Challenging behaviour not managed at disability centre, Hiqa finds

A Brothers of Charity centre for the disabled failed to properly manage challenging behaviour that left one resident "crying and shaking" and threatened the safety of both staff and residents, health watchdog Hiqa has found.

Inspectors were concerned that staff and residents at the Liosmore centre in Limerick “continued to be subjected to risk and harm from behaviours that challenge” following an inspection in February this year.

Nine people were resident when the inspection, which deemed the centre to be majorly non-compliant in all nine areas assessed, took place.

Inspectors said staff were “particularly vulnerable to threat and injury when delivering personal care” and there was an ongoing requirement to remove other vulnerable residents for their physical and psychological safety.

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In one incident, staff had to use a side exit to re-enter the building as the resident blocked the hallway. Staff interventions included “firm physical sitting or standing restrictive holds” and this was seen as a “practical or safe recommendation”. The report found a lack of clear direction for staff in behaviour management strategies.

Hiqa also found a Daughters of Charity centre to be seriously non-compliant in five of seven areas assessed. It said residents’ privacy and dignity had been infringed.

Residential services

The findings were part of 22 reports on residential services for people with disabilities, including 10 on services run by the Brothers of Charity, seven on Daughters of Charity services and three reports on two centres operated by the Cork Association for Autism.

A report on the autism association’s Greenville House followed an inspection in June this year, the sixth since 2015. The centre had been issued in February this year with a “notice to refuse and cancel registration”.

Hiqa was concerned that those responsible for governance and management did not have the necessary competence to ensure residents “are safe and have a good quality of life”.

Since then there had been “demonstrable improvements” including the secondment of a senior Health Service Executive manager to the centre. Inspectors, however, still found insufficient clinical oversight and major non-compliance in administering medication to residents as prescribed and they were concerned about the risk of medication errors.

Crobally House

Two reports were published on the autism association's Crobally House. The first was based on an inspection last September and the second on a follow-up inspection in January.

Hiqa subsequently called the provider in for a meeting, because it had failed to show it could “deliver a safe service”.

Isolation or “single separation” was used to keep two incompatible residents apart and inspectors found there was an overreliance on this method and that a review of the practice had not taken place as required.

Inspectors found “the mix and incompatibility of residents accommodated together was having a negative impact” and separate vehicles were used to transport residents to keep them apart.

A Daughters of Charity centre in Ashington, Dublin 7, failed significantly in five of the seven areas assessed, including safeguarding, health, safety and risk management, and governance.

Residents also “highlighted that their privacy and personal space was regularly disturbed. This was especially an issue for them at night when they were attempting to sleep.”