A NURSING home in Portlaoise has been ordered to improve the standard of care it provides following an inspection, which found that a number of its elderly residents had suffered severe weight loss.
A report by the Health Information and Quality Authority (Hiqa) on Kilminchy Lodge nursing home found residents were receiving “very little food or fluids throughout the day” and records on fluid and food intake were “very poorly maintained”.
“One record indicated that the resident had eaten a regular diet despite the fact that she had chewing and swallowing difficulties,” said the report, which was compiled following an announced inspection by Hiqa last November.
“The person in charge indicated that this resident would not have been able to eat the food items that were written on the food intake record.”
When Hiqa inspectors brought one resident’s weight loss to the attention of the person in charge of the nursing home, she told them she was shocked, but she did not offer an explanation. Inspectors requested an immediate review of the resident, it said.
Hiqa concluded that the nursing home had failed to comply with statutory requirements laid down in the Health Act 2007 because of its poor management of residents with weight loss. This was just one of 18 problems identified by inspectors that did not comply with health regulations.
One resident who received dental care following the Hiqa inspection had to have 10 teeth removed. He told the inspectors that he was delighted to have received dental care because his teeth had been causing him health problems.
The report said some of the 37 residents living at the home were poorly groomed and were wearing soiled clothing and footwear when the inspectors were present.
Hiqa, which has the power to close down nursing homes which pose an urgent risk to residents, carried out an unannounced follow-up inspection at Kilminchy Lodge on December 29th, 2009, to check if the issues its inspectors identified had been addressed by the registered provider of the nursing home, Patricia McCarthy.
Inspectors said they were satisfied there was a clear management structure in place, records were readily accessible and a system had been put in place to ensure the ongoing management of residents who had weight loss.
However they identified seven problems which needed to be rectified. They found the heating system was inadequate and the left wing of the building was not sufficiently warm on the day of their visit. Proper arrangements were not in place for disinfecting urinals.
The standard of personal care provided to residents was not consistent and inspectors found that some male residents were poorly groomed, according to the report.
Despite the serious weight loss problem identified by Hiqa in its first inspection in November 2009, food intake records were inadequately completed by staff at the home, said the report.
Ms McCarthy, who is the registered provider of services at Kilminchy Lodge Nursing Home, noted in her response to the initial report the inspection process was “informative but very stressful”.
“We would like to point out that any resident that had significant weight loss did have malnutrition assessments completed. It appears from the report that no action had taken place, although this is not the case,” she said.
Ms McCarthy said she would also like it clearly noted that one week before the initial inspection, the person in charge had left the premises having given one week’s notice. “This in turn left the service provider with no choice but to step in to the position until the position could be filled.”
In her response to the follow-up report, she said she appreciated any suggestions that would enhance the life experience for elderly residents at Kilminchy Lodge.
Key Findings Kilminchy Lodge Nursing Home Report
- Poor management of residents with weight loss.
- Not all staff files contained evidence of Garda vetting, although the person in charge said that she had applied for this.
- Nursing staff did not provide sufficient supervision to care assistants or direct their work practices. Most care assistants did not have formal training.
- A lack of clarity in the management structure, the role of the nursing staff in the allocation of work and the supervision of care assistants.
- Some residents, who were cognitively impaired, sat for long periods without any meaningful stimulation.
- Staff were not suitably trained on the prevention, detection and response to abuse.
- The care plan was not comprehensive and did not reflect the assessment findings.