Laois nursing home found to be non-compliant in some regulations governing care and welfare of residents

Compliance with regulations at Stradbally nursing home are poor and not sufficient to ensure the care and welfare of residents is fully met.

That's the overall assessment made by the Health Information and Quality Authority (HIQA) in a new report following an inspection of Droimnín Nursing Home in the Laois town.

The report published on December 16 follows inspections of the facility where 58 people are cared for on the days inpsectors visited.  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.

Of those cared for at the centre on the day of the inspection, 16 residents were maximum dependency, seven high, 19 medium and 16 low. 

While the centre was found to be compliant or substantially compliant 18 standards, it was found to be not compliant in relation to staffing, training and staff development, governance and management, notifications of incidents, individual assessment / care plan and residents rights. 

Under the notifications of incidents category, HIQA reported that a number of allegations of staff misconduct had not been notified to the office of the chief inspector as required.

The new report outlines the assessment made.

"Overall, inspectors found that the actions taken by the registered provider to achieve compliance with the regulations were not sufficient to ensure that the care and welfare needs of the residents were fully met.

"Many of the issues identified on the last inspection had been addressed and some improvements were noted in respect of the premises, however, overall levels of compliance with the regulations remained poor, and new areas of non-compliance were identified on this inspection," it said.

The report said that Droimnin Nursing Home Limited, a company comprising three directors, is the registered provider of Droimnin Nursing Home. It said that while the provider is not involved in the operation of any other nursing homes, the company directors are involved in the operation of a number of other nursing homes throughout the country.

"None of the directors attended the centre in person on the days of inspection while one did attend the feedback meeting at the end of the inspection via remote technology," it said.

The inspection report commented on staff and management issues.

"There was a recently recruited person in charge who works full-time in the centre and meets the regulatory requirements. There have been a number of changes to the person in charge in the recent past. The current person in charge was appointed
to the role approximately four weeks prior to this inspection and is the fourth person in charge in the past three and a half years.

"Similar to the findings of previous inspections, the centre did not have the management structure in place as set out in the statement of purpose and function (SOP). According to the SOP and previous commitments as submitted to the office
of the chief inspector by the registered provider, the person in charge is supposed to be supported in her daily role by an assistant director of nursing and two clinical nurse managers.

"On the days of inspection the two clinical nurse manager posts were vacant and the assistant director of nursing was on leave. This left the centre relying heavily on the person in charge as the only supernumerary management person on duty. In addition, the person in charge had worked on the floor the previous Thursday night to cover unplanned staff nurse absences. Consequently, there was no member of the management team available in the designated centre on the following day. In addition, the SOP states that a general manager (0.5 whole time equivalent) is in place in the centre. This post was not filled at the time of inspection.

"Inspectors found that the person in charge did not have sufficient management support. The systems in place are not sufficiently robust enough to ensure sufficient oversight and supervision of staff and to respond to residents needs," said HIQA.

The report said registered nurses, healthcare assistants, activities, catering, household and administrative staff make up the
complement of staff responsible for the delivery of care and support to residents.

"There were insufficient staff to support activities for residents on the days of inspection. Inspectors were informed that a staff member dedicated to the provision of activities to residents had resigned a number of weeks before the inspection and
another was an unplanned absence.

"As the system in place was dependant on the presence of these staff, their absence had a significant impact on the programme of activities. Over the course of the two day inspection, inspectors observed residents were seen to spend significant amount of time in their chairs in sitting rooms or in their bedrooms with limited stimulation other than music or televisions playing in the background that was of interest to only a small number of residents," they said.

The inspectors said that overall, there was evidence of good systems of communication that included monthly governance and management meetings, staff meetings and group meetings.

"However, records reviewed by inspectors were not sufficiently detailed to show what was discussed or what actions had been taken to drive improvement. Regular data on aspects of care such as incidents, wounds and falls was collected by the person in charge. However, improvements were required with regard to the audit tools in use, to ensure all relevant details were captured, which could then inform comprehensive, tailored action plans for improvement," said HIQA.

Inspectors noted that staff were being accommodated in the Oughaval Building 2.

"Consequently it's usage is not as set out in the statement of purpose and function and in accordance with condition 01 of the registration of the centre," it said.

The registered provider was requested to regularise this.

Overall, the inspection noted that there was evidence of a good system of staff performance appraisal, however, adequate arrangements were not in place for the supervision of staff, including arrangements for enhanced supervision, in instances where concerns had been identified relating to staff performance.

They said a review of the training records evidenced that staff were supported and facilitated to attend training relevant to their role.

The nursing home was the location of a number of deaths over in early 2021.