Staff turnover concern at nursing home

CONCERN about the high turnover of staff in a Meelick nursing home has been expressed by a health watchdog.
Inspectors from the Health Information and Quality Authority (HIQA) found Ennis Road Care Facility (ERCF) was non-compliant with four standards: records, governance and management,
fire precautions, as well as training and staff development following a recent inspection.
The long-stay residential facility was compliant with standards on persons in charge, staffing, statement of purpose, notification of incidents, complaints’ procedure, visits, personal possessions, end of life, premises and food and nutrition.
Eight breaches of national health regulations were detected following a previous unannounced inspection last September.
The latest inspection report related to an unannounced risk-based inspection undertaken on February 25 to follow up on previous inspection findings in 2020, all of which had identified issues with the governance and management of the service.
This had resulted in the chief inspection reducing the number of beds registered from 84 to 45 to allow for governance and management structure to strengthen and to demonstrate sustainable governance.
While several improvements were noted on this inspection, management change and staff retention continued to be a cause of concern.
The registered provider actively recruited for the post of person in charge and at the time of inspection, there was a newly appointed assistant person in charge. One of the senior nurses was newly appointed to the role of clinical nurse manager..
HIQA found there had been a significant staff turnover in the previous 15 months, with four different persons in charge, six clinical nurse managers, three administration staff, 15 nurses and several healthcare assistants.
Since November 2020, the inspection report revealed 19 new staff had started including nurses, health care assistants (HCAs), administration, housekeeping and activities staff.
“Even though the service was no longer reliant on agency staff, and staff recruitment was actively ongoing, such a turnover of staff impacted both the governance and management and the day-to-day running of the service in areas such as knowing and understanding residents’ needs and ways, and their continuity of care.
“While inspectors acknowledged the efforts made by the registered provider to strengthen the governance and management of the service with the implementation of the board of management, the new management structure required time to become familiar with the service, and embed the changes required to ensure the service provided was safe, appropriate, consistent and effectively monitored.”
In its response to HIQA, the provider outlined newly recruited staff would be assigned and rostered to work with a senior clinical staff member in a mentorship role during their induction and probation period.
This staff member will then be responsible for signing off on their development.
Senior management will endeavour to ensure that the practices of new nursing and care staff are monitored by ensuring they form a particular focus of routine clinical audits such as medication management audits, assessment and care planning audits.
A dedicated staff member has now been assigned responsibility to ensure that all of the records required under the required standard are maintained.
Management confirmed a programme of audits is under review to ensure they are consistent and can provide information, which is comparable across the group.
Each department is responsible for conducting their own audits. Specific clinical audits will be assigned to be either the responsibility of the assistant director of nursing or the clinical nurse manager.
The centre is committed to ensuring all staff are supported and valued. The provider attributed the “small unforeseen attrition of staff” following the Covid-19 outbreak to recent HSE recruitment drives.
“All staff that left have completed an exit interview and the information is currently being collated to inform ongoing retention strategies.
“In addition, staff satisfaction surveys are conducted annually and staff are also provided with the opportunity to raise any issues with the person in charge at any time point in their employment.”
In light of the Covid-19 pandemic, the provider has created additional visitor areas, one of which was located to the left of the main entrance.
This comprised a wooden structure, which enclosed part of the window in the foyer to enable supervision of visiting without encroaching on the privacy of people’s conversations.
There was comfortable seating and a coffee table with hand sanitisers, and wipes for cleaning
surfaces following the visit in this area. Covid-19 precautions advisory signage was displayed here as well as throughout the centre. The main entrance to the centre was wheelchair accessible.
The report stated residents were heard complimenting the cosiness of the centre throughout the day. The centre was visibly clean and tidy, and no clutter was seen throughout the building. The cleaners’ room was secure and when viewed it was clean and tidy, and new storage facilities were in place since the previous inspection. Good hand hygiene practices were observed along with adherence national guidelines regarding Personal Protective Equipment usage and decontamination of equipment such as hoists.
There was a relaxed atmosphere and inspectors saw residents freely walking around the centre and activities taking place in the day room where staff facilitated bingo in the morning; a karaoke session and staff encouraged residents to partake and good fun and interaction was seen.
Residents spoken with were complimentary about the staff and in general, inspectors saw positive interactions between residents and staff.
However, one observation indicated that a staff member did not understand cognitive decline in residents and ignored a resident when they were trying to get the staff’s attention.
This was highlighted both to the staff member and the registered provider representative.
Residents said they were very grateful to the staff who worked so hard to keep them safe.

by Dan Danaher