Hiqa reports critical of HSE disability services

Major patient safety concerns have been raised in a series of critical reports into HSE-run disability services around the country.

Inspectors from the Health Information and Quality Authority (Hiqa) noted incidents of peer-to-peer abuse, misadministration of medications and failures to adequately report complaints of alleged mistreatment following visits to a number of large disability centres in Cork, Kilkenny and Donegal.

During an unannounced visit to the St Raphael's Campus in Youghal, Co Cork, it was found that a resident had not been given adequate food and nutrition for a period of more than 18 hours.

Those working at the centre said there were not enough members of staff on duty on that particular day to get the resident out of bed and feed them appropriately.

The Youghal campus, which had court-applied restrictive conditions placed on its registration last year due to previous negative findings by Hiqa, also came in for criticism for incorrect use of seizure and antimicrobial medicines which could have “potentially catastrophic” or even fatal impacts on patients.

The facility is currently in the middle of a winding-down process and is due to close next year, but inspectors recorded an ongoing “lack of clarity for staff around the reporting of allegations of abuse”.

One resident alone had made 15 complaints of physical abuse by one of his peers over the space of less than a month, but none of these incidents were properly investigated, inspectors said.

Serious failings in governance and management were identified at an unnamed disability service in Donegal during another unannounced inspection in March.

Despite initially being told by the person in charge that there had been no “incidents, suspicions, allegations or investigations of abuse” there since 2013, Hiqa officials later found that such allegations had indeed been made and investigations were instigated.

Inspectors said the person in charge subsequently handed over documents relating to the alleged incidents of abuse, and they concluded that “there was a significant risk to the safety of residents as a consequence of seriously inadequate safeguarding arrangements in the centre”.

Speaking to inspectors, some members of staff felt they were being seen as “troublemakers” if they highlighted problems with safeguarding measures or instances of possible mistreatment.

Elsewhere, Hiqa was not satisfied that the requisite improvements had been made to service provision at St Patrick’s Centre in Kilkenny which was taken over by the HSE in October 2015 following “significant failings” by the previous care provider.

Incidents of peer-to-peer aggression had continued since the handover, and there were still “significant concerns regarding the lack of suitable governance and management arrangements to oversee the quality and safety of care provided to residents” which had “direct negative outcomes for residents”.

A smaller community-based facility for six residents in Westmeath failed to demonstrate compliance for any of the nine standards tested during a visit in March, and the two-story house had no overall evacuation plan in the event of a fire.

It was also found to be deficient as regards safeguarding measures, as the member of staff designated to deal with complaints told inspectors they were “not aware that they had been assigned this responsibility” and said they did not have time to carry out managerial roles alongside their frontline duties.

The findings came in a raft of 11 inspection reports released by Hiqa on Monday. Other centres visited managed to demonstrate more consistent compliance with regulations, and there was evidence of a good quality of life for residents within these services.

The State's health watchdog also provided an update on two autism care centres which are operated by Gheel Autism Services on behalf of the HSE after it took over control from the Irish Autism Society following negative inspection outcomes published in July.

Inspectors found that significant improvements had been made in safety and quality of life of residents at both premises.