Residents at Sligo nursing home had unexplained bruising according to HIQA

St John's Community Hospital, Ballytivnan, Sligo.

Sligo Champion

Several incidents of unexplained bruising to residents at a Sligo care home have been identified following a HIQA inspection

HIQA, in a report published on St John’s Community Hospital, Ballytivnan says the incidents were not appropriately managed in line with the centre’s safeguarding policy. As a result, effective measures were not identified to reduce the occurrence of such incidents.

Several residents who were at risk of injury and who sustained recurrent bruising did not have an appropriate assessment carried out to determine the root cause of the injuries and an appropriate care plan developed to prevent the occurrence of such incidents.

The report outlined how the oversight arrangements in place for the review of the accidents and incidents failed to identify the increased occurrence of unknown bruising and peer-to-peer incidents in the centre.

As a result, the provider’s systems failed to identify the level of clinical risk associated with the incidents and the interventions that were required to reduce the level of risk in the centre

The inspectors on an unannounced inspection last December found that not all residents living there experienced a good quality of life.

“Evidence found on inspection indicated that there were a number of actions required on behalf of the provider to reach full compliance with the regulations and to ensure that the service provided in the centre was safe and appropriate and that residents enjoyed a good quality of life.

“These actions relate to the protection and safeguarding of residents, ensuring that care records reflect the current needs of the residents and that interventions incorporate the updated guidance and treatment plans identified by clinical teams,” said the report.

The provider had not notified the Chief Inspector in writing about three safeguarding incidents that had occurred in the centre.

These included: An incident related to an allegation of financial abuse was not reported to the Chief Inspector; an incident related to unauthorised access of a member of the public into the hospital was not notified to the Chief Inspector and not all allegations of suspected abuse or incidents were notified to the Chief Inspector.

A number of incidents related to physical aggression between residents, which reported clear safeguarding risks to the residents, were not notified to the Chief Inspector.

The report also detailed how a number of residents with acquired brain injury were not sufficiently supported to participate in activities in accordance with their interests and capabilities and were not able to access their community if they wished to do so.

Furthermore, a review of one resident’s responsive behavioural record indicated that their responsive behaviour had dis-improved due to the lack of meaningful activities available to them in the centre which was identified in several multidisciplinary team meetings.

While day room supervision was available to support residents with responsive behaviours, the inspectors observed that some residents spent long periods with little to do and limited social interactions with staff or with each other.

“Even though staff were allocated to provide social care activities in the day room of Tir na nÓg unit, the provision of personal care and ensuring the safety of residents took precedence over social care programs.

“As a result, the residents did not receive good quality social care programs in the centre,” said the report.

Some residents who were accommodated in multi occupancy rooms did not have sufficient storage space to store their personal belongings, such as photographs and other personal items.

St John’s comprises of five units, Tir na nÓg, Rosses, Cairde, Curam and the Hazelwood unit and accommodates male and female residents over the age of 18 and on the day of the inspection there were 79 residents there.

The findings of the inspection primarily related to one unit inspected by the inspectors called Tir na nOg,

On the day of the inspection, 24 residents were living on Tir na nOg unit and were supported by seven staff which normally comprised three nurses and four healthcare assistants, a clinical nurse manager was also based in this unit.

While there were staffing resources identified for this unit, a number of residents accommodated required regular staff supervision, there were a number of peer on peer incidents which required notifications to be submitted to the Office of the Chief Inspector.

In addition, inspectors found that residents with complex needs who were living on another unit,and who were assessed for additional supports were not in receipt of these supports.

This led to poor social care outcomes for these residents and was a significant factor in the high number of peer to peer incidents reported.

The registered provider did not ensure that the number and skill mix of staff available in the unit inspected were sufficient to meet the assessed needs of the residents.

For example, there were insufficient social care staff rostered to provide activities for a number of residents in the centre.

As a result, those residents who required additional support to engage in meaningful activities due to their complex care needs were not sufficiently supported in the centre.

In addition, the social care plans that were in place for one-to-one support for a number of residents to attend activities outside of the designated centre were not happening due to the lack of social care staff available.

Inspectors reviewed residents’ care records and spoke with staff and residents. Inspectors found that the residents did not go out of the centre because there were no staff available t support them on these outings.

There were 11 residents who were under 65 years living in St John’s. Out of these, additional support was secured for personal assistance hours for three residents.

However, even for these three residents additional personal assistant hours for the provision of social care activities and outings and the residents were not been used effectively.

This was impacting on the well-being and the quality of life for these residents.

The overall feedback from residents was mixed, some residents were content living in the centre, while some said that they would like to be at home.

Residents who expressed a view told the inspectors that staff were kind and helped them with their personal care, assisted them at mealtimes and also provided support with managing their laundry.

The inspectors observed that there were seven residents located in the sitting room with no member of staff in the room to supervise and offer support to residents.

Rosters showed that there were eight staff allocated to this unit during the day however no staff were present in the sitting room.

Many residents living in Tir na nOg were assessed as having complex care needs which required specific support to maintain their safety and well-being and care plans showed that a number of residents requiring enhanced supervision such as 15 minute observations by the staff team.

Records indicated that a number of residents displayed responsive behaviours in this unit which often led to peer to peer incidents in which residents became aggressive with each other, and staff were required to intervene and de-escalate the situation to ensure the resident’s safety.

Inspectors were informed by the management team that there were problems sourcing additional supports and this often meant that residents did not have access to support in line with their assessed needs.

For example the lack of personal assistant hours meant that some residents missed out on opportunities to engage in outings and activities into their local community which was impacting on the well-being and quality of life for these residents.

The registered provider confirmed that they were liaising with community services in order to re-instate these services for the residents.

The daily routine was largely focused around the provision of personal care and meal time support.

Inspectors were informed by the staff team that there was an activities programme for the day of the inspection but this was not displayed in the unit inspected.

This meant that residents had to wait to be informed by staff as to what activity was being planned for that particular day.

The inspectors found that while there were management systems in place to monitor and review the quality of the service provided, they were not being used to ensure that the service was safe, appropriate, consistent and effectively monitored.

The inspectors also found that the provider’s arrangements to meet the assessed needs of each resident were insufficient citing one resident who was assessed as having pain did not have an appropriate pain care plan developed to support their ongoing needs.

The registered provider had not ensured that there were appropriate evacuation procedures in place to ensure residents could be evacuated in a fire emergency.

It noted how one fire exit located in Tir na nOg unit had steps to the external pathway. This would hinder the safe evacuation of residents using mobility equipment such as wheelchairs or zimmer frames or for those residents requiring ski sheet evacuation.

There was no signage in place to indicate the location of the fire assembly point.

In response, St John’s stated that daily staffing allocations have been reviewed and staff are now formally allocated on a daily basis to social care activities and this is documented in the unit diary.

Links have been re-established with Sligo Sports and Recreation Partnership and a programme has been arranged.

The Sligo Sports and Recreation Partnership are also working closely with the Person in Charge in the development of a business case for an outdoor gym which will support the physical and social wellbeing of residents.

On completion of the business case this will be put forward for funding. It is anticipated that this will be in place in 2024.

The Person in Charge has reviewed the governance and management of all incidents and has implemented a robust review mechanism for all incidents that occur.

This system will ensure that all incidents are fully reviewed at the time with all appropriate measures to mitigate against any further harm.

The risk management policy has been reviewed and updated to reflect that in the event of unexplained bruising or incident of unknown origin the process that must be followed.

Formal links have been established with the local Garda Siochana Community Liaison Team and an identified link person is now available to St John’s.

It is planned to have quarterly safeguarding meetings with the Garda Community Liaison officer.