The resignation of several staff members from the well-known Droimnín Nursing Home and Care Centre in Laois has led to a temporary halt to admissions to the facility in Stradbally.
The relatively new nursing home is the subject of a published investigation report by the health service watchdog, Health Information and Quality Authority (Hiqa). The home is part of the Brookhaven health care group.
The report sets out the findings of a two day unannounced triggered inspection in December 2017 following receipt of unsolicited information of concern received by the Health Information and Quality Authority (Hiqa).
The concerns alleged issues on inadequate staffing and a poor quality of care provided to residents. The 70-bed unit had 82 residents at the time of inspection.
"Evidence found during this inspection did substantiate these concerns. The inspectors found that 28 members of staff (20 full time positions) had resigned since August and staffing levels were inadequate to meet the care and welfare needs of residents.
"As a result the provider nominee agreed to a temporary hold on all new admissions into the centre until such time that the management are reassured that the staffing complement is stabilised and that the care delivered is safe, appropriate to residents' needs, consistent and effectively monitored," said Hiqa.
The authority says its inspectors focused on care and welfare of residents and staffing, and also monitored progress on the actions required arising from the last inspection carried out on the 17th August 2017.
The inspectors met with residents, relatives, the provider nominee, the person in charge, the deputy manager and staff members during the inspection.
Hiqa say managerial change has taken place and recruitment is underway, but issues remain.
"The centre's management team has undergone significant change over the past nine months, and has had two changes to the person in charge. As a result of the change in front line staff, the centre has put into place a recruitment plan and additional measures to minimise the impact on resident care needs.
Despite these measures the inspectors found clear evidence that the turnover in staff is impacting negatively on resident care.
The Hiqa inspectors found clear evidence that the "significant changes to the clinical staff was having a direct negative impact on the care for residents."
● the failure over an extended period of weeks to provide adequate staffing levels on each unit to deliver the care
● gaps in mandatory training records for fire and the detection, prevention and response to abuse
● the complete absence of nursing assessments and development of care plans for a high percentage of the resident's files reviewed.
Each unit has one nurse on duty. However, the required documentation was not in place to guide nurses on the individual needs of residents in order to ensure that their medical and nursing needs are met.
"These gaps in documentation coupled with the high turnover of nursing and care staff posed a significant risk for residents," said Hiqa.
The inspection report found that the "vast majority of staff" that the inspectors spoke with over the course of the two day inspection "repeatedly highlighted the issue of healthcare staff shortages."
"The overwhelming majority stated that the recent turnover of staff was significantly impacting on staff members' ability to effectively meet residents' needs," it said.
Healthcare staff that inspectors spoke with informed the inspectors of occasions where cover was not provided for staff on unplanned leave.
To counteract this issue the management team have implemented a new on call system. To date this system has not resolved the ongoing issue of providing cover when staff shortages occur.
The inspectors were informed of and observed long periods of delay in responding to residents that requested assistance with care related issues. Large groups of residents were also observed sitting in communal areas and were unsupervised for extended periods of time.
The inspectors also noted that concerns about the high level of staff turnover had been recorded in the minutes of residents' meetings. In these minutes, reassurance was given by that all steps were being taken to address the issue of staffing to ensure continuity of care.
In its response to Hiqa, managment said this matter has been subject to comprehensive review by the Management Team and measures have been put in place which will ensure that correct staffing numbers are in place and that the skill mix of staff is appropriate to meet the needs of the Residents taking into account size and layout of the Nursing Home.
It said safe and effective recruitment practices in line with the nursing home’s policy are in place to recruit staff. Particular attention will be focused on ensuring that newly recruited care staff will have the required skills and experience necessary to enable them to respond to the needs of the residents.
"The Management team, along with the Clinical staff, will focus particular attention on ensuring that care staff receive the necessary support and supervision to enable them perform their job to the best of their ability going forward," said the report.
The nursing home's website says it places it "residents at the centre of all our efforts."
"We strive constantly to achieve this through the provision of excellent care in a happy and respecting environment, while encouraging and supporting each person to enjoy their life as they wish.
"We foster a culture of independence and choice where our residents can recover and build confidence in themselves and their abilities. At Droimnín Nursing Home we deliver the very highest standard of nursing and medical care to all our residents."
The home was built in 2011. It is part of the same healthcare group that operates a nursing home in Ballyragget Co Kilkenny.
Gearoid Brennan is the Chief Executive.