HIQA inspection uncovers staffing issue at Clare home

STAFFING issues have been identified in a Killaloe nursing home following an inspection by an independent health watchdog.

The Lakes Nursing Home can accommodate a maximum of 57 residents, and on April 6 last during an unannounced HIQA inspection, there were 54 residents in the residential centre.

On the day of inspection there were sufficient numbers of staff on duty to attend to the direct care needs of residents.

The person-in-charge, however, confirmed that the centre was faced with ongoing recruitment challenges and that staff turnover was high. Records evidenced multiple shortfalls in the allocation of healthcare assistants.

It was confirmed that when staff phoned in at short notice they could not be replaced.

Residents had provided feedback to the provider through the resident surveys, voicing concerns on staffing in the centre.

The results of a residents’ survey identified that 33% of respondents stated they were satisfied while 17% stated they were not happy and 50% were recorded as not applicable.

A commitment was given to complete a full review of the system and processes in place to ensure that residents and relatives were supported in voicing any concerns they have.

Feedback from the residents and relatives spoken to on the day of inspection was mixed.

Residents and relatives spoke highly of individual staff. Inspectors were told by residents that they felt there was a high turnover of staff and that there were insufficient healthcare assistants on duty providing the direct care.

Residents commented to inspectors that ‘’all the old staff have left and the new staff don’t have the know-how’’ and ‘’staff here are brilliant, not enough of them’’.
The centre was compliant with standards on staffing, visits and health care.

It was substantially compliant with regulations on governance and management, individual assessment and care plan, protection and residents’ rights.

However, it was not compliant with rules on premises and infection control.

This inspection was undertaken to follow up on the previous inspection findings from May 2021 and to also follow up on unsolicited information received by the office of the Chief Inspector specific to staffing, complaints, management and the quality of care.

Inspectors found repeated non-compliance with the regulations reviewed and also found that the compliance plan response to the previous inspection findings had not been fully implemented.

Inspectors found evidence that complaints made to staff were not always recognised as a complaint and were not logged as a complaint.

A review of the staff rosters found multiple examples whereby there were staff shortages varying from 12-24 hours of direct care for the day. There were three healthcare assistants vacancies. When staff call in as unavailable at short notice cover is not provided due to availability of staff.

“Inspectors observed layers of dust and dirt along corridors, in resident bedrooms and in the kitchenette on the first floor. The premises in general was in a poor state of repair.
“Hand gels dispensers were visibly unclean with layers of gel encrusted on them.

“Resident equipment was not clean, and due to damage and rust, they were not amenable for cleaning.

“Wheelchairs in use by residents were visibly unclean. Commode chairs were not clean and were visibly soiled.

“The sluice machine was not in working order resulting in inappropriate disposal of waste.

“Cleaning trolleys had ingrained dirt and layers of dust. The floor areas surrounding some toilets were not visibly clean,” the report stated.

In its response, the centre outlined it will produce and monitor the staff roster at least two weeks in advance, always ensuring that a suitable number and skill-mix of staff are deployed, whose duties are allocated appropriately.

Since the inspection, five new Healthcare Assistants have been recruited: two are now in post and three will commence over the coming weeks.

In the event of unanticipated staff shortage, due to sickness leave for example, the centre will review the roster to bridge the gap with existing nursing or agency staff.

The centre will review complaints, implement corrective actions and ensure that lessons are learned, and appropriate quality improvements established as indicated. Further training will be provided to nursing staff on complaints awareness and management.

All staff will be encouraged to report and record all concerns and complaints at the earliest convenience, so that they can be resolved at a local level where possible.

The kitchen on the first floor has been completely refurbished, while work has started to repair damaged flooring.

Since the inspection, a thorough deep clean of the entire home has been undertaken.

The person-in-charge will monitor the standards of cleanliness and hygiene to ensure that appropriate standards continue to be maintained.

The housekeeping service will be reviewed to ensure it is adequately resourced for the cleaning and decontamination of all equipment.

The centre will continue to monitor the quality of the residents’ individual assessments and care plans, ensuring that they accurately reflect each resident’s assessed care needs and preferences, and that they are reviewed and updated as required.

It will review safeguarding plans in conjunction with the named nurses to ensure that all aspects of the plan are in place, that the plan is individualised and person-centred.

A review of the twin rooms will be completed in respect to the rights, preferences, privacy and dignity of both occupants of the room.