HIQA have published a report from an unannounced inspection of a Laois nursing home which failed eight out of ten regulations. 

During the September inspection, residents at Drominín nursing home in Stradbally were reportedly left unsupervised near a large open window, remained in communal areas 'until the early hours of the morning', and a 'failure of leadership' left residents 'at significant risk to their welfare and safety'.

Inspectors noted a Covid-19 outbreak at the facility, and that staff 'were uncertain about the overall status of the outbreak' and what parts of the nursing home were experiencing this outbreak.

At the height of the Covid-19 pandemic, 18 of the 65 residents at the nursing home died due to an outbreak at the facility.

"Some staff were observed wearing personal protective equipment (PPE), including face masks, while others were not. One staff member were observed to not be complying with the registered providers uniform policy," the report read.

"Inspectors observed that, contrary to public health and infection prevention and control guidance, staff were moving between the ground and first floor."

Inspectors found errors and issues with the documentation of medication, care plans, staffing rosters and incident reports. Meal plans required by patients with diabetes, malnutrition and those at risk of choking were not complied with. 

Diagnostic blood and urine tests on residents with deteriorating health were reportedly delayed or not carried out, the report outlined. Staff were reportedly unaware of one resident's pressure sores due to failures in a direct chain of management.

The monitoring of another resident with a cardiac condition was not carried out, despite signs of deterioration, the report claimed. 

HIQA stated that the inspection found 'significant deterioration in the care and well being of residents'.

This inspection of Drominín nursing home in Stradbally was undertaken due to information of concern received on the care of residents, and prompted HIQA's Chief Inspector of Social Services to bring an application before Portlaoise District Court to remove Droimnin Nursing Home’s registration.

The nursing home has been placed under strict conditions until the next court hearing in February.

Inspectors received mixed feedback from residents while conducting their inspection.

On two separate nights while the inspection was carried out, inspectors noted that residents in communal areas were
requesting assistance to go to bed. Some residents were seen to be asleep in their chairs.

"Staff, who reported being too busy, did not respond promptly resulting in residents waiting extended periods of time for assistance to go to bed," the inspection report read.

Staff informed the inspectors that these residents did not go to bed until the early hours of the morning.

Inspectors also observed that a large window in the first-floor communal area was 'wide open' while a number of residents were present and unsupervised.

"Inspectors noted that the placement of furniture in close proximity to the open window was such that a resident with exit seeking behaviour would be able to access the open window. This presented a significant risk to residents," the report stated.

Both staff and residents were found to be unsure of who was in charge at any given time, due to reportedly frequent changes in staff at the nursing home.

"They [residents] described this as a source of frustration, as when they sought clarification from staff, staff themselves were often unclear about who held responsibility and to whom residents' concerns should be directed," inspectors said.

The report found Drominín nursing home non-compliant with eight regulations and substantially complaint in two areas. 

With staffing capacity and capability, the nursing home failed in regulations surrounding governance and management, persons in charge, training and staff development, and the keeping of records.

With quality and safety regulations, the nursing home failed to achieve compliance with food and nutrition regulations, individual assessment and care plans for residents, healthcare of residents, and the protection of residents.

The nursing home was found 'substantially compliant' in ensuring residents rights and staffing.

"This inspection found that the overall management of the centre was ineffective and that oversight of the quality and safety of the care provided to residents was poor," the report read.

"The impact of this was that a number of residents were consistently in receipt of sub-standard care. This failure of governance and leadership placed all residents living in the designated centre at significant risk to their welfare and safety," inspectors said.

Inspectors found that recommendations made by medical professionals were not implemented, noting that the basic monitoring of one resident with a cardiac condition was not carried out in line with medical recommendations, despite the resident showing signs and symptoms of clinical deterioration.

There was poor oversight of records on medication management, nursing documentation, and incidents were found to be poorly recorded.

One incident in which a resident sustained a serious injury had not been appropriately documented or reviewed by
management, and the incident record did not align with the information submitted to the Chief Inspector, nor with the nursing notes or the verbal account of the incident provided to inspectors.

Staff rosters were incorrect over four days of this inspection, while a staff handover sheet to ensure that staff had access to up-to-date information on care was found to contain incorrect and inaccurate information.

Inspectors found that nursing records were 'duplicated' over a seven day period, which 'did not provide assurance that the daily care needs of residents had been met'. 

There was no evidence that serious incidents, including the unexpected death of a resident or a serious injury, had been appropriately recorded or investigated. In addition, incidents relating to medication omissions that had been brought to the attention of the management team, were not documented or investigated.

The report argued that due to the absence of monitoring from management staff, staff responsible for monitoring patients were unaware of pressure-related wounds.

Healthcare staff were reported to undertake kitchen duties due to staffing shortages, resulting in residents waiting for periods of time to acquire assistance.

Inspectors found that residents at risk of malnutrition and who had experienced significant weight-loss, were not provided with nutritional care in line with their care plans.

"The nurse management team were not aware that the communication system between the care and catering team was ineffective," inspectors said.

Drominín failed to comply with regulations surrounding food and nutrition, with residents prescribed certain diets due condition such as diabetes or malnutrition not receiving the meals prescribed.

Residents who were at risk of choking and were prescribed certain diets did not consistently receive meals in accordance with their needs, while these needs were reportedly not communicated to staff responsible preparing the meals. 

"The food provided to residents was not wholesome and nutritious, nor did it reflect the prescriptions of health care professionals," inspectors found.

Care plans were not found to be updated and monitored. One resident reportedly required updates to their care plan following a trip to the hospital, which was not implemented. Another patient required the treatment of a pressure ulcer, while this care plan was also not implemented.

HIQA inspectors stated that Drominín failed to take reasonable measures to protect residents from abuse and to provide for appropriate and effective safeguards to prevent abuse. 

Inspectors state the Droiminín was made aware of several care incidents that were indicative of potential safeguarding issues, and that these incidents were not recognised, and were not documented or investigated in line with the centre's policies and procedures.

The court case to remove Droiminín's registration has been adjourned to until February 3, 2026.