MAJOR PATIENT SAFETY concerns have been raised in a series of critical Hiqa reports into large HSE-run disability centres in Cork, Kilkenny and Donegal.
In unannounced inspections in May and June of this year Hiqa inspectors at St Raphael’s in Cork found that one resident was not provided with adequate food and nutrition for over 18 hours.
Staff told Hiqa inspectors that this was due to a lack of staff available at that time to assist the resident out of bed.
The person in charge at the facility outlined that she did not have a copy of the night duty roster – despite requesting it on several occasions since she starting her role in February of this year.
The report also outlines how one resident’s healthcare record had a care plan relating to dementia, despite the resident’s healthcare file containing no definitive diagnosis of dementia.
Based in Youghal in east Cork, the St Raphael’s campus was banned from admitting new residents by a court last year, after adverse findings by Hiqa. It is due to close next year.
Abuse
Since its last inspection, Hiqa was also in receipt of unsolicited information in relation to abuse allegations at the facility.
For one resident, there were 15 recorded incidents last October and November where the resident was noted as alleging that someone “had hit me”.
The report noted:
Staff did explain that this was part of this resident’s behavioural support requirements.However, other than recording when the resident said someone “hit me” there was no evidence of “screening” of these specific allegations of abuse to establish if an abusive act could have occurred and if there were reasonable grounds for concern.
Seven staff had not received training in protecting vulnerable adults, the report added.
HIQA was notified in April 2016 that four residents had lapbelts in place as a restraint, while some residents were also observed spending long periods of the day not engaged in any meaningful activities.
Inspectors also observed unsafe practices involving the administration of medicines.
On the second day of the inspection, inspectors as an antimicrobial medicine due to be administered at 8am had not yet been administered by 10.30am.
The report said:
Due to the potentially catastrophic and fatal impact of delayed administration of antimicrobials and the misadministration of ‘rescue’ medicines in the management of epileptic seizures on the vulnerable residents living in this centre, the inspector deemed this to be at a level of major non-compliance.
In March an announced inspection took place at Ard Greine in Donegal where HIQA found seven major non-compliant issues.
This inspection said there significant risks to the safety and welfare of residents in the centre, which was formerly the Sean O’Hare Unit, established in 2008.
Hiqa consequently postponed its registration inspection, and a specific safeguarding and risk management inspection was carried out instead.
In one instance, a resident who reported an allegation of abuse was not believed by staff.
In January of this year, meanwhile, two female residents had been physically assaulted by a male resident at the facility, while they were being transported in the car.
Chemical restraint
A number of staff informed inspectors that they were seen as “troublemakers” when they raised safeguarding concerns with the person in charge. The report added:
In particular, inspectors were deeply concerned by the categorical denial of the person in charge and another person participating in the management of the centre that there had been any allegations, incidents or suspicions of abuse, something which was clearly not the case.
Chemical restraint was frequently used in this centre. In one case chemical restraint had been administered to one resident 44 times in a two-month period.
One resident, meanwhile, had fallen 11 times from May to December 2015, the report said. It added:
Inspectors did not have confidence in the fitness of the person in charge to manage the centre.
In a follow-up inspection in May, Hiqa found staff at Ard Greine remained unclear as to what constituted abuse, and the procedure to be followed.
‘Unacceptable practices’
In a statement, Finian McGrath, Minister of State for Disabilities said: “The reports of HIQA inspection visits can often make for distressing reading and my first thoughts are always for the residents and their families.
“It’s vitally important that these unacceptable practices are being brought into the light and residential centres are being compelled to improve their standards or face losing their registration. While there is much to be done, these reports are a sign that the system of regulation is working.
He added: “It is also worth noting that HIQA finds many examples of excellent practice in the centres for people with disabilities that it inspects – five of the reports published today found centres with a high level of compliance with the regulatory requirements, providing a good standard of support and care to residents.
“The majority of the issues identified in today’s reports took place in large congregated settings. I completely agree that smaller, community based centres are a better option for people with disabilities.”
Currently, around 2725 people live in congregated settings.
McGrath said the government’s objective was to reduce that figure by a third by 2021.
He said capital funding of €20 million from the Department of Health is being made available to the HSE in 2016 to move people out of congregated settings.
In a statement this evening, the HSE said that it welcomed today’s reports.
It said it welcomes the positive findings in a number of the centres and added it will ensure the learnings and good practice from these inspections are shared.
The HSE also acknowledged that in four particular centres there were areas of significant non compliance in the reports published today.
The HSE wishes to reassure residents and their families that a comprehensive programme of work is underway to address these issues as quickly as possible. The HSE has an agreed action plan with HIQA for each centre to address the areas of non compliance identified in today’s report. Many of the issues identified have been addressed and other actions are currently being implemented.
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