Further improvements needed at Stewarts Care centres, Hiqa has said

Mark Hilliard

A residential care service for children and adults with both intellectual disabilities and complex health needs has been told it must further improve its standards, having faced serious sanctions less than two years ago.

The Health Information and Quality Authority (Hiqa) said while positive steps have been taken by Stewarts Care Ltd, the operator of eight separate centres, more was required to ensure progress.

Its overview of the service, which provides care for more than 150 people, followed initial 2017 reports identifying concerns around practices and how they affected the lives of residents. The centres in question are primarily based in Palmerstown, Dublin.

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A statutory notice of proposal to cancel the registration of two of its centres was issued in June, followed by four more in August. Such notices are the first step in a potential move to close a facility.

However, Stewarts Care subsequently provided Hiqa with plans to improve its performance - a process that instigated an ongoing series of inspections during late 2017 and 2018, the results of which were outlined in a report published on Monday.

Many of the original problems identified at the centres included issues relating to “restrictive practices” - measures that restrict movement and behaviour to various degrees - healthcare, safeguarding and safety, residents’ rights, privacy and dignity.

In its report, Hiqa noted there “continued to be relatively high levels of non-compliance with the regulations and National Standards in the centres”, although residents’ quality of life was improving.

“The provider was advised that this progress must be sustained and that further improvements are needed,” it said.

Consideration is currently being given to applications by Stewarts Care to register an increased number of designated centres on its Dublin campus and in the community as part of its reconfiguration plan.

One area of concern requiring further attention outlined in the report related to safeguarding and safety issues.

In 2017, inspectors noted that measures had not been implemented to protect residents from harm or abuse and that appropriate action was not taken in response to allegations or suspicions of abuse.

There was also “widespread” use of restrictive practices and a “poor understanding” of what constituted such practices.

Follow up inspections last year identified an overall improvement in this area. However, the report said there were continued inconsistencies in the implementation of safeguarding practices to ensure residents were protected from harm.

There were improvements in safeguarding training and in the number and quality of plans to protect people from risks although this was not consistently implemented, it said. The number of residents in each house had also led to ongoing problems.

“There continued to be a high level of restrictive practices in use in the centres,” it said. “In addition, there was inconsistency in the way restrictive practices were being managed across the centres on the campus.”

Further inspection reports are due to be published later this year.

In a statement, the board of Stewarts noted that Hiqa is now willing to accept an application for registration for all of its care homes.

“Stewarts has always been committed to providing a high standard of care and support to persons with an intellectual disability,” it said.

“The conditions described in those [earlier Hiqa]reports were not acceptable and the governance and management systems which pertained at the outset of this period (pre-2107) were not capable of addressing the shortcomings.

“Although the scale and complexity of services means that change can be difficult, and slow, the Board accepted fully its responsibility to resolve the issues of non-compliance highlighted by Hiqa’s work.”

It noted Hiqa’s report made reference to improvements at the care facilities in several areas of service including protecting the rights and dignity of residents, management structures and staffing levels.