AN INSPECTION REPORT on a centre for older people in Limerick has expressed concerns about accommodation standards and quality of life for residents. 

The unannounced inspection at St Ita’s Community Hospital took place on 31 July and 1 August 2018. A total of 15 areas, such as staffing, fire precautions and infection control, were examined by the Health Quality and Information Authority (Hiqa) during the inspection. Just three areas were found to be completely compliant. 

The service at St Ita’s Community Hospital is provided by the HSE. The centre is registered for an operational capacity of 78 residents, providing respite and palliative care, as well as continuing care for long-term residents. 

At the time of the inspection, there were 70 residents registered in the centre. 

Premises issues

In its inspection report, Hiqa determined that the service provider is “failing to achieve compliance with the regulations in providing a safe and effective service for all residents living at St Ita’s Community Hospital”. 

It added that “insufficient action had been taken by management to improve circumstances around accommodation and quality of life for residents, particularly those accommodated in multi-occupancy rooms”.

Many long-term residents continued to be accommodated in multi-occupancy rooms for up to five people, and this is something which “adversely impacts on the daily quality of life, privacy and dignity of many residents”, according to the inspectors. 

These circumstances were acknowledged by both staff and management. 

In relation to quality of care, inspectors found that staff generally demonstrated a good knowledge and understanding of the needs of residents. Overall, it was noted, residents received a good standard of healthcare and were provided with access to medical resources. 

However, the inspectors noted that the multi-bedded rooms afforded limited personal space, privacy or storage for personal belongings and that arrangements in place, such as the use of privacy screens, could not effectively protect personal privacy in these circumstances. 

For example, personal storage facilities were particularly inadequate on the Camellia unit where wardrobes were narrow and personal belongings were seen stored on crowded bed-side lockers, chairs and bed-heads. 

It was also noted that access to outdoor space for residents, other than those on the Orchard unit, remained limited. On the days of inspection, no resident or visitors were seen to avail of the outside spaces that the provider had indicated were available. 

Infection control and fire safety issues

The centre was generally bright and clean throughout, according to Hiqa. However, there was evidence found of inadequate infection control procedures. 

While hand-hygiene audits were taken regularly, the report outlined that a substantial number of staff had not received current training in infection prevention and control. 

At the time of the inspection, one unit had implemented access control protocols as a result of an outbreak of a healthcare-related infection. 

It was also determined in the report that current fire-safety training had lapsed for a significant number of staff since the previous Hiqa inspection. 

Management confirmed that fire drills were not taking place outside of a training context.

A fire exit adjacent to Orchid unit was obstructed by the storage of equipment on one of day inspection, according to the report. 

However, it was noted that staffing levels were appropriate to occupancy levels and the layout of the centre. Supervision arrangements were in place that included the presence of a registered nurse at all times. 

Service users

At the beginning of the report, the inspectors noted that they had met and spoke with residents throughout the inspection in various locations of the centre, including on the wards and in communal areas. 

In general, residents said that they felt well cared for in the centre and that staff were helpful and kind, according to the inspectors. 

Visitors spoken with also commented positively on care provided at the centre, the inspectors noted, although some said they would prefer if rooms could be more private because they felt they were intruding when visiting a relative while another resident might be resting in an adjacent bed. 

Concluding the report, the inspectors said that “significant action was required on the part of the registered provider to ensure improved regulatory compliance and the provision of a safe and effective service for residents, particularly in terms of the arrangements for personal accommodation, communal facilities, training and access to meaningful recreation and activities for all residents”.