At-risk home residents left unsupervised due to staff's kitchen duties

Residents at risk of falls in a nursing home were left unsupervised in communal rooms because staff said they were also required to prepare meals in the kitchen.

The finding by the Health Information and Quality Authority (Hiqa) is included in a critical report into the Cahercalla Community Hospital and Hospice, located on the outskirts of the town of Ennis in Co Clare.

The facility was found to have a range of problems, including a "high un-witnessed fall rates", poor oversight of assessment and care planning and poor supervision of staff.

According to the Hiqa report: "Inspectors observed that residents with complex mobility needs were left unsupervised in communal rooms.

"On two occasions, inspectors observed unsupervised residents in the communal areas, who were assessed as being at high risk of falling, attempting to mobilise independently.

"Care staff explained that they were not available to supervise residents as they were also required to attend to kitchen duties such as dining room service and tray preparation for meals, which resulted in less time to deliver direct care."

The centre, run by Cahercalla Community Hospital Company Limited, had 100 residents at the time of the inspection.

Many were happy and complimented staff, but some referred to restrictions due to Covid-19 and said they were bored.

"Residents were observed to spend long periods of time in bed and unsupervised in the day rooms," the report said. 

Residents told inspectors that there was not much to do during the day and that they didn't know what activities were happening.

Access to a garden was restricted by a locked door and inspectors also followed up on unsolicited information received by the Chief inspector regarding concerns in relation to residents' rights and the management of complaints. 

"On review, inspectors found the concerns outlined to be substantiated," it said.

Areas of non-compliance with standards included governance and management, and assessment and care planning, while clinical oversight of care in the centre was poor and staffing was inadequate to meet the needs of the residents.

The centre was issued with a compliance plan, as was another centre, the Ennis Road Care Facility, run by Beech Lodge Care Facility Limited, on the outskirts of Limerick.

Its 44 residents appeared happy and relaxed, but Hiqa found some issues, such as a member of staff not putting on the required PPE when they were about to enter a resident's bedroom in the isolation wing.

Inadequate staffing levels

Hiqa said the provider could not independently staff the centre with the numbers required to care for the current occupancy of 44 residents.

The centre didn't have a strategy to determine the numbers of staff required if it was to admit the total number (84) of residents that it was currently registered to accommodate.

Some en suite facilities were not clean and there were gaps in administration records, so Hiqa could not be assured that residents received medication in accordance with their prescription.

An inspection of Cherryfield Housing with Care, run by Fold Housing Association Ireland in Hartstown, Dublin 15, found there had been a security breach in June 2020 and the office of the Chief Inspector was not notified of the incident.

Inspectors were informed that this incident had been referred to the gardaí but "there was no report or evidence made available to inspectors to review which would have provided assurances that this incident was subject to an internal investigation to determine how the security breach occurred".