Hiqa raises concerns about non-compliance in disability centres

The Health Information and Quality Authority has raised concerns about non-compliance in multiple disability centres. Picture: Sasko Lazarov/Photocall Ireland

The Health Information and Quality Authority (Hiqa) has raised concerns about non-compliance in multiple disability centres.

Three disability centres, in particular, had non-compliance in relation to the care of residents.

Issues in a centre in Clare included the suspension of family visits during level 5 lockdown, which negatively affected residents, as well as problems with the building itself. 

The cancellation of day services also negatively affected residents in one centre in Sligo, and Hiqa claimed "little effort" had been made to come up with activities to keep residents occupied throughout the day.

One centre, Inis Grove Adult Residential Service in Co Clare, was found to be non-compliant with five regulations.

The centre provides a full-time residential service for up to three adults, and was inspected on November 30. 

This centre was also inspected in January 2020 and Hiqa found incidents of non-compliance which needed to be addressed. 

However, Hiqa determined that following the November inspection, not enough progress had been made.

Part of the plan for improving the centre was to relocate to another location, but this had been hindered by the Covid pandemic. 

While the inspector noted some improvements, overall they said the inspection findings "did not provide assurance of governance systems that ensured effective management and oversight so that residents received an individualised, safe, high-quality service".

Issues included internal reviews highlighting a significant number of recorded behaviour-related incidents, but no pattern or trigger was identified. 

The inspector said this was of serious concern as the behaviour of one resident then triggered another resident to engage in self-harming behaviours.

Hiqa was also critical of the centre suspending family visits in response to level 5 Covid restrictions. "Residents suffered distress exhibited as behaviour of risk and harm as a consequence of suspended visits.

"When visits had been allowed, this had a positive impact on resident emotional and psychological well-being with reduced incidence of behaviours."

It was evident that residents struggled to understand and cope with this loss of family contact.

The inspector also noted that while some repairs and refurbishments had been completed, overall the premises "present[s] poorly and ultimately are not suited to the assessed needs and associated risks of the residents."

Harmony, based in Sligo, is a residential and shared care house for up to six adults.

The centre overall was broadly compliant and had done well in the inspection, but the inspector noted that the centre was not compliant with supporting residents' general welfare and development.

"The provider had not ensured that suitable arrangements were in place to involve residents in meaningful activities in the centre during times when day service was not available due to current restrictions ... the inspector could see that ... little effort had been made to support residents with interesting things to do during the day."

The inspector claimed that residents spent most of the day of inspection sitting in the centre with "nothing to do", and had limited interaction from staff. 

The inspector also reviewed activity plans and records, which indicated to them that there was no structured activity plan for residents. 

"There was a limited record of individualised activities to suit each person's assessed preferences."

The records kept were vague and were lacking in details of what residents had been supported to enjoy.

A Muiriosa Foundation centre based in Mullingar, which can cater to eight residents, was also broadly compliant, but some issues were identified by Hiqa.

While Hiqa commended the centre and staff for its serious efforts in resolving ongoing issues, the inspector was not assured that "the current living environment and the diverse needs of all of the residents were being met within the centre". 

The inspector noted that there was evidence from clinicians that the shared living arrangement may be exacerbating a deteriorating situation for one resident, albeit inadvertently.

"It is acknowledged that there are multiple factors involved and efforts have been made to alleviate the situation. 

"However, there was evidence from incident reports that very disruptive incidents occurred with some frequency, which disrupted residents' sleep at night.

"On occasion, the residents were taken from their home for periods of time, to allow incidents to be managed." 

Two physical assaults had also taken place, primarily as a result of this incompatibility of need and disturbance.

The inspector noted that these incidents have been occurring for a significant period of time. 

In 2019, a business case was submitted to the funding agency in relation to a change of living environment, but this had not yet progressed.

Other reports published by Hiqa today showed non-compliance in other disability centres, but mainly in relation to governance, management, record keeping and fire safety.