SOME RESIDENTS at a public nursing home in Athy, Co Kildare, were left in their beds for several days at a time and faced the “pervasive use” of restraints such as bed rails and lap belts, a report by a State watchdog has found.
The Health Information and Quality Authority also uncovered serious errors in medication records, structural deficits in the premises, staff shortages and no strategic vision for the nursing home based at St Vincent’s Hospital, which has 153 residents.
Managers at the nursing home told the inspectors that cutbacks due to the current economic climate meant staff spent large amounts of their time off-duty fundraising to improve the care for residents. Private funds were used to upgrade the dining rooms on each ward, to provide an enclosed garden area for each ward and to buy equipment such as hoists, bed covers, blinds and chairs, says the report.
The report praises the person in charge of the home, Helen Dreelan, and her team for working to improve the quality of care. But it strongly criticises the culture of care provided to those residents with the highest dependency at the nursing home run by the Health Services Executive.
“There was a culture whereby dependent residents were left in their beds for several days at a time. This was a traditional practice that had been carried on for years without any proper assessment of these residents’ needs for activation and meaningful engagement,” says the report, which followed a three-day inspection of St Vincent’s Hospital in August.
The report says there was little thought given to the “psychological and physical effects of residents being left in bed for very long periods of time”. It also criticises a lack of flexibility around residents’ mealtimes and bedtimes, which were more suited to staffing routines than residents’ choices.
Evening meals were provided between 4pm and 4.30pm, which was only a short time after their lunch, says the report.
Inspectors saw a pervasive use of bed rails, a small number of residents with lap belts on their chairs and the use of ankle sensors on some residents that set off alarms when they went close to a door.
There was no evidence that alternatives to restraints had been explored by staff, and inspectors found that the alarms set off by the ankle sensors were loud and very intrusive. Residents’ level of agitation increased with the noise of the alarms, said the report.
Inspectors found three examples of a resident’s medication having no doctor’s signature, which meant nursing staff administering medication to residents without a proscribing signature.
It also found the level of staffing at night was not adequate.
The report found defects with the premises, which is an old workhouse built in the 1840s. It retains a hospital-like appearance with several multi-occupancy rooms and is not residential in character. There is “very little privacy”, not enough toilets, showers and wash hand basins, and several bathroom doors were missing, it says.
“The issues identified impinged on residents’ rights to dignity and privacy and affected their quality of life and there was no plan to address the deficits identified with the premises,” says the report.
The report concludes that there is a “lack of strategic vision” for the centre and highlights 21 separate breaches of the regulations governing nursing homes in the Health Act 2007.
In a response to the authority’s inspection report, William Quinn, general manager of St Vincent’s Hospital, said the inspection was a positive experience for management and staff.
“The recommendations following on from the inspection process provide an opportunity for the team to improve the service experience for the residents entrusted to our care.”
“The residents and relatives have indicated that they enjoyed the experience but were a little disappointed that more time for direct interaction with inspectors was not available,” said Mr Quinn, who is the named provider of the service on behalf of the HSE.
An action plan has been agreed with the HSE setting specific timescales to meet each of the deficits uncovered by the inspectors.