HIQA report critical of Kanturk Hospital
HSE "failed to address deficits in governance and management" according to HIQA report on Kanturk community hospital
A report by the Health Information and Quality Authority (HIQA) has said the findings of its latest inspection at Kanturk Community Hospital had "demonstrated that the HSE had failed to address the deficits in governance and management" identified during previous inspections.
In its report, HIQA said that "poor findings and inadequate provider responses" to three previous inspections completed since January 2018 had precipitated the most recent unannounced inspection, which took place last November.
The subsequent report found the hospital to be non-complaint in more than a dozen specific regulations under the headings of 'Capacity and Capability' and 'Quality and Safety'.
Under the first heading, HIQA noted that "an absence of an effective system of governance was evident" in the failure to progress remedial works required to address fire safety risks; a failure to improve the privacy and dignity of residents; and "a lack of involvement of and oversight by senior managers in plans to address both issues."
Inspectors said a comprehensive review of occupancy levels was not carried out to inform the profile and number of residents that could appropriately be accommodated at the hospital, and reported "findings of repeated regulatory non-compliance over four inspections".
They went on to say that despite three inspections with findings of poor regulatory compliance since January 2018, the HSE had "failed to implement their own compliance plan and to make necessary improvements".
Examples cited included: the failure to appoint a director of nursing; that long-term residents continued to be accommodated in situations that "adversely impacted their daily quality of life, privacy and dignity"; that personnel records reviewed did not contain Garda vetting disclosures; and that no system to determine if staff training to ensure the protection of residents was "understood and implemented".
"The evidence of this inspection and documentation reviewed demonstrated the absence of a coherent approach on the part of the HSE in addressing fire safety risks while upholding and improving the privacy and dignity of residents," read the report.
"In conclusion, the findings were that the HSE had failed to take the necessary action to strengthen the governance and management of this centre for the purpose of improving the quality of life for residents and supporting staff on the ground in striving to achieve greater regulatory compliance."
In relation to the Quality and Safety element of the inspection, HIQA found that while some staff understood and demonstrated a strong person-centred approach to care and interaction with residents, "the prevailing culture was that of a hospital, focussed on caring for 'patients'".
"Daily routines and practices did not reflect the fact that the centre was a person's home or recognise that, while health impacts quality of life, it should not define quality of life for residents. "As with previous inspections, institutional practices continued to negatively impact many aspects of each resident's daily lived experience," read the report.
The report also found that appropriate personal storage facilities were not available to residents; the premises "was not fit for purpose" for the number of patients living there; procedures consistent with the national standards for infection control "were not demonstrated"; the findings of non-compliance in relation to fire safety reported during an inspection last August had yet to be addressed; and that individual assessment and care plans "were not comprehensively completed or updated in a timely manner."
The report found that while staff had been trained in relation to the detection and prevention of abuse, this training had "not resulted in improved outcomes for residents" and that the lack of protections "was evidenced in the exposure of residents to institutional practices on a daily basis".
In relation to 'residents rights', inspectors observed "some interactions that respected peoples human rights; however, this was not always seen."
"Some staff members showed kindness and offered choice, while others performed their duties in a perfunctory manner," read the report.
"There appeared to be an over-reliance on the activities coordinator to socially engage with residents, and it was not seen as the responsibility of everybody to engage and socially interact with the residents," it added.
A compliance plan drawn up by HIQA set out a list of regulations deemed to be 'non-compliant' and the actions that needed to be undertaken to address these deficiencies.
The full report and the Compliance plan, which contained steps being taken to address the issues identified, can be viewed in full at www.hiqa.ie.
Statement from Cork Kerry Community Healthcare following HIQA report into Kanturk Community Hospital
We accept today's report by HIQA into Kanturk Community Hospital, and acknowledge the serious issues it raises.
We also acknowledge that this is part of a series of HIQA reports raising these issues.
We want residents and their loved ones to know that we are taking these reports very seriously and are acting to bring about improvements at Kanturk Community Hospital.
Improvements were made on foot of previous reports, but some of the steps taken didn't have their full impact as quickly as we would have liked.
We acted as soon as it became evident that further action was needed, and a significant programme of change is now well underway at the community hospital.
Kanturk Community Hospital is already moving towards a vastly improved environment and experience for residents.
While the initial efforts we put in place did not bring about the changes that both we and HIQA were hoping for, we have now further enhanced our efforts.
A high-level group of senior managers from across Cork and Kerry has been set up to oversee and support the staff at Kanturk Community Hospital as they continue to bring about the changes and improvements which need to take place.
This group will also make sure that the efforts we put in have the impact we hope for, while a new Quality and Safety Committee will also be set up for the community hospital.
We have also actively sought the input of residents, and this has informed the changes - for example, residents have had an input into the redecoration carried out recently. Putting the residents at the centre of what we're doing is a more time-consuming approach, but is very worthwhile.
Other recent improvements include:
· An occupational therapist has visited to assess residents, with more occupational therapy intervention planned for the coming weeks.
· Training took place throughout 2018, we are now ensuring it is applied to day-to-day practice. Staff training and mentoring will continue during 2019.
· Work is underway and will be completed shortly on a new area where residents and their visitors can go and have a cup of tea or coffee, away from the main communal/shared areas.
· The Cork/Kerry Health and Well-being division will support the team at the community hospital as they deliver this ambitious programme of change.
· In December, a survey of residents and their loved ones took place. We were encouraged by some of the positive feedback in that survey, which included comments praising the staff for how caring and kind they are. Areas mentioned for improvement are being acted on.
· The need to provide a dementia-friendly environment has also been identified, and this will be pursued as part of wider discussions with an occupational therapist.
Significant improvements are planned for the building itself, with some already underway:
· A plan for the extension and extensive refurbishment of the facility has been finalised, with an application for planning permission to be lodged shortly. This ambitious construction project will provide a much better environment for residents and staff.
· In the interim, refurbishment works have taken place in advance of the more extensive work. These works also address the fire safety issues raised by HIQA.
· New televisions have been installed, interactive tablets for residents' use are on the way, and each resident is getting a new wardrobe.
This report does not reflect our values, or the standard of care we strive to provide for residents at all community hospitals. We are committed to working with HIQA to ensure that we address the issues raised.
It is very clear that significant change is needed at Kanturk Community Hospital, and work is underway to bring that change about, with real changes already evident.
We wish to thank residents, their families and staff for their patience and understanding."