Offaly nursing home found to be non-compliant in governance and management
A previous inspection found that an incident of suspected resident abuse had not been reported within three days
AN unannounced inspection by HIQA of Esker Ri nursing home outside of Clara, found the facility to be non-compliant in governance and management and also record keeping.
The inspection took place on December 7 2023, and was published this month on February 27.
A previous inspection by HIQA in August 2023 found the nursing home to be non-compliant in 7 areas. On that occasion inspectors found that the provider Blackden Limited had failed to notify the Chief Inspector of incidents occurring in the centre. Notification had not been submitted within three working days of an incident of suspected abuse of a resident.
The nursing home which is located at Kilnabin, in Clara provides accommodation for a maximum of 143 male and female residents over the age of 18. Resident's bedrooms are over three floors and include single and twin bedrooms with full en-suite facilities.
The number of residents present on the day of inspection in December was 126. On the same day the centre was experiencing an outbreak of Covid-19 and a number of the residents were being cared for in a dedicated isolation area that was separately staffed.
Inspectors found that the provider had taken ''some action with regard to their governance and oversight of the service, and the implementation of systems to support the safeguarding and protection of residents.''
However, they also found that a poorly defined organisational structure resulted in unclear roles and responsibilities of the management team. This impacted on establishing, implementing and maintaining effective management systems that included the oversight and management of risk, the management of adverse incidents involving residents, complaints, and records management.
A review of the records at the facility found that the management of records was not in line with the regulatory requirements. For example, staff personnel files did not contain all the necessary information required by the regulations.
Two staff files did not contain a full employment history, together with a satisfactory history of any gaps in employment. Records of staff rosters were not maintained in line with the requirements and did not reflect the roster that was actually worked by staff.
In addition, roles were not accurately described within the roster. For example, the assistant director of nursing was identified in the roster as a clinical nurse manager.
The hours worked by the regional manager in the centre were not recorded on the staff roster. This meant that the organisational support for the person in charge was not clearly evidenced. Some records were not maintained in a manner that was accessible.
Training and staff development - Staff were not appropriately supervised to carry out their duties to protect and promote the care and welfare of all residents. This resulted in poor fire safety awareness as evidenced by fire doors wedged open and poor supervision of staff to ensure that policies and procedures were in place to manage complaints.
Governance and management -The provider had failed to ensure that there were sufficient staffing resources in place to consistently maintain planned staffing levels and that the clinical nurse management structure was maintained, in line with the centre's statement of purpose. This impacted on the overall governance and oversight of the service.
The service was dependent on the use of agency staff to support the nursing rosters. While there was evidence of ongoing recruitment, on the day of inspection the provider did not have the staffing resources to cover planned and unplanned leave. The organisational structure, as described in the centre's statement of purpose, was not consistently available and, therefore, not effective.
The inadequate level of available clinical nurse managers resulted in the assistant director of nursing suspending their management and supervisory role. On the day of the inspection, the assistant director of nursing was deputising for the person in charge, however a review of the staffing allocation documents and rosters found that they were working as a clinical nurse manager.
In light of this, accountability and responsibility for the oversight and monitoring of key aspects of the service were not clear. This included the oversight of risk management systems, complaints, and record management.
Additionally, there were inconsistent and poorly defined systems in place to escalate risks to the senior management. The poorly defined organisational structure impacted on establishing and sustaining effective management systems to ensure the service provided was safe and appropriately monitored. This was evidenced by; poorly documented and ineffective risk management systems, inadequate staff supervision, inadequate oversight of record management, inadequate identification and management of a potential safeguarding incident.
Individual assessment and care plan - A sample of resident's assessments and care plans found that they were not in line with the requirements of the regulations. For example; Care plans were not guided by a comprehensive assessment of the residents care needs. Some resident's care plans did not accurately reflect the needs of the residents and did not identify interventions in place to protect residents when identified as being at high risk of falls. Consequently, staff did not have accurate information to guide the care to be provided to the residents.
The provider had planned to remedy the areas of non compliance before the next inspection.