Elderly residents left restrained and unsupervised in chairs

NURSING home staff restrained elderly residents in their chairs because they considered them vulnerable to falls – yet staff still left them unsupervised.

This situation was highlighted in a recent report by inspectors from the Health Information and Quality Authority (HIQA).

They also noted there was no documentary evidence in care records to show that restraint was in the best interests of residents at the Queen of Peace nursing home, near Knock Shrine, in Co Mayo.

The home, which provides care for up to 37 residents who have physical problems associated with aging and dementia, was “in good decorative condition and was clean and generally well organised” but inspectors said there was “little evidence that recreational and social opportunities were available to residents”.

“A large number of residents interviewed stated that the only activity available was that provided by an occupational therapist who came once a week for one and a half hours,” inspectors said.

Inspectors also witnessed that most residents “sat along the walls of the main sitting room and had few opportunities to interact with staff except when receiving personal care”.

On the day of inspection, eight out of 26 residents with cognitive impairment did not have access to specialist skilled interventions or recreational activities appropriate to their needs.

On a positive note, residents said they were satisfied with how they were cared for and two residents described very positively how their health and wellbeing had improved since admission.

They also spoke positively about their quality of life and said staff were always kind and respectful to them.

However, inspectors were concerned that residents did not have lifestyles that promoted their independence or maintained their abilities.

In relation to vulnerable residents who required the support of specialist restraint chairs to protect them from falls, inspectors said “The high levels of frailty of these residents had not been matched by appropriate staff input and residents’ who were confused or had dementia were left in day rooms for prolonged periods without supervision.”

Inspectors also said the assessment process for the use of restraint was inadequate.

The care plans examined did not show that all aspects of the care needs of residents were being regularly assessed and reviewed. There was no information to indicate that residents were consulted about their care or that their views were taken into account.

The last entry on a weight chart scheduled to be completed monthly was dated January 2009.

Confirmation of garda vetting was not available in the two staff files sampled.

The provider said that this was due to a delay as the member of staff had worked abroad.

In their response to the inspection findings, the service providers said they were reassessing the use of restraints. They said staff had been reminded that where vulnerable residents were seated, they must be supervised at all times and never left unattended.

A commitment was also given to ensure care plans are completed and updated every three months and residents consulted where possible. In addition the providers said they aimed to increase the provision of recreational activities.

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