Nursing unit under fire over staffing levels

St Anne's Community Nursing Unit in Clifden

Workers at a HSE-operated community nursing home in Clifden complained there were not enough staff to meet the needs of residents during a surprise inspection by the Health Information and Quality Authority.

The visit found two ‘major’ issues of non-compliance – staffing levels and privacy and dignity for some residents forced to use commodes.

‘Moderate’ issues were also recorded relating to government and management; health and social care needs and health and safety and risk management.

HIQA inspectors made the unannounced visit to St Anne’s Community Nursing Unit on the Westport Road over two days last October. There were 23 residents there at the time, and one vacancy in the two-storey building.

In a ‘major’ non-compliance recorded on management, inspectors found there were insufficient resources to ensure “the effective delivery of care”.

“The person in charge stated that although she had found deficits in auditing the [patients’] care plans, she did not have sufficient time to enact a quality improvement plan.

“Staff members spoken with stated that they did not have adequate staff to meet the needs of residents, in particular there was a decrease in staffing levels after 6.30pm, when there is one nurse and two care assistants to meet the needs of 17 maximum-dependency residents and seven high-dependency residents,” the report reads.

It adds that the HSE failed to provide “an appropriate comprehensive response” to queries from the inspector.

HIQA also found major non-compliance with effective care and support at the centre – issues relating to the provision of toilets had not been addressed since a previous inspection.

“Residents residing in the five-bedded room do not have access to a toilet/en suite within the environs of their own bedroom space. As a consequence, the use of commodes/continence wear does not promote residents’ independence, privacy or dignity in line with the National Standards.

“In order for a current resident to access a toilet/shower they have to be assisted by hoist out onto the corridor to access a shower/bathroom/toilet. While there is a small toilet in the upper corner of the five-bedded room is only accessible to mobile residents due to its size. To use this facility, you have to pass through the private space of the resident in the corner area of the room.

“At times during the inspection, this area was found to be cramped and unsuitable for the number of people accommodated therein and the activities ongoing. There was little room to use a hoist or sit by a bed. As the wardrobes are located on entry to the room it is difficult for residents to access personal items. It is impossible to personalise your own personal space as there was no space to do this,” the report found.

In its response to a list of requirements set out, the HSE said: “We have plans in place and funding to construct a new 50-bedded unit on the grounds of St Anne’s. This is to replace the local community hospital and St. Anne’s. It will be completed by 2021.”

They added that an electronic care planning system is being introduced, which will allow more efficient use of nurses’ time on the floor, and they are “actively working on” recruiting staff, although it is a “major challenge”.

The HSE is also in the process of recruiting a Director of Nursing for the Clifden area, and hope to have this completed by May 2017.