Nursing home addressing issues of non-compliance

A Health Information and Quality Authority (HIQA) report, from an announced inspection of a nursing home in Ennis, found 10 out of the 18 ‘outcomes’  were non-compliant, two of which were categorised as ‘major’ non-compliance.

The HIQA inspection took place at Ennis Nursing Home, Showgrounds Road, on September 30 and October 1 of this year but the report was only published last week.

Despite the issues of non-compliance, the report states that residents of the nursing home told the inspector they were happy living in the centre and they felt safe there.

Staff also demonstrated good knowledge of the residents’ care needs when speaking with the inspector. However, “significant improvements were required in the documentation of nursing assessments and care plans and medication management”.

The report found major non-compliance in the area of safeguarding and safety. The inspector found that training in adult protection had not been delivered to all staff or was overdue for some others. Improvements were required in resident support documents and care plans and the report stated “a number of staff had not received training relevant to supporting residents with behaviours that challenge”.

The inspector was not satisfied that the procedures for identifying and alleviating the causes of behaviour that is challenging were clear to all staff.

An action plan was drawn up by Mowlam Healthcare Services, the service provider at Ennis Nursing Home, outlining its response to each of the issues cited as non-compliant at the time of the inspection. It said that by November 30, education had been provided to all staff in effectively supporting residents with behaviours that challenge.

The inspection report found major non-compliance in the nursing home’s medication management.

“Overall, the inspector was not satisfied that residents were protected by the designated centre’s procedures for medication management,” the report states.

“Significant improvements were required in medication safekeeping, medication administration and documentation pertaining to MDA medications, which are medications that require strict controls under the law.

“MDA medications were stored in a separate locked press within the treatment room and two nurses held an identical key. The inspector found that this was not in compliance with the centre’s policy of holding the key on the person of the designated nurse and it was therefore not clear who was accountable in the event of an error occurring,” the report continued.

“A medication round was observed and, overall, practice was in line with current professional guidelines for nurses. However, upon later examination of a tablet crushing device, the inspector found that a tablet remained there and there was no documentation available for whom the tablet had been intended for.”

According to the company’s response, by November 20, a new medication management system was introduced and “all medications are stored securely and are inaccessible to non-nursing staff”.

Suitable staffing was deemed to be moderately non-compliant, with the report stating “whilst there were nurses on duty at all times, the inspector was not satisfied that there were appropriate numbers of staff on duty at all times, to meet the social and emotional needs of the residents”.

Moderate non-compliance was discovered in the area of health and safety and risk management. An example of this was that there was no risk assessment carried out on the two smoking rooms in the nursing home but the report noted that measures, such as a fire retardant bin, fire extinguisher and call bell, were in place.

The report noted the nursing home was compliant in relation to its statement of purpose, the fact that the centre was being managed by a suitable qualified and experienced person, there were protocols in place in relation to that person’s absence and the recording of incidents that occur in the centre. It was also found to be compliant in relation to residents’ end-of-life care. The centre was compliant in terms of the provision of food and drink at times and in quantities adequate for their needs and with regard to residents’ rights, dignity and consultation, as well as space provision for residents’ personal belongings.

The nursing home’s governance and management was deemed to be moderately non-compliant.

“Improvements were required in implementing recommendations and learnings from audits,” it stated.

The report also stated that a range of audits were available for review at the time of the inspection and that “some training needs had been identified as overdue for some staff, such as training in the management of behaviours that challenge but, at the time of the inspection, this training remained outstanding”.

“There were medication audits completed both internally and by external professionals. Issues pertaining to documentation errors post administration of medication were identified by the external professional in November 2013 and June 2014. The inspector found that these audit findings did not contribute to an improvement in the quality and safety of medication management, as similar errors continued to occur.”

The inspector found moderate non-compliance with regard to information for residents because a signed contract of care was not on file for all residents. Further moderate non-compliance occurred in relation to record-keeping. The inspector was not satisfied that sufficient records were maintained in relation to fire drills/practices taking place or that documentation relating to complaints was as robust as required by regulations.

“For instance, there was five documented complaints for 2014, however, there was evidence in residents’ forum meetings of complaints of laundry going missing following a room change and these were not documented in the complaints’ log.”

Minor non-compliance was reported in the area of complaints procedures but residents told the inspector that they would not be afraid to complain, if they had a problem.

Evidence of one member of staff’s nursing qualification was outstanding when the inspection took place.

Moderate non-compliance was also found with health and social care needs and under the heading of safe and suitable premises.

The response from Ennis Nursing Home stated it had addressed the issues in relation to health and social care needs and planned to address the premises issues before the end of March next but added that a decorative upgrade programme had already begun.