Actions taken by Valentia House to achieve compliance with the regulations ‘were not sufficient to ensure the safety, care and welfare of the residents’, according to the latest HIQA inspection report of the nursing home.
While inspectors found that many of the issues identified during inspections on December 1, 2020, and on March 18, 2021, had been addressed and improvements were noted, overall levels of compliance with the regulations remained poor, and new areas of non-compliance were identified on this inspection.
The report noted that the nursing home is not compliant with the following regulations: staffing; training and staff development; records; governance and management; infection control; medicines and pharmaceutical services; individual assessment and care plan and managing behaviour that is challenging.
The report noted that the centre has ‘a history of poor compliance with the regulations’ over the course of two inspections on 1 December, 2020, and 18 March, 2021. There had been ongoing engagement with the office of the Chief Inspector which included attaching a restrictive condition on the centre’s registration. This restrictive condition required the centre to come into compliance with three regulations by December 31, 2021: staffing, infection control and premises. However, in the latest report, the nursing home was found to still be non-compliant with staffing and infection control regulations, and only substantially compliant with the premises regulations.
Additional non-compliance was identified during this inspection in relation to records, individual assessment and care plan and managing behaviour that is challenging.
Despite some improvements since the previous inspection, inspectors identified further issues during both days of inspection which identified that the centre failed to achieve compliance with the staffing regulations. The report noted that, while the service provider had fulfilled the previously made commitment to rostering two staff nurses at night, the rosters showed that overall nursing staffing levels were less than those outlined in the centre's statement of purpose.
As a result, the clinical nurse manager was required to work nursing shifts and was rarely available to be rostered in a supernumerary capacity. They also noted that the lack of nursing staff meant that there was no contingency in the event of planned or unplanned absences.
There were serious deficits found in infection control practices during the inspection. According to the report, there was not adequate management arrangements in place to ensure the delivery of safe and effective infection prevention and control (IPC) within the service. Examples included a lack of IPC audits seen to identify good practices and deficits; a lack of a Covid-19 contingency plan seen on the day of inspection; insufficient cleaning resources and ineffective planning, organising and management of staff, leading staff to cross over all areas of the centre.
Some of the other issues noted in this area included storing resident equipment such as unclean wheelchairs, hoists slings, in the same room as sterile dressings and supplies; an excessive amount of healthcare risk waste bags stored in an unsecure area awaiting collection; staining and rust observed on commodes, trolleys, wheelchairs, and nebulizer compressors and the storage of equipment and boxes on floors.
Improvements noted since the last inspection included the restoring of a second nurse for night duty; the construction of a new laundry facility; the purchase of domestic equipment ensuring that two domestic staff could work separately in the centre; the replacement of the majority of the carpets with suitable washable flooring; additional storage space; upgrades to en-suites and shared bathrooms; the main driveway had been top-dressed and was in good condition and the creation of a safe, circling walkway in the enclosed courtyard.
The latest inspection was carried out over two dates: March 1 and March 14, 2022. The first day of the inspection was undertaken to assess whether the changes that had been implemented were effective in ensuring the safety and welfare of residents in the centre and in improving regulatory compliance. The second day was carried out during an escalating outbreak of Covid-19 within the centre.
The nursing home was issued a compliance plan, which outlines which regulations the provider or person in charge must take action on to comply. All of these actions must be taken by June 30, 2022.