A LITANY of problems were found at a private nursing home in Maynooth, Co Kildare, when it was inspected by the Health Information and Quality Authority.
There were serious deficits in staff training, unsafe practices in the administration of medication, and no evidence the TLC Centre employed sufficient staff to deal with a large influx of patients from Dublin’s St James’s Hospital in September and October last year.
An inspection report on the home, published yesterday, says the authority visited the facility last October following complaints from two separate people.
Both were concerned about the large number of admissions to the centre in a short space of time. They were worried there were not enough staff to care for residents.
The report says a contract was agreed between the home and a hospital – known to be St James’s – at the end of August, under which 50 residents would be sent to the home over a three-month period.
“However, this was not adhered to and residents were admitted from the hospital to this centre at a rate of two to three residents per working day over a one-month period.”
The home had 30 residents but, after the agreement with St James’s, 40 additional residents were admitted within 30 days.
On the day of the inspection, the person in charge could not tell inspectors how many extra staff had been recruited to care for the 40 extra residents.
Inspectors were told the centre received assistance from another TLC Centre in admitting residents, but there was no record of these additional staff. Five staff nurses on duty during the inspection said no additional help came from another centre except for one person who came to “give us some pointers”.
The inspectors’ report found residents were not fully assessed when admitted and a robust care plan was not developed with them.
The centre’s chief executive is Dr Liam Lacey, who is president of the Irish College of General Practitioners and a member of the group overseeing the implementation of recommendations by the State’s Commission on Patient Safety.
He said yesterday extra agency staff had been taken on, but were not on the rota. “There were sufficient staff at all times,” he said, adding that he had the bill to prove it. He said extra patients were admitted over a short period due to “bed pressures” at St James’s. The home has dealt with “all the major hospitals”, he confirmed.
Meanwhile, the inspectors’ report says there was no system for the organisation of care delivery at the home or to determine the number or skills mix of staff required to care for the residents. It found residents’ actual dependency levels did not match what was recorded in their files, and handovers from night duty did not contain sufficient detail to enable staff coming on duty to provide consistent and adequate care.
They noticed one patient got a higher dose of medication than authorised by a doctor on two separate occasions and crushed medications were being administered on the day of inspection without a doctor’s prescription. When inspectors found an offensive odour coming from a wound dressing on one patient, they asked a staff nurse when the dressing was due to be changed. The nurse said it was “due to be changed the previous day” but wasn’t “as they were too busy”.
Another resident’s care plan stated their weight should be monitored periodically, but it was only recorded on admission. There was no registered nurse assigned to the Alzheimer’s unit. “This contributed to poor outcomes of care for one resident and inadequate care planning for another resident that inspectors reviewed.”
Dr Lacey disputed aspects of the report. “We feel that there was a perfectly adequate level of care provided,” he said.