Nursing home still in breach after four 2020 inspections

Eight issues outstanding at Meelick facility says HIQA which also visited in February, May and July

EIGHT breaches of national health regulations were detected in a Meelick nursing home following an unannounced inspection last September, according to the findings of a new report.
Inspectors from the Health Information and Quality Authority (HIQA) found Ennis Road Care Facility (ERCF) was non-compliant with changes to information supplied for registration purposes, persons in charge, staffing, governance and management, statement of purpose, infection control, fire precautions and residents’ rights.
The inspectors acknowledged the efforts made by the registered provider to strengthen the governance and management of the centre including the recruitment and appointment of a nurse management team and 33 new staff.
This was an unannounced risk-based inspection undertaken to follow up on the “poor inspection findings” in February, May and July 2020, all of which had identified issues with the governance and management of the service.
Following the last inspection in July 2020, the provider advised the Chief Inspector that they planned to establish a new board of directors to enhance the governance structure of the company.
However, at the time of this inspection, this enhanced structure was not in place.
In order to ensure better oversight of the service, weekly meetings were convened in the centre where the registered provider representative, person in charge and the clinical nurse manager two discussed set agenda items relating to clinical, non-clinical, staffing and complaints.
The person in charge submitted a report to the registered provider representative each Monday evening and these were then discussed at the weekly meeting on Tuesday mornings with actions agreed and issues followed up on subsequent meetings.
This was an improvement from the findings of the previous inspection.
The provider had recruited a new employee to fill the role of person in charge, and this employee had commenced employment in the centre on 10 August 10, 2020.
Previously, it was identified that the service was under-resourced in the context of staff directly employed by the centre to ensure the safe, consistent and appropriate care of residents.
During the inspection July 2020, the provider had committed to submitting a proposed staff strategy for the nursing home to reflect the staffing requirements for 45 and 84 residents, however, this had not been submitted.
Despite several requests for this strategy during the course of the inspection the inspectors were not furnished with this document.
On this inspection, inspectors found that additional staff were recruited and the service was no longer reliant on the Health Services Executive (HSE) to staff the centre.
However, it was a concern that 20% of the nursing staff working in the centre were agency staff and not employed by the centre.
The staff complement for health care assistants was adequate for the current residents. A clinical nurse manager one was recruited and was due to take up post in September. An administration staff was responsible for the overhaul of the systems for creating, storing and accessing records; she now had an assigned room with storage and had made progress in the maintenance programme for records to be in line with regulatory requirements.
In an urgent compliance plan submitted following the May inspection the provider reported that an independent external company would undertake monthly infection control audits generating an action plan for the centre to follow, however, to date, this had not happened. New cleaning templates and regimes were introduced by the previous person in charge, for areas such as cleaning, deep cleaning and curtains as part of quality infection control practice and audit.
Residents spoken with gave positive feedback to inspectors and reported improvements in life in the centre.
They confirmed that they were aware of the complaints procedure and said they would express any dissatisfaction or concerns they had to the person in charge.
The inspector observed that the activities programme facilitated in the garden day room was fun and energising and residents were encouraged in a respectful way to participate.
The activities person actively engaged with residents in a social and fun manner.
While it was reported to the inspectors that the activities co-ordinator facilitated one-to-one activation with residents in their bedrooms from 9:15 to 10am, there was no other activation observed throughout the remainder of the day for residents in their bedrooms.
Meals were pleasantly presented and residents gave positive feedback regarding their food and mealtime experiences and reported there was an improvement in their dining experience.
Menus were displayed on a large white notice board on entering the dining room.
In its response, the centre outlined the registered provider representative is the person in charge since September 28, 2020.
All required documentation and forms have now been submitted to HIQA as required.
The centre currently has a sufficient number of staff to cater for the amended registration capacity of 45.
Ongoing recruitment program continues for the positions that need to be addressed and to build capacity to cater for increased occupancy into the future.
A new strategy for weekly and monthly audits for all nursing and senior nursing staff is now in place .
The statement of purpose has been updated to include all details that were not present in the previous version and this was submitted to HIQA on September 11, 2020.
Infection prevention and control weekly and daily audit had been continued by staff nurses and senior nurses.
The clinical nurse manager is completing detailed infection prevention and control audits monthly. Ongoing staff training in infection prevention and control continued.
The cleaners’ room is now tidy and extra measures were put in place re same. All staff have been retrained in all aspects of infection control.
Emergency floor plans have been updated in all bedrooms and audited by management.
One activity coordinator, who had completed recreation course and proven to be highly enthusiastic and innovative, was employed full time at the centre on the day of inspection.
Another full time activity coordinator has been employed and was awaiting garda vetting.

By Dan Danaher