.
Inspectors observed that a smoke detector located in a communal dining room had been covered to prevent it from functioning, this practice prevented the automatic detection of smoke and the activation of the fire alarm.
Overall, the premises were clean and well maintained. The inspectors observed that there were good infection prevention and control practices and procedures in place.
Resident feedback was obtained at meetings which were convened regularly. Residents were supported to continue to practice their religious faiths and had access to newspapers, radios and televisions. Visiting was facilitated and observed to be managed in line with the national guidelines. The provider did have processes in place to protect residents however improvement was required to ensure the protection and safeguarding of all residents in the centre.
A detailed report on actions required and taken by management was included with the report.
The full report can be viewed on the HIQA website.