Investigation summary:SEVERE CRITICISM is levelled at the Health Service Executive and the former Northern Area Health Board (NAHB) as well as at Dublin's Beaumont hospital in the latest report into Leas Cross nursing home.
The commission of investigation report, published yesterday, says the root of the problems at the nursing home began when the NAHB allowed it register an additional 73 beds in 2002, bringing it from a 38- to an 111-bed home.
The health board allowed it register these extra beds “without adequate regard to the well-being of residents”, it says, and it failed to impose conditions on its registration to ensure the numbers of residents increased at a reasonable rate when it had sufficient staff.
It said the decision to approve the expansion was taken “at a high level” within the NAHB without regard to the history of the home and based solely on one standard inspection. It failed to monitor it closely afterwards, the report adds.
The NAHB then purchased a number of contract beds in the home in August 2003 and transferred highly-dependent patients from St Ita’s Hospital, Portrane, Dublin, to Leas Cross.
Between September and November 2003 some 23 patients were transferred from St Ita’s to the home. This intake coincided with a significant deterioration in standards of care in Leas Cross. The commission questioned whether it was necessary for so many of those patients to be transferred within just a few months.
It also found the NAHB did not make sufficient efforts to determine the suitability of the home to accommodate them.
The report also says information provided to the commission by patients’ families suggests staff at Beaumont hospital were witnessing a recurring pattern of residents being admitted from Leas Cross with problems that either were or could be indicators of poor care at the home. These included things like pressure sores and dehydration. “It seems that the staff at Beaumont did not convey any concerns which they may have had about Leas Cross to the health board or to the HSE.”
Again in 2004 the report says Leas Cross was re-registered “notwithstanding the existence of a serious complaint” of which inspectors and health board management were aware. It said the practice of the health board in this regard “seriously undermined the inspection process and potentially posed serious risks for the residents of nursing homes”.
The report concludes that between September 2003 and August 2005, when the home closed after a Prime Time documentary highlighted deficiencies in it, standards of care at Leas Cross fell below acceptable standards. This period coincided with a significant increase in highly dependent frail residents admitted from St Ita’s and other general hospitals.
The principal cause of the decline in standards was the failure of the home to employ a sufficient number of competent staff to provide the necessary standard of care. The ratio of nursing staff to care attendants was inadequate and many care attendants lacked appropriate training.
While the commission notes that the Nursing Home (Care and Welfare) Regulations 1993 do not specify staffing levels other than pointing out that “a sufficient number of competent staff” must be in place, it said there was “ample provision in the legislation” to enable the health board/HSE to take action where they identified a failure to meet required staffing levels.
Furthermore the report says the HSE/health board had information over a number of years of recurring problems at the home that should have alerted it to impending problems, which could have been avoided.
But the information was in different offices and no one individual in the health board had full knowledge of all the information available to it. It added that the HSE could not rely on it administrative arrangements “to excuse this failing”.
The commission found the nursing home inspection process was deficient and in 2004 there was only one routine inspection “owing to staff shortages in the inspectorate”.
In further criticism of the HSE the report says there was intense activity by it in the home in May 2005, which appeared to be mainly in response to the Prime Time programme. In June 2005 the HSE told the home it required in excess of 20 additional nursing staff and the commission said this was sudden, poorly communicated and unjust. It was the commission’s view that the true staff requirement should have been identified and communicated much earlier when the home expanded.
In addition it said the manner in which the HSE closed the home “may not have been in the best interests of the residents”. Its actions strongly suggested it was trying to react quickly to the TV programme and/or because of the potential costs and risks associated with keeping it in operation at the appropriate standard.
There is also criticism of Leas Cross itself in the report. From the very beginning the home took in six residents before it got registration or a fire safety certificate. There was no evidence it used any formal assessment tool to determine staffing levels and between 1999 and 2005, management and staff failed to keep a record of the complaints made to them by residents or residents’ families or of the home’s response to them. It also said those who wished to make complaints were frequently frustrated at not being able to find key staff or had difficulty communicating with staff who lacked fluency in English.
The report found primary responsibility for maintaining standards of care at Leas Cross rested with the home’s proprietor John Aherne and its matron.
Meanwhile, the report also deals with the transfer of patients with intellectual disabilities to the home from St Michael’s House in Dublin. It found St Michael’s promised the family of Peter McKenna – who had Down syndrome and Alzheimer’s disease – it would monitor his care and provide clinical backup after he was transferred there and this did not happen.