Resident at centre for disabled had to ‘purchase’ staff

A resident of a centre for the disabled in Co Kildare had to “purchase” staffing when his day services were closed, as his needs could not be met within the staff compliment at the centre, according to a Hiqa inspection.

During inspections of two centres on the St John of God Community Services campus in Co Kildare in early March, the Health Information and Quality Authority (Hiqa) found staffing levels were inadequate, particularly overnight.

Some residents were put to bed as early as 7pm because of low staffing levels.

There was just one staff member for 18 residents overnight in one centre and one staff member for 13 residents overnight in the second centre, where 10 of the residents had epilepsy.

Inspectors raised “grave concerns” that institutional practices observed in the larger centre had a negative impact on residents’ lives.

They also raised concerns over a lack of activities for residents. In the smaller of the two centres, inspectors said most residents were observed walking around the centre seeking engagement from staff and the inspectors.

In the larger centre, some male residents’ activity logs included “nail cutting”, which inspectors said was a basic need, not a meaningful activity.

The inspections found both premises were unsuitable for residents’ needs.

Bedrooms were very small, basic and institutional. Space was so limited in the smaller of the two centres that a resident who returned from hospital with a fractured leg had to be taken off an ambulance stretcher because the hall was too narrow for him to be carried into his room.

“This clearly highlighted that the premises was not meeting the needs of the residents and was unsuitable for its stated purpose and function,” the inspectors found.

They said the larger centre was in a poor state of repair throughout. Paint and plaster work was cracked and curtains were hanging off windows.

Inspectors found there were 13 access points to the larger centre and that a HSE dentist’s office for residents from other centres on the campus was located on this premises. Inspectors found this posed a risk to residents’ safety.

Corrective action

They also raised concerns that corrective action was not taken when incidents occurred. For example, records showed that, in the smaller centre, a resident had fallen from his bed, blocking the door for staff.

During the inspection the same resident was found on the floor, again blocking the door. Inspectors said they were “very concerned” about the staff’s inability to access residents in emergency situations.

Inspectors found that, in some cases, restraints were being used due to a lack of understanding of the underlying causes of behaviours.

For example, a closed vest garment had been used on a resident since 2007 to prevent stripping. However, inspectors said there was no evidence that efforts had been made to determine the underlying cause of this behaviour.

Other issues raised by the inspection team included:

- Inadequate measures for the protection of residents from harm and abuse;

- Concern around food and nutrition;

- Concern at a lack of governance and oversight;

- Personal information on residents being kept in a broken press and not, therefore, securely stored.

In its response, the centre management said it is taking steps to address issues raised during the inspection and provided timelines for same.

The management said a full review of staffing would be undertaken, that the handling of incidents and accidents would be reviewed, and that it would put in place a committee to develop a plan for accommodation which is fit for purpose.