Droimnín Nursing Home Stradbally
Multiple non-compliances were found by a health services watchdog at the Stradbally nursing home where a Covid-19 outbreak claimed many lives this year.
The Health Information and Quality Authority (HIQA) has published two reports following unannounced visits to the Drominín Nursing home in January and February during the third wave.
The second report published following the February visit summarises what it found at the home, which is operated by Brookhaven Healthcare, on both occasions.
“The centre had been inspected in January 2021, during the recent outbreak of COVID-19. At that time multiple non-compliances were found, including governance and management, staffing, training and staff development, premises, food and nutrition, infection control and medicines and pharmaceutical services.
“On this occasion inspectors found the provider had made significant efforts to bring the centre into compliance and addressed a number of issues and non-compliances from the previous inspection. There was a clear management team in place, who were able to provide up to date information during the inspection. They provided evidence of the improvements that had been made which had a direct impact on the quality of life of residents,” said the February assessment.
It found that: “The deterioration of the premises that had occurred prior to the COVID-19 outbreak indicated there was a gap in the oversight arrangements the provider had in place to ensure the premises were well maintained and was a safe and comfortable environment for the residents and staff who lived and worked in the centre,” said the February report.
HIQA says the centre has two buildings that are purpose-built. The centre provides accommodation for a maximum of 101 male and female residents, over 18 years of age
There were 57 residents during the first inspection when the outbreak was ongoing but this has fallen to 45 in February when the outbreak was under control but after several residents had succumbed to the virus.
Five inspectors visited over three days in January. HIQA said this was an unannounced risk inspection of the designated centre. It said this risk inspection had been triggered as a result of a significant outbreak of COVID-19 which affected 49 residents and 42 staff and sadly at the time this inspection was completed, had claimed the lives of 14 residents.
The report fund found that doctors from Portlaoise hospital were paying regular visits to assist with care. It says the person in charge, and many of the nurses, care staff and household staff were not available to work due to COVID-19.
The January report addressed the standards at the time of inspection.
“Prior to the COVID-19 outbreak the centre had a mixed compliance history and significant improvements were found when the centre achieved full or substantial compliance at the previous announced inspection in May 2019.
“However, the improvements were not sustained and non-compliances relating to governance and management, staffing and inappropriate storage of equipment, which were found in November 2018 were repeated on this inspection. After the first day of inspection, the Chief Inspector met with the provider to discuss the weak governance and management arrangements in the centre, inspectors' findings and concerns about the care and welfare of residents.
"The provider was required to put a person in charge to manage the outbreak and ensure that residents were assessed as their condition changed and were provided with appropriate care. A new person in charge was appointed later that day,” said the report.
The report says the provider had prepared a comprehensive preparedness and contingency plan for COVID-19.
“However, the contingency plans were not adequate to deal with the scale of the outbreak in the centre,” says the report.
The inspectors found that there were insufficient numbers of nursing and care staff with the appropriate knowledge and skills to meet the increasing dependency and care needs of residents with COVID-19 infection and residents needing one-to-one supervision.
The January report said Inspectors found that residents were at risk of infection as a result of the provider failing to ensure that procedures, consistent with the standards for infection prevention and control were implemented by staff.
PPE issues were addressed during the first inspection.
The report found that the oversight of key areas such as infection prevention and control and the upkeep and maintenance of the centre were not robust and did not ensure that care and services were safe and appropriate.
The report said that given that cleaning is a core requirement for the management of an outbreak, it was evident that there was a knowledge deficit in relation to infection prevention and control.
During the height of the outbreak, residents' records and information provided by staff, demonstrated that there was poor oversight of residents' care and staff supervision.
Up to 20 residents died at the home in January from Covid-19.
Substantial changes and improvements were found by two inspectors in visited Drominín on February 16 as the Covid-19 outbreak at the home was nearing an end.
“On entering the centre inspectors noted there was a more relaxed atmosphere than on the previous inspection days,” said the report.
It said staff and management described heightened anxieties and the difficulties brought on by the COVID-19 pandemic.
“Staff expressed empathy with the residents and acknowledged that the recent outbreak of COVID-19 and the associated deaths had been a very sad, difficult and anxious time for the residents. The provider had made counselling services available for staff and residents,” said the report.
Having fallen below standards in January after an inspection that took place when 14 residents had died and most staff and residents had caught the virus, the home now fell short in just one area.
HIQA found that the governance arrangements at the centre had been strengthened to improve oversight in the centre and to identify potential risks and opportunities for improvement.
HIQA said that staff spoken with, including those involved in cleaning practices, confirmed they had received training, and inspectors observed good cleaning practices in the centre.
HIQA added that the provider had responded to the COVID-19 outbreak by ensuring there were additional resources available in the centre.
“This included strengthening the management team, and ensuring a consistent level of nursing, care and cleaning staff to make sure residents' needs were being met,” said the report.
HIQA found that there were enough staff on duty to ensure that the residents' needs were met in a timely manner. The provider had used agency staff to fill shortages on the staff roster during the COVID-19 outbreak to maintain appropriate staffing levels in the centre.
In addition, the provider had also contracted 5 days a week to supplement the centre's team of household staff.
The inspectors found that the Drominín premises was not compliant with standards after the second visit.
“A number of maintenance and infrastructural issues required action to ensure appropriate standards were in place. A number of the concerns identified had the potential to impact on infection prevention and control measures,” said the report.
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