A poor state of health

The lessons of Leas Cross have still not been learnt by nursing homes, says Juno McEnroe

NURSING homes are continuing to breach healthcare standards by having inadequate staff numbers and dilapidated buildings, and ignoring inspectors’ repeated demands, to the detriment of the elderly woman or man trying to live out the last days of their lives peacefully and with some degree of dignity.

It is now nearly eight months since the man responsible for the country’s primary care met distraught and angry relatives of former Leas Cross residents face to face at a press conference.

Aidan Browne of the Health Service Executive (HSE) tried to placate distraught sons and daughters of former patients with promises of reform, working groups and dedicated inspection teams.

“The HSE shares this regret and wishes to now assure the public that it is making every effort to ensure that such circumstances do not occur again,” the health chief said, pledging a star system would be introduced to grade nursing homes in future.

No star system has ever emerged. Furthermore, Mr Browne has since moved on to alternative pastures in the health system. His successor Laverne McGuinness was unavailable for interview last week.

A trawl through inspection reports reveals serious issues still plague the industry and addressing problems is often left to families, rather than HSE employees.

In Galway, concerns persisted in some homes.

At Rosemount Nursing Home in Gort, inspectors found a male resident was served his lunch on a bed table in his bedroom. On the same table, there was also a “waste basket with his urinal inside it”.

Patients said staff had no time to assist those needing help to walk every few hours, while one nurse spoon fed a nutritional supplement to a male patient without a napkin.

“The food dripped down onto his jumper and was left to dry in it,” said the report.

Footplates were not being used on any wheelchairs and one was in a “dangerous condition” with broken armrests, it continued.

Inspectors were also concerned about restraints used on residents.

“Resident... was sitting in a chair and was restrained by the use of a large table pushed up against his arms which were in front of his chest,” said the report. This method of restraint was “unacceptable”, concluded HSE inspectors.

A total of 18 accidents were recorded at the 40-bed home in one month, which inspectors found to be “excessive”.

A range of issues were raised by inspectors about cleanliness. Black mould growth was found on a ceiling and some sheets were dirty and stained. The inspection also found bed linen was “shabby and very creased”. Duvets, table cloths and personal clothing among items were un-ironed.

“This was unsightly and undignified for residents’ use,” the report in February noted.

Rosemount’s acting manager Donal Walsh defended conditions at the home.

He said that in the case of the waste basket on a bed table, the patient may have placed it there himself. He added that the home had complied in removing any unsafe items.

He admitted a table had been used as a restraint for an elderly man but he had been a danger to staff and residents and also could have pushed it away if he wanted.

“At the time, it was the best there that was available,” added Mr Walsh, who also said the rate of accidents had decreased at Rosemount.

During a night inspection at the Alzheimer’s Care Centre at Swords, Co Dublin, staff were found waking patients at 5.30am. The inspection took place after a number of complaints.

“Night staff [were] actively awakening and rising 22 dependent persons between 5.30am and 7.10am,” said the report, noting that some were fully clothed while others were left in their night clothes and dressing gowns.

“Many of the dependent persons in the sitting room slept in their chairs until breakfast commenced at 8.10am.”

The home was ordered to cease this practice immediately.

The chief executive at the hospital where the centre is located, Stephen Eustace, said that residents with dementia often wandered at night. However, he admitted the procedure of staff actively waking residents that early had stopped since the critical HSE report.

“Some wouldn’t know the difference between night and day,” he added.

In Kells, Co Meath, a 10-page HSE report was damning of services at Kilmainhamwood Nursing Home during a recent inspection.

There was “inadequate and insufficient care” in relation to the assessment of a person following a fall and a subsequent fractured femur.

Although the resident complained to nursing staff, she “should have been reviewed by a medical practitioner”, noted the report.

Inspectors were also highly critical of the insufficient record and care of wounds.

“Wound assessments did not refer to MRSA status, in relation to two wounds which were MRSA positive,” it added.

There was also an unacceptable standard of care for dependent people’s continence management, with one relative claiming her mother was only permitted by staff to use a commode twice a week due to the “workload required” hoisting her onto it.

An unsigned written note was openly displayed about her toiletry needs, claimed the report.

Other criticisms centred on a lack of contracts of care for patients and Christmas decorations being stored in the visitors’ room.

Inspectors were also concerned about staff using a hoist for dependent people. One resident’s leg was cut while being lifted. The report also noted that “the inadequate arrangements for the disposal of clinical waste is a recurring breach”.

Furthermore, inspectors noted nurses transcribing doctors’ orders. A nurse was seen taking medicines from labelled containers and putting them into unlabelled ones before giving them to patients. This practice of administering medicines signed in advance was deemed as “unsafe practice” by inspectors.

Kilmainhamwood’s manager Marie Helene Finegan defended the facility’s conditions. “Any issues that were brought up in [the report] were dealt with immediately and resolved,” she said.

Ms Finegan said the female patient who had only used the commode twice a week did so for medical reasons. She also said concerns that rodent bait was being used in bedrooms were resolved, as it was now placed outside.

Methods of dealing with medicines have also changed at the Co Meath facility.

In another home, the Care Choice Montenotte Centre in Montenotte, Cork, the standard of wound care was a concern at a third consecutive inspection.

“The constant lack of correct dressing techniques shows [a] lack of informed assessment and expertise,” concluded the most recent inspection of the home carried out between November and January.

Three patients had very long toenails and were in need of foot care; a litany of dirt problems were discovered, including a wheelchair seat encrusted with food debris and floors in unhygienic states; some residents could not watch television in rooms due to their positioning; stale smells and smells of urine were also found in a few rooms; in one bathroom a soiled incontinence pad was stored in an open bin.

There were 103 patients in the home during inspections.

The home’s financial manager Helen O’Regan defended its conditions but admitted some practices were changed since the critical report.

Issues raised about wound care were not acceptable, she said, but stressed they had related to two very complex cases at the time.

She defended the home’s “very thorough” cleaning regime and said one resident had also voluntarily taken off their incontinence pad. On the issue of viewing television, she said some patients had no interest.

In the Olde School Nursing Home in Skibbereen, Co Cork, there was concern over the lack of a sluice room as soiled sheets were being soaked in a sink. Commodes were beginning to rust when seen in May and some were being used not only as a toilet but as a seat when showering patients and “this could lead to spread of infection”, warned a report.

The home was given a guide on minimising the chances of Legionnaires disease occurring as a shower head was found to have scale on it. The stove in the dining room had no cover on it and water was too hot at 54C, running the risk of scalding patients.

When an inspection team visited Rochestown Nursing Home, in Monastery Road, Cork, in March they found the nurse in charge only had two years’ experience as opposed to the three years required under legislation.

There were “insufficient recreational” activities for residents and storage space for their personal possessions was “very limited”.

There were also hygiene concerns and furniture was in disrepair, while an insufficient number of carers worked during the night. Owner Brenda O’Brien said a new head nurse was now working at the home. She defended activities for residents, saying: “I have music, I have bingo, they have a hairdresser every week, they have chiropody and that has always been the case.”

She added: “This is all false. It is all repaired since then, everything that they have asked to do is done since they came out.”

In Cavan, at Fairlawns Nursing Home, Baileboro, an inspection last December found a list of breaches including medication given to patients without a doctor’s instruction.

A rusty commode was also being used as a toilet, toilet roll holders were absent in the majority of rooms, while soap dispensers were up too high for patients, the inspection found.

The home’s manager Bride Cahill claimed all medications had been sanctioned but “bulk signed” by doctors rather than individually.

She admitted this was against HSE regulations. She said a commode was old but not rusty and it was important that soap dispensers were high up enough for staff, to reduce infection. She said she had taken issue with nearly all 16 concerns raised by the HSE inspectors.

The resources being pumped into inspection teams were “ridiculous” and a “waste of money”, she contended. “How much of the taxpayers’ money have they spent on training these people to go out to nursing homes to do such nitpicking as they have done,” said the Cavan facility’s manager.

In Mayo, an inspection at Ballinamore Nursing and Convalescent Home in Kiltimagh last September found hot water in sinks at 64C , well in excess of the standard 43C temperature, posing a serious risk of scalding.

An electrical cable was also found joined with a connector, covered in tape and draped down a hallway and over a door handle. The home’s owner Hugh O’Boyle said the HSE breaches had since been rectified.

Concerns at other nursing homes during recent inspections included:

In Ashborough Lodge Nursing Home, Milltown, Kerry, a very slight woman with a poor appetite had no weight check recorded in more than three months.

During a visit to the Suncroft Lodge Nursing Home, Co Kildare, radiators were found to be dangerously hot and had resulted in a resident burning their arm.

At the Catherine McAuley Nursing Home on Dominic Street, Limerick, inspectors said the last recorded fire drill took place in 2004.

In Woodlands Nursing Home, Navan, Co Meath, foreign staff were speaking in their native tongue while feeding patients. Care staff also failed to communicate with residents during other activities.