The Donegal nursing home where seven residents died due to a flu outbreak in March and April appeared to have “no established procedure” to enable early detection of flu, a report has found.
A report of inspections conducted by the Health Information and Quality Authority (Hiqa) published today finds that while the residents of Nazareth House home in Buncrana were well cared for, there were a number of deficiencies in areas such as staffing arrangements, reporting procedures and cleanliness.
Two inspections at the home by Hiqa on April 2nd, 3rd and 4th were triggered by a report of a significant number of resident deaths in March and April, the report said.
In all, nine residents died between March 22nd and April 8th.
Seven were classified as possibly consequent to an A (H3N2) influenza-related illness. The other two residents died of unrelated causes.
Nazareth House responded to all the issues raised by the authority’s inspectors and has indicated in the report that, in many cases, the problems identified have already been addressed or procedures tightened.
Inspectors found the home had failed to comply with regulations in a number of respects, including in its arrangements for cover in the absence of the person in charge of the home, in relation to the staffing mix to meet the needs of the residents, and in some aspects of infection prevention and control.
“Robust communication procedures were not in place. Senior management was not communicated with in a timely manner and there was a lack of clarity and accountability about how the information on the outbreak had been reported,” the report said.
Five residents died in the centre itself and four died at Letterkenny General Hospital. Their average age was 89 and postmortems were not undertaken on any of those residents who died.
There were 39 residents in the home on the days of the inspections in April, some 23 of whom were classified as “maximum dependence”, while 11 were of “high dependency”.
Some 65 per cent of the residents were in advanced old age – between 80 and 100. The other 35 per cent were aged between 70 and 80.
The authority’s inspectors found that “in general the health care arrangements for residents was satisfactory” with significant interventions and specialist advice from local doctors and other professionals such as speech and language therapists.
Residents who exhibited symptoms of illness were “seen expediently” by their doctors or by the out-of-hours service and these contacts were recorded.
There were also good contacts with hospital services and with the local palliative care team.
The inspectors found staff were “familiar and knowledgeable” about residents’ care needs. Records and communication on the current health status were conveyed clearly at each handover, and the staff team worked well together to share the workload and monitoring arrangements.
Inspectors said deficits in the overall standards of cleanliness impacted on good infection control management. Some commodes and bath chairs had not been cleaned effectively and were stained or damaged by rust.
Other aspects of the home were criticised, including the fact that some bedrooms had temperatures below the recommended minimum.
There was also no clear process for managing equipment that required repair.
Other issues raised included that mobile phone and wifi access at the home was “a constant challenge” for anyone trying to access the internet during the outbreak.
Residents’ care records were accessible via a “hard wired” internet connection. But the inspectors said the “poor arrangements for internet access compromised the ability of outside professionals to obtain and relay information in a timely manner”.
In response, Nazareth House said that while it had fully upgraded its IT systems and internal cabling just eighteen months ago, the internet providers had an “underdeveloped” residential and business broadband service in the Fahan area and that it had been informed that this would remain.
During the inspection, there was s student on placement at the centre. The inspectors were told there was appropriate insurance and Garda vetting in place. But they found the system in place for the employment of staff “was not in accordance with good practice guidance for the recruitment of staff to work with vulnerable people”.
There was “no confirmation” that indicated the student was medically and physically fit to undertake work with vulnerable people and the required three references were not available.