INSPECTORS who discovered 'do not resuscitate' orders in the files of six nursing-home residents were concerned their lives were at risk.
The inspectors spent five days at the Village Nursing Care Centre in Ballygarriff, Craughwell, Co Galway, at the end of November and early December last year.
The directive was a one-line statement saying the resident should not be resuscitated in an emergency, the report from the Heath Information and Quality Authority (HIQA) revealed.
The form was signed by a relative and a nurse but the "inspectors were concerned that this could place the lives of residents at risk".
The report said the provider had allowed these directives to be put in place "without developing or implementing a policy to provide direction for how the policy would be implemented and highlighting the orders may have no legal basis".
There was no supporting documentation showing that the residents involved were incapable of being involved in the directive.
"A senior nurse was asked about what should be done if one of those residents should have an emergency that required resuscitation.
"The nurse was unsure about how to respond to such an event and stated that it would be a dilemma."
A second report of an inspection carried out on January 23 found improvements but said there continued to be a risk to residents due to the lack of clarity in relation to the 'do no resuscitate' orders.
Pat Kennedy, who took over the management of the home on January 14, told the Irish Independent that staff training was now under way on a range of areas to ensure everyone understood what was expected of them.
"Our policy is if in doubt to always to err on the side of resuscitation.
"We will go back over each care plan, cross-checking them and making sure all staff are well-informed."
A separate inspection of another nursing home, the Sunhill Nursing Home in Blackhall Road, Termonfeckin, Co Louth, over two days in September and October last year found that "on occasion residents had called 999 for medical assistance".
A GP attended on a set day each week but medical access outside this was limited "which may result in delayed treatment and appropriate healthcare", said the report.
During previous inspection visits in 2012, they found that the availability of the nurse and care staff to residents was not timely and was limited.
An action plan was set out by the inspectors after their last visit which noted improvements.
Sunhill's management than- ked HIQA for a "positive follow-up inspection" and said all suggestions raised by the inspector had been taken on board.