A number of issues around staffing and quality of service for residents have been highlighted in a HIQA report on Dunlavin Nursing Home.
HIQA carried out an unannounced inspection on Sunday, January 5. In a report published earlier this month, inspectors found Dunlavin Nursing Home had not met the requirements of the regulations in three areas including staffing, governance and management and residents' rights.
The report states the inspection was triggered after the regulator received information of 'insufficient staffing resources and staff training' which was 'partially substantiated on this inspection'.
Five areas were also rated as 'substantially compliant' requiring some action to be deemed fully compliant. The five areas included training and staff development, statement of purpose, end of life, premises, individual assessment and care plan and managing behaviour that is challenging.
During the visit, inspectors observed staff 'were hurried and busy with assisting residents with tasks of care' and it was suggested that this meant 'their ability to engage socially with residents was compromised'. While residents said they were comfortable and well-cared for, the inspectors noted that some expressed concern about the continuity of care due to the level of staffing and the turnover of new staff in the months prior to the HIQA inspection.
The inspector stated that 'good levels of compliance' noted at the previous inspection in 2019 had not been sustained and a 'deterioration in the centre's compliance with the regulations was evident on this inspection'. In relation to staffing, the inspector was concerned by an increase in staff turnover and arrangements for staff leave and felt this could have a negative impact on care for residents. The inspector said staff, residents and relatives told them 'the service was strained and the frequency of new unfamiliar staff was disconcerting for residents, especially residents with dementia'. While new staff had been recruited, the inspector noted their findings 'did not give assurances' that there was enough staff to meet the needs of residents.
The inspector noted that on the day, three staff members were unable to attend work and two members of staff were replaced by the person in charge at the centre.
The HIQA inspector also reviewed the staff roster for the three weeks prior to the inspection and identified some staffing shortages. They suggested that residents' social or psychological needs were not being prioritised because staff concentrated on residents' personal care or clinical needs at times of staff shortages. Concerns were also raised that there were no arrangements in place to coordinate activities for residents at weekends or during the activity coordinator's holidays.
In relation to governance, the inspector suggested that the systems in place were not robust enough to identify staffing improvements or to sustain compliance with the regulations. While it was noted that nursing home management reviewed staff levels and made efforts to ensure reserve staff were available, this was 'quickly exhausted due to high staff turnover'. The inspector also noted that no staff member had been deputised to act as the person in charge of the facility at weekends or nights.
While arrangements were in place to allow residents to be involved in the running of the centre and information provided about the activity schedule, the inspector observed no coordinated activities planned at weekends. The inspector noted that residents who remained in their rooms may not have access to activities in line with their interests. The use of a noisy sitting room for sensory activities with residents was also found to be unsuitable by the inspector. While the centre had landscaped and secure gardens, 'residents choice to access these outdoor areas at will was restricted and they required the assistance of staff to open locked doors'. In relation to staff training and development, the inspector noted that mentoring of new recruits by existing staff was often compromised due to staffing shortages. A review of the centre's statement of purpose was suggested to ensure that it accurately described the service provided. The inspector also stated that further information was required in documents detailing residents' individual end of life wishes.
The report also noted that more detailed information was required in some residents' care plans in relation to areas including the activities they enjoyed or their clothing preferences. It was noted that a dining area had been provided in the dementia unit since the last inspection, however, the inspector expressed a concern that there was not adequate equipment storage space at the facility.
The inspector suggested that residents' freedom of movement was limited due to the use of key-coded locks within the centre without adequate risk assessments being carried out. The report stated, 'staff demonstrated genuine respect and empathy in their interactions with residents but due to inadequate staff on a day-to-day basis, staff met residents basic needs but they struggled to provide the level of person-centred care and support that some residents, especially residents with dementia needed'.
Dunlavin Nursing Home management had the opportunity to respond to the queries raised by the HIQA inspectors before the report's publication and their replies included within the HIQA report. Dunlavin Nursing Home management said a full staffing review was being carried out and processes put in place to review residents' needs before the roster was finalised to ensure continuity of care. This revised rostering process would aim to ensure staff have time to respond to all of the residents' needs.
A review of activities was also under way to give residents access to activities seven days a week. Dunlavin Nursing Home management also said that a schedule of activities for residents had been devised.
A staff committee had also been established to meet regularly with issues raised to be addressed by the person in charge at the nursing home.
Dunlavin Nursing Home management said meetings of the senior management team had been taking place weekly since the inspection to monitor staff levels and residents' needs. A staff nurse would be named on the roster to act as the person in charge at weekends and nights. In relation to staff training, Dunlavin Nursing Home management said rosters would be reviewed to ensure that existing staff were available to work with new staff members. Dunlavin Nursing Home management said that all conversations about end of life care would be documented in care plans. A full review of care plans had also been carried out to add enhanced details about residents' preferences. They also stated that a review of the premises to reduce restrictions on residents' freedom of movement had started. Residents also had access to the secure outdoor space as doors had been unlocked following the inspection.
A spokesperson for Dunlavin Nursing Home said where absent staff cannot be replaced with agency staff, the director of nursing and assistant director of nursing 'regularly assist staff in the delivery of a very person centred care model in Dunlavin'.
'Staffing levels are reviewed regularly using the Rhys Hearne Model. This takes into account residents dependency levels and their individual Care Needs. Dunlavin Nursing Home has at all times implemented rosters above the Rhys Hearne Model recommendations.'
The spokesperson also noted that staff at the nursing home are supported at all times in their role by external therapists and entertainers.
'Dunlavin Nursing Home is hugely supported by the local community who are an integral part of life for our residents in our nursing home. The community bond with our residents is very real. Their support, particularly during the Covid pandemic, has been immense. At Dunlavin Nursing Home, we remain committed to delivering our residents with a 5-star standard of care in a non clinical and homely environment.'
'We completely endorse and welcome embrace any recommendations from the HIQA regulator and as always continue to work in partnership with them with full and transparent disclosure made on a timely basis,' the spokesperson added.