Nursing home failed to identify ‘unknown bruising’ on residents, Hiqa finds

Residents at a nursing home in Co Sligo were found to have “unknown bruising” that the nursing home “failed to identify”, a report by the Health Information and Quality Authority (Hiqa) found.

The oversight arrangements in place for the review of the accidents at the HSE-run St John’s Community Hospital in Co Sligo “failed to identify the increased occurrence of unknown bruising and peer-to-peer incidents in the centre”.

“As a result, the provider’s systems failed to identify the level of clinical risk associated with the incident and the interventions that were required to reduce the level of risk in the centre,” the report found.

Records also indicated a number of residents often had “peer to peer incidents in which residents became aggressive with each other” in which staff were required to intervene and de-escalate the situation to ensure the resident’s safety.

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In a statement on Thursday, the HSE said there was “no way to prevent people from experiencing minor bruises and scratches”.

It said a medical officer would continue to review any incidents or accidents in the centre, with all instances of bruising to be reported on a HSE national incident management system.

The HSE said a review of all peer-on-peer incidents had been completed, which found some information on incident forms “lacked the necessary depth of information required”.

The statement added its risk management policy had been updated to include a focus on any “unexplained bruising” on residents.

In another nursing home, in Co Meath, most of the residents “did not have opportunities to engage in meaningful social activities”.

During the Hiqa inspection of St Ursula’s in Co Meath, one resident discussed staffing levels with inspectors and felt there had been a lot of changes in staff personnel. Sometimes “you only got to know the new staff, and they were gone”, the resident said.

The resident said they “knew that staff on duty were so busy with other sicker residents and understood that they had to wait to get attention”.

Some residents with dysphagia (swallowing difficulties) and high-dependency needs who required assistance with eating and drinking were “not appropriately supervised at meal times and that staff practices did not ensure a high-quality, safe mealtime experience”, Hiqa found.

For example, the food was served cold and in a form that was not reflecting residents’ prescribed “modified” diet. Residents were observed not to sit upright, which increased the risk of aspiration and choking, according to the Hiqa report.

Inspectors also observed that residents did not have access to a safe supply of fresh drinking water at all times on the first day of the inspection.

Issues relating to staff shortages were evident in several other reports published by Hiqa.

At St Ursula’s nursing home, inspectors were “not assured that the existing fire safety arrangements at the time of inspection adequately protected residents from the risk of fire in the centre or their safe and effective evacuation in the event of a fire”.

For example, there were inappropriately stored items that were obstructing evacuation routes as inspectors observed a hoist charging at the bottom of the stairs to the staff area, inspectors found.

Inspections of the 50 centres were carried out between December 2022 and March 2023.

Of the 50 reports published, inspectors found evidence of good practice and compliance with the regulations and standards in a number of inspections.

Hiqa found that 23 centres were either fully compliant or substantially compliant with the national standards and regulations. In general, these centres were found to be meeting residents’ needs and delivering care in line with the national standards and regulations.

Levels of noncompliance varied in the remaining inspection reports, with 18 centres non-compliant with three regulations or less, and nine centres non-compliant with four or more regulations.

On these inspections, noncompliance was identified in areas including governance and management, contract for the provision of services, premises, infection control, fire precautions, residents’ rights, food and nutrition, records, training and staff development.

Where noncompliance with the regulations was identified, providers were required to submit compliance plans to demonstrate how they will make improvements and come into compliance with the regulations.