Residents left for up to 15 hours without food in Mayo centre

Residents in a care centre for adults with intellectual disabilities were left without food for up to 15 hours a night, an inspection report by the Health Information and Quality Authority (Hiqa) has found.

An inspection of Áras Attracta in Swinford Co Mayo, which housed 97 residents at the time of the inspection in February, found some were underweight and that residents were not offered assistance in an "appropriate and dignified" manner at mealtimes.

The inspections were undertaken as a result of “unsolicited information” provided to Hiqa following the death of a resident at the centre.

The inspection of the centre found supper was served between 7pm and 7.30pm in the evening while breakfast began at 10am in the morning.

This meant some residents were left without food for up to 15 hours, a practice which the inspectors noted was not based on the needs of individual residents, but to facilitate staff duty arrangements.

The inspectors found some residents were underweight. Some of these had been prescribed supplements and high calorie diets but there was no evidence on the daily record sheets that these residents were receiving the fortified diet recommended for them.

As part of the inspection they also observed the residents and staff at mealtimes. The subsequent report found “mealtimes were not a pleasant experience or a social occasion”.

Inspectors observed some residents being offered spoonfuls of food in quick succession before the individual had swallowed the previous spoonful and observed staff rushing residents through their meal and asking “are you ready” repeatedly between spoonfuls of food.

Inspectors also recorded a lack of awareness by staff as to the ability of some residents; some residents who were assisted by staff were later seen eating their meals independently.

Some of the dishes were served cold, having been left uncovered on an unheated trolley for between 20 and 25 minutes before being served.

The residents were not offered any beverages for the duration of the meal, were not offered second helpings and were not consulted about their preference before gravy was poured on their meals.

The inspectors were so concerned at the experience of residents at mealtimes that they requested the person in charge of the home to sit in the dining area during lunch, an experience she described as “enlightening, difficult and distressing”.

The inspectors also found the centre’s practices around the use of seclusion were “unsatisfactory”. A bedroom had been used for seclusion on five occasions in a 14-month period, contrary to the centre’s own policy which stated the room was not to be used for the purposes of controlling behaviour.

They also found the room had not been risk assessed and was therefore unsafe, as a resident had had access to scissors while in seclusion.

In its report Hiqa expressed concern that the person in charge of the centre “had not ensured that the service provided was safe, appropriate to residents’ needs, consistent and effectively monitored in areas such as mealtimes, nutrition and the use of restrictive practices”.

At the end of February an action plan for the centre was submitted to Hiqa stating that its recommendations had either been implemented or were in the process of being implemented, and that meal times had been revised with breakfast commencing at 9.30am and supper being served from 9.30pm.

A subsequent Hiqa inspection in May found practices at the centre had “significantly improved” as regards nutrition and the use of restrictive practices, and an effective management system had been put in place which “had resulted in a significant improvement in the provision of quality and safe care for residents”.

In a statement the HSE said it had also carried out three inspections of the centre. Of the 59 recommendations made by between the HSE and Hiqa, a spokeswoman said 52 had been fully implemented and the remainder were underway.

“Governance within the service has been strengthened and the HSE has been assured following review that the service being provided currently is safe. This has been externally assured by Hiqa the regulatory body in their report of May 2014,” the statement said.