HIQA Closes Cashel Nursing Home

A NURSING Home in Cashel had to be closed in May following the cancellation of its registration by the Health Information and Quality Authority (HIQA). Hiqa inspectors found that St Anne’s Nursing Home on John Street had some residents covered in blankets due to the cold, while other residents had lost weight which was not properly recorded.

A NURSING Home in Cashel had to be closed in May following the cancellation of its registration by the Health Information and Quality Authority (HIQA). Hiqa inspectors found that St Anne’s Nursing Home on John Street had some residents covered in blankets due to the cold, while other residents had lost weight which was not properly recorded.

The fifth inspection of the Home found that there had been some improvements on previous inspections, but “insufficient progress” had been made in key areas. “The overall design and layout of the premises is not suitable for its stated purpose and does not meet the individual and collective needs of the residents in a manner that is comfortable and maximises their wellbeing, privacy and dignity, ability to exercise independence and freedom of choice,” states the Inspector.

“The absence of strong clinical leadership, robust management systems and a culture and process of ongoing review and continuous improvement continued to impact on the findings and the continuity, quality and safety of the services and care provided to residents.” The registered provider was Margaret Ryan. The Person in Charge was Aderonke Agboji.

“While the inspector is satisfied that the person in charge is committed to meeting legislative and best practice requirements ultimately the absence of adequate support, clinical competency of all staff employed, appropriate systems of supervision and review, the physical environment and sound clinical mentorship militate against the achievement of desired clinical outcomes,” adds the report.

Some progress had been made on five grounds: suitable and sufficient staffing and skill-mix; health promotion; residents’ freedom to exercise choice; risk management; medication management.

However, further improvement in these areas was required and further serious issues arose during the inspection in relation to the provision of suitable and sufficient heating for residents, fire safety management systems and mandatory staff training requirements.”

There were some improvements. The inspectors noted that staffing levels were increased and based on the rosters reviewed were consistently maintained; some remedial environmental improvements had been undertaken and a process of risk assessment and management had commenced. New bed linen had been purchased and residents’ beds and wardrobes were clean and ordered.

However, serious other concerns remained: “There was no fire/smoke detection in the laundry which is not linked to the fire alarm system. Two oil tanks and three gas cylinders were in close proximity to the laundry”; “suitable and sufficient heating was not provided. On entering the designated centre at 10:50hrs on the first morning of inspection the inspectors found the environment to be cold; radiators were cold to the touch. Four residents seated in the communal room were each covered with a blanket.

“The provider told the inspector that the main timer was not in use and that the heating had to be manually put on by staff when they felt it was required and turned off when they felt that the environment was sufficiently heated.” Additionally, when the heating was put on there was no means of safely controlling the temperature of the radiators. One resident who observed the inspector to touch a radiator in the main communal room told the inspector “that is never on”.

Other than those staff undertaking further education there was no evidence to support that mandatory manual handling training requirements for staff had been adhered to. Records were not maintained in a manner so as to ensure completeness. The stability of residents’ weights was not monitored. The inspectors noted two residents with recent significant weight loss and no reference to the weight loss in the nursing narrative record. The inspectors were not satisfied that there was a proactive approach to the management of continence and elimination. “Inspectors were not satisfied that care plans and care were supported by a high standard of evidence-based nursing knowledge, accurately reflected the residents’ needs and thereby ensured that residents were provided with suitable and sufficient care at all times.”

St Anne’s responded to the inspection: “We thank you for your observations during the inspection and we have taken your views on board. We have rectified the items that we can do straight away but we have to wait for the planning application to be approved before we can do the outstanding items. This is going to take time which you will have to take on board. Anything that we can do to implement we will do to the best of our ability.” Full report at Hiqa.ie