A centre for children with intellectual disabilities was found to be “dirty and poorly maintained” during an inspection by the Health Information and Quality Authority (HIQA) last November.
Inspectors observed that ceilings were dirty with patches of dried food, mould and faecal matter identified as being a result of incontinence wear being thrown.
A report on the facility, based in the northeast of the country, stated that corners, ceilings and window spaces were “heavy with cobwebs and spiders”, including over a child’s bed.
Bedrooms were limited in furnishing and decoration due to identified risks related to property damage.
There was also limited use of pictorial signage for children who required support with their communication needs.
Furniture items in living rooms were damaged with torn upholstery, broken legs and cracked tabletops.
The fabric of some of the furniture used by the children was observed to be dirty, with the furniture made of a material that could not be effectively cleaned.
Inspectors also observed “hardware solutions” to prevent damage – such as building a timber frame in a child’s bedroom to stop the door from hitting the wall and a bed frame that was screwed into the floor.
HIQA requested information from management on whether it had explored the use of toughened furniture that would resist damage and be easier to sanitise, while still being home-like and suitable for children, and found that it had not.
The report outlined how various deficits were observed in the provider’s oversight of the centre, resulting in it “failing to identify important aspects of the quality and safety of resident support and implementing control measures and quality improvement actions in a timely fashion”.
Heavy reliance on agency staff – HIQA
At the time of the inspection, the provider was “heavily reliant” on the use of agency personnel to meet basic minimum staffing requirements for the three children living in the centre, with over 200 shifts in a space of two months covered by contingency arrangements.
“This was not optimal to ensuring an effective continuity of staff support for the children and assurance that care delivery was consistent,” according to the report.
When it came to quality and safety, the inspection found the condition of the premises throughout was “a serious concern”, with out-of-date or rotten food in fridges.
There was no running water in some bathrooms. However, the provider confirmed by email the morning after the inspection that a plumber had resolved the issue.
The report stated that many areas of the centre were dirty with brown staining, mould, mildew, and heavy dust and cobwebs.
Cleaning lists identified that these areas were subject to daily or weekly cleaning, up to and including the day of inspection.
Infection control practices were also poor regarding management of cleaning tools, handling of clean and soiled items, and hand hygiene practices by staff.
Seven mop buckets were stored outside the house next to a sign that stated: “Do not leave mops and buckets outside”.
They were dirty, with garden debris and moss, and a full bin bag on top of these and various other items for disposal stored in the same space.
The inspectors also observed “completely ineffective fire safety systems in place”, from assessments to appropriate fire containment.
Urgent actions were issued to the provider on fire safety arrangements and infection control standards.
Following the inspection, the service, centre and deputy centre managers identified “urgent works” that were carried out, with a plan for them to be reviewed fortnightly.
However, the Chief Inspector of Social Services issued a notice of a proposed decision to cancel the registration of the facility due to “significant concerns” over the quality and safety of care provided for residents.
Subsequent inspection found non-compliance issues
In March of this year, HIQA conducted a follow-up inspection.
Overall, it found that improvements had been made since November and staff were observed to “interact and support the young people in a caring, person-centred and dignified manner all times”.
However, issues of non-compliance remained with a number of key regulations.
It stated that – taking into account the continued level of non-compliance and the complex needs of the young people living in the service – the chief inspector had made the decision to reduce the number of registered beds from five to three until the issues had been adequately addressed.
The inspector also reserved judgement on the proposed decision to cancel the registration and afford the provider more time to bring the facility into compliance.
The provider remains subject to regulatory oversight by HIQA.
Two dozen reports published by HIQA
In total, 24 inspection reports have been published by the health watchdog.
Residents at another centre – operated by a different provider – were “impacted negatively” by ongoing safeguarding incidents, resulting in a meeting with the chief inspector.
While improvements had been made by the time the inspection took place, HIQA found that residents had not been protected from all forms of abuse.
In response, the provider looked at alternative service and accommodation options for them.
Immediate actions were also issued to another provider regarding poor governance and oversight of a centre, and risks around fire containment and evacuation of residents.
In response, the provider appointed a person in charge to provide oversight of the facility and to ensure staff participated in fire safety drills.
Inspectors found good practice in many of the centres including one in the east, where surveys completed by family members praised staff and how the autonomy and independence of residents was promoted.