HIQA inspectors have found evidence of poor management and risk to patients at a number of care homes for those with intellectual disabilities.
The organisation published 11 reports this morning.
At one centre housing 40 people with intellectual disabilities in Co Donegal it was found a number of cases of abuse hadn't been reported.
Several allegations of abuse weren't properly investigated.
This resulted in vulnerable residents not being adequately safeguarded and in one instance not believed by staff when they reported an allegation of abuse.
HIQA says the provider was asked to take immediate action in response to the serious safeguarding and risk issues identified on inspection.
Following the inspection, the provider responded to the Authority in writing, giving assurances that they had commissioned a team of external managers in quality improvement and risk management to review the service and to report back to the Authority on their findings and the actions taken to ensure that residents are safe.
The full report can be downloaded here.
Excerpt from report -
Safeguarding and Safety Measures to protect residents being harmed or suffering abuse are in place and appropriate action is taken in response to allegations, disclosures or suspected abuse. Residents are assisted and supported to develop the knowledge, self-awareness, understanding and skills needed for self-care and protection.
Residents are provided with emotional, behavioural and therapeutic support that promotes a positive approach to behaviour that challenges. A restraint-free environment is promoted. Theme: Safe Services Outstanding requirement(s) from previous inspection(s): Some action(s) required from the previous inspection were not satisfactorily implemented.
Findings: Inspectors found significant evidence of allegations or indicators of abuse which had not been managed in a way to ensure the safety of residents and which had not been investigated in line with national safeguarding procedures. Two requirements made following the last inspection on 3 July 2014 in relation to staff training and local procedures to guide staff in the event of an allegation of abuse being reported had not been addressed.
The provider had stated in their action plan response that all staff would be made aware of the procedure through discussion at staff meetings and shift handovers. This had not occurred and 14 staff had yet to attend update training on the protection of vulnerable adults. At the opening meeting with the person in charge, inspectors were categorically told that there had been no incidents, suspicions, allegations or investigations of abuse in this centre since the commencement of regulation in November 2013.
However, from speaking to residents and staff and reading daily care records, inspectors quickly identified that a number of allegations of abuse had been reported to persons participating the management of the centre and that formal investigations had taken place. This was also confirmed with the intellectual disability services manager.
The person in charge subsequently provided inspectors with documentation of allegations of abuse that had been reported and one investigation that had taken place in 2015. From review of the documentation provided by the person in charge and consideration of the information provided by residents, staff and from care records, inspectors concluded there was a significant risk to the safety of residents as a consequence of seriously inadequate safeguarding arrangements in the centre. Examples of this included:
• The procedures used by the person in charge and others participating in the management of the centre to investigate abuse were inconsistent and did not provide assurance to those making allegations that their concerns would be heard and adequately responded to.
• An inadequate approach to responding to allegations of abuse. Staff members were unaware/unclear as to the appropriate procedures to follow when reporting allegations or indicators of potential abuse. For example, inspectors identified one instance where a resident alleged that they had been struck by a member of staff. When asked by other staff to ''act out '' the alleged assault, staff concluded from the resident’s response that the alleged assault was unfounded and did not report the allegation of abuse. In another example, a resident was inappropriately questioned by staff following an allegation of abuse and the person in charge failed to investigate the allegation in accordance with the centre’s safeguarding policy and procedures.
• Inadequate consideration of past history of resident on resident abuse when planning with residents where they choose to live within the centre.
• Failure to carry out an appropriate risk assessment or put in place adequate control measures to protect residents from peer abuse. One example of this related to a resident with a significant past history of peer abuse yet there was an absence of this history in on-going assessments or care records despite staff confirming to inspectors that the risk still existed. Another example was evidenced in an incident which occurred in January 2016 when two female residents had been physically assaulted by a male resident while being transported in the car. Following the assault, no adequate action had been taken to safeguard the female residents and a further similar incident occurred during a car journey the following week.
• A number of staff informed inspectors that when they raised safeguarding concerns with the person in charge, they were either not listened to or felt they were seen as “trouble makers”. The management of aggressive behaviour was not managed in line with national guidelines and this posed a risk to residents and staff.
While behaviour management plans were in place, these had been developed by nurses without guidance or input from a psychologist, behavioural support specialist or other members of the multidisciplinary team. There was an absence of proactive or reactive strategy in residents’ behaviour management plans, or when present, these were not consistently or appropriately implemented into practice.
For example, in one house, inspectors were told by staff that two male staff members were required to be present as a risk management control measure. However, on review of staff rosters, inspectors found that female staff were regularly left on their own to supervise residents. In one instance; inspectors were informed that a male resident had to be physically and chemically restrained following an aggressive outburst when female staff were left alone in the house.
Inspectors identified a number of examples of residents being physically restrained by staff including one incident where four staff members restrained and transferred a female resident to another location during a behavioural outburst. From review of the records relating to this incident, inspectors identified an absence of an appropriate behavioural management assessment or subsequent review to determine the appropriateness or otherwise of the intervention. The centre’s operational policy advises that use of physical restraint should only be used following all alternative options having been utilised and where the resident or others are at significant risk of harm.
This policy had not been followed in the incidents reviewed by inspectors. Furthermore; there were significant staff training deficits in the management of behaviour that challenges and the staff members involved in physical restraint lacked training in the appropriate techniques which put residents at significant risk of unnecessary injury.
Inspectors identified that chemical restraint was frequently used in this centre. Inspectors were told that it was used as a form of therapeutic intervention. In one case chemical restraint had been administered to one resident, 44 times in a two month period. However, there were no specific protocols in place to indicate when it should be used audits completed to identify the frequency of chemical restraint being used. These tools would ensure that staff administering the medication were aware of the clinical rationale for such usage. The records reviewed by inspectors indicated that chemical restraint was used in every house on a very regular basis.
Judgment: Non Compliant - Major