Major issues uncovered during 'unannounced' inspection at Tipperary nursing home
HIQA report has found major compliance issues in Sonas Nursing Home based in Carrick on Suir.
The Health Information and Quality Authority (HIQA) has released details of major issues uncovered during a two day inspection of Sonas Nursing Home in Carrick-on-Suir. The report was released this week, of an inspection which was carried out in March of this year when 53 residents were on-site.
The inspection, which was originally due to take place over one day, was extended after inspectors uncovered significant issues. HIQA issued an immediate compliance request requiring the service to improve the cleanliness of the centre before returning for a second day of inspection.
However, inspectors found the concerns had not been adequately addressed, prompting an urgent compliance plan request seeking assurances on staffing resources, information governance and management systems.
While inspectors acknowledged that staff were kind towards residents, they found that care was not always delivered to an acceptable standard or in a timely manner.
During both days of the inspection, residents experienced delays when using call bells to request assistance. Inspectors also witnessed residents calling out for help because they had no access to their call bell.
Although staff had been assigned to supervise communal areas, inspectors noted they did not consistently engage or interact with residents during these periods.
Many residents shared their experiences with inspectors. While some recognised that staff were busy and "trying their best", the majority expressed frustration at the length of time it took to receive assistance and care.
Family members and friends were free to visit throughout the inspection and although several visitors said they were generally satisfied with the care their loved ones received, others raised concerns about staffing shortages, high staff turnover, laundry management, the quality of care and delays in responding to requests for assistance.
Some visitors also reported that concerns they had previously raised were not properly addressed. One visitor told inspectors they had made a formal complaint but received no response.
Inspectors found the care environment itself was not maintained to an acceptable standard of cleanliness.
Floors were visibly dirty and an unpleasant odour was noted throughout the centre. While conditions improved slightly after HIQA directed the provider to carry out additional cleaning, inspectors found there was only one cleaner on duty on both days of the inspection.
Residents were also found to have limited opportunities for social interaction.
On the first day of the inspection, the only organised activity available was access to the hairdresser, while many residents spent prolonged periods sitting in communal rooms watching television with little engagement.
The provider failed to ensure staffing levels to meet residents’ needs or manage the size and layout of the centre. This resulted in extended waiting times for assistance, inadequate housekeeping and insufficient staff to supervise care.
Inspectors found issues in the nursing management structure, with no cover arranged when two clinical nurse managers were absent on planned and unplanned leave.
HIQA said this lack of management oversight contributed to poor quality care, inadequate staff supervision, deteriorating environmental standards and a negative impact on residents quality of life.
The report also highlighted inadequate oversight of nursing care and documentation, with incomplete assessments and care plans that had not always been developed in consultation with residents.
Although clinical and environmental audits were regularly carried out, inspectors found they failed to address significant issues, including the poor standard of cleanliness throughout the centre.
Action plans developed following previous audits had not always been completed, while complaints from residents and families about delayed responses to call bells had not been monitored or audite
The inspection found the centre to be non compliant with 17 regulations, with HIQA requiring the provider to implement urgent improvements across staffing, governance, record management, and infection control.
IMPROVEMENTS
Following the visit, Sonas said they had completed a deep clean of the centre by an external company, and they “restored” staffing levels so that a minimum of two housekeeping staff are on duty daily.
Other changes were made to staffing levels and hours increased, and the centre say that a “full complement of staff is in place for the housekeeping and laundry departments”.
Software is updated, said Sonas, to monitor call bell response times and “this remains an ongoing improvement initiative”.
Some staff vacancies were also filled, while schedules for cleaning , daily reviews of care plans, and daily walk-rounds now take place by managers.
Complaints handing training was undertaken by the clinical management team, and ideas and suggestions taken from the residents.
Other actions taken by Sonas include a full review of the social, therapeutic and recreational programme so that activities can take place seven days a week, the variety of which was designed in response to residents’ requests.
Sonas’ reply in the report also stated that they were undertaking a review of the communal areas so residents had more choice about where they spent their time, and “work is ongoing to develop all staff in terms of their ability to engage in a meaningful way with residents”.