State-run Donegal nursing home criticised by Hiqa

Staffing numbers and the management of unintentional weight loss among residents at a Co Donegal nursing home have been criticised by inspectors from the State's health watchdog.

The Health Information and Quality Authority also strongly criticised the finding of heavily soiled commodes and infected laundry at the State-run Carndonagh Community Hospital.

Residents’ rooms needed effective cleaning as bedroom floors were noted to need sweeping and washing, according to an inspection report published yesterday. “There were some commodes that were heavily soiled with faeces and were in need of thorough effective washing.”

Inspectors found a quantity of soiled laundry in need of attention but this had not been addressed for several days as the member of staff responsible for laundry was on leave. “This caused a bad odour to prevail in the sluice area,” the report noted.

The hospital was found to have significant shortcomings despite repeated inspections in recent years. Inspectors concluded that staff could not adequately assess and provide appropriate care to a constantly changing group of residents. There were no dedicated cleaning staff. Staff could vary between care, cleaning and catering duties.

With care needs taking priority, inspectors found that hygiene standards were poor and significant risks arose where equipment such as commodes were heavily soiled.

The report accuses the home of a “persistent failure” to ensure the right numbers and skill mix to care for residents, as required by previous inspections.

Inspectors also expressed dissatisfaction with the monitoring of unintentional weight loss of residents, the assessment and management of cases of diabetes and epilepsy and arrangements for the admission and discharge of residents.

In one instance a resident lost 3kg in six months and was seen by a dietician but there was no information in the nursing records as to how the weight loss was to be managed. Another patient lost 8kg in less than a year but there was no plan in place to ensure further weight loss did not occur.

“Inspectors found that residents who were losing weight were not monitored systematically and some had not been weighed for some time although weight loss had been recorded. The safe management of residents who had epilepsy was also a concern as medication identified as necessary to manage an emergency situation was not prescribed in one instance and was out of date in another.”

This was the seventh inspection of the hospital, which accommodates 40 residents, including 11 with dementia. Previous inspections had revealed significant failures in relation to staffing shortfalls, an inadequate skill mix among staff and a failure to comply with training requirements.

Staff were not using an appropriate cleaning procedure or equipment to ensure the risk of infection was minimised. Other areas of concern were medication management and the standards of cleanliness and hygiene.

The report acknowledges that the hospital took some remedial action on foot of recommendations made at earlier inspections but said there was no comprehensive response that ensured all regulatory failures outline were addressed. Inspectors warned of an “escalation” of regulatory activity as a result of the persistent failure to improve staffing levels.

St Joseph’s Community Hospital, also in Co Donegal, was also criticised in a separate report from Hiqa.

It reviews the actions taken to address regulatory failures identified in previous inspections – last August, inspectors identified 31 areas of non-compliance. These included poor management of a resident’s behaviour that did not provide adequate protection for all residents, deficient risk management procedures, poor signage and standards of decoration and inadequate training for staff in elder abuse and moving and handling.

Inspectors were particularly concerned about aspects of admission and discharge activity. The majority of residents were discharged home but there were a significant number of discharges to other community hospitals and it was not evident why some residents had so many changes and were moved from the acute hospital to this community hospital and on to other community hospitals in the area.