MAJOR changes to governance and staffing have been introduced recently in Cahercalla Community Hospital and Hospice to address shortcomings identified in the latest Health Information and Quality Authority inspection. That’s according to Cahercalla Board chairman, Dr Michael Harty, who has admitted the standard of care fell below normal standards during a major Covid-19 outbreak. A risk inspection by HIQA over three days on January 20, January 30 and February 1 found Cahercalla was non-compliant with 12 national regulations.
While Cahercalla went 10 months without contracting any Covid-19 case, it had 23 confirmed cases among residents from December 28 to the end of January, of which four passed away, which was a matter of great regret to Cahercalla. Even though Cahercalla did fall short of HIQA standards during the Covid-19 outbreak, Dr Harty reassured families of patients the facility is now on a very strong footing and has addressed all the issues raised by the independent regulatory authority. Given Cahercalla is run on a not-for-profit basis, Dr Harty stated the board feels an extra responsibility to deliver on the trust the community has given it.
Dr Harty outlined Cahercalla received the latest HIQA report at the start of February and sent an action plan to the regulatory authority about a month later. In view of this report and following the recent retirement of senior management, Cahercalla entered into a new agreement with Mowlam Healthcare to provide clinical governance from February 22.
He said Cahercalla had another HIQA inspection on March 16 and the authority was substantially happy with the changes in the nursing home since its previous January inspection following substantial compliance in eight out of the 11 national regulations and substantial progress in three other areas. It is expected that this report will be published in mid May.
Dr Harty pointed out the clinical governance and overall management of the nursing home has been turned around within 10 weeks of the January inspection. “The Cahercalla board fully accepts the findings of the January inspection and we accept it makes very hard reading and falls below the standards that Cahercalla would normally aspire to.
“The inspection was carried out at our lowest ebb when we were in the middle of a Covid-19 outbreak. Every phone call we received during the first two weeks in January was for a change in roster because someone was either Covid-19 positive or a close contact. One third of our staff were out on Covid-19 or normal leave. I would like to pay tribute to the staff who worked longer hours and extra shifts and put in a huge commitment to help us get over that very difficult time.”
He acknowledged the HSE and HIQA were very supportive when Cahercalla was trying to cope with staffing shortages during the pandemic. With 23 staff out on Covid-19 leave, Cahercalla got 16 nursing and health care assistant staff from the HSE and also had to secure between 12 and 14 agency staff at the pandemic’s height.
With a new management team in place and Cahercalla declared Covid-19-free at the end of March 28 days after the last positive case, has accepted new admissions since March 28. There are plans to provide some high level rehabilitation services in Cahercalla in conjunction with the HSE to allow patients to be discharged quickly from acute hospitals.
HIQA inspectors observed residents with complex health care needs associated with their diagnosis of Coivd-19 spending extended periods of time alone in their bedroom with no evidence of clinical monitoring or nursing supervision.
One resident remained in an isolation unit on their own for five days after their requirement to be isolated had passed. The resident told inspectors that they were waiting to return to their usual room but staff were too busy to organise this, however, inspectors were aware that, on the same day, there was an extra member of staff on that unit. Other residents reported waiting extended periods of time for their call bells to be answered.
Inspectors observed some kind and respectful interactions between staff and residents and, some residents reported that staff treated them with kindness and respect.
According to the inspection report, inspectors observed a resident using a commode by their bedside with their bedroom door open. Uncovered commodes were also observed in other bedrooms. “The absence of a single centre wide approach to staffing had real consequences for residents, for example, residents remained in bed and showers were not provided in one unit while another unit, which was operating with a reduced number of residents, had an extra staff member which staff had not reported to the manager in charge on that day.”
The report claimed the chaotic roster management system resulted in poor allocation and skill mix of staff across the five units in the centre. Significant gaps were apparent in staff knowledge of infection prevention and control procedures, and identification of typical and atypical symptom of Covid-19 across all units in the centre.
“Staff were inadequately supported and supervised. This resulted in poor care for residents, inadequate documentation of care delivered or required, and poor communication especially in relation to communicating care needs of residents to HSE and agency staff who came to help during the Covid outbreak. At times during the outbreak, a number of nursing shifts could not be covered resulting in units having no nurse on duty for periods of up to 12 hours.
“On these occasions the residents were cared for by care assistants with medication administered by a nurse who remained on duty after their shift or who came from another unit for that purpose only.”