Enable Ireland facility is not person centred

A Cork centre for people with severe disabilities has undergone an architectural review after inspectors criticised the layout which prevents residents from accessing the garden, and in some cases, the dining table.

The criticism of the design of the Enable Ireland premises was among a number of significant concerns highlighted by inspectors from the Health Information and Quality Authority (Hiqa) following a visit to the centre in February.

Additional areas of concern included:

- No evidence that an assessment of need was carried out prior to the residents’ admission to the centre.

- Documentation regarding residents’ personal care planning did not adequately capture or describe their healthcare needs, including residents assessed as having a maximum dependency with co-existing complex medical needs.

- No evidence that residents’ care plans were formally reviewed and in consultation with the resident.

- Residents on whom restraint was used (bed-rails, chair belts for upper and lower body) had not been assessed for their use. There was no evidence of consent for the use of restraint.

In relation to the layout — while inspectors described it as “homely and warm”, they said it required review to ensure it was “fit for purpose”.

Inspectors said residents were restricted in their movements and to accessing areas due to the poor design. “Corridor widths could not accommodate two residents accommodated in a high-dependency ambulatory chair passing one another, or a resident and a staff member passing one another,” Hiqa said. A ceiling hoist was not operational.

The design and layout of the kitchen meant residents in high-dependency chairs could not access the dining table.

There was no room available for residents to meet with visitors in private.

Hiqa also found no evidence that senior management regularly visited the centre and no evidence of effective arrangements to support, develop and performance manage the workforce. The health watchdog said it was “evident that the centre’s routines and activities were resource led and not person centred”.

In its response, Enable Ireland said it would ensure that individual written service contracts, in a format accessible to residents, would be agreed and signed off with current and future residents or their advocates. They said the contract would reference individual care plans.

Enable Ireland also said staff receive training to implement person-centred models of service; that bi-annual review and planning meetings are held with each service user and that residents receive comprehensive services across two locations (residential service and day service) according to their needs and wishes. In relation to use of restrictive procedures, it said they were not used but that some of the residents require “postural management supports”.

In relation to management, Enable Ireland said the director of service for the region had held the role of “person in charge” owing to the long term absence of the adult services manager on sick leave, but that they were recruiting for a replacement.

In 2012, three staff members left the organisation through voluntary redundancy and these have not yet been replaced.