HIQA uncovers a number of issues during Offaly nursing unit inspection
An unannounced inspection by HIQA of Birr Community Nursing Unit found non-compliance in some areas.
Inspectors found that residents had little opportunity to leave their bedrooms and there was no privacy during visiting hours.
Birr Community Nursing Unit was described in the report as a single-storey facility located in a quiet residential area, within walking distance of Birr town centre. The centre can accommodate 76 residents over the age of 18 years, both male and female for long term and respite care. Two beds are also dedicated to rehabilitation care.
Bedroom accommodation for residents is provided in two bedrooms with four beds, 13 bedrooms with three beds, eight twin bedrooms and 13 single bedrooms. Twenty-six bedrooms have en suite toilet, washbasin and shower facilities and 10 bedrooms have toilet and washbasin facilities only. A palliative care suite is available in the centre.
Overall, the inspector found that residents living in Birr Community Nursing Unit received good quality health care from a team of staff that were dedicated to enhancing the quality of life of the residents. The inspector observed resident and staff engagement throughout the inspection. It was evident that staff knew residents well and residents were comfortable and relaxed in the presence of staff. All interactions were conducted in a caring and respectful manner, the report stated.
While the centre was found to be clean in areas occupied by residents, further attention to cleaning was required in store rooms, treatment rooms and sluicing facilities. The inspector observed areas throughout the centre that required repainting due to general wear and tear and the person in charge confirmed that a programme of works was being developed to address these issues.
Over the two days of the inspection, most residents were seen to spend a significant amount of time in their bedrooms. Communal space was extremely limited in two units and there was very little opportunity for residents to leave their rooms. Dayrooms were observed to be dual purpose as they also served as each unit's dining room. The inspector observed that dining room tables occupied the majority of the room space and this resulted in limited space and furnishings that would be expected in a dayroom for residents to relax in.
The inspector spoke with ten residents in their bedrooms and the resident’s feedback mirrored the inspector's observations. Feedback was that dayroom space in each unit was limited and small in size. As a result, many residents told the inspector that they felt more comfortable staying in their bedroom as the dining room, outside of meal times, was not an appealing area to spend their day or relax in. Residents told the inspector that the dining room and dayroom combination was less than ideal as it did not help ‘break up the day’ through a change of environment.
On occasions, the instability of the staffing rosters impacted on the continuity of residents' care such as the provision of showers on days when there was a staff shortage. However, residents were provided with bed baths as an alternative and offered a shower later in the week when staffing levels were as planned.
The number of beds in one bedroom meant that there was insufficient distance between beds which meant residents' rights to privacy and dignity was compromised. As found on the previous inspection, curtain screens in multi-occupancy bedrooms provided visual protection for residents but these screens provided little or no protection from the noise and odours that a resident might experience in multi-occupancy bedroom accommodation. A reduction of beds in another bedroom provided residents with additional and usable communal space within their bedroom to store personal possessions and use at their leisure. Furthermore, a second four bedded multi-occupancy bedroom in one unit in its current configuration, required review to ensure that it complies with regulations.
In addition to the multi-occupancy nature of the bedrooms, there was limited communal space for residents to spend time away from their bedrooms, meet visitors in a private space or have confidential discussions with the staff. This was further reduced because: The parlour room was used by staff for breaks.
There were areas of the premises that required painting, redecoration and maintenance. Some equipment used by residents also required replacement. For example, some rooms had chipped paint and exposed plaster that required attention. Corridor walls had scuff marks and minor chips in the paint. Taps in the sluice rooms were dripping and had limescale build up on the faucet. Some equipment such as commodes required replacement due to rust on the wheel castors. Grab Rails on some toilets were heavily rusted at their base connection to the floor. This compromised effective cleaning There was inappropriate storage of items throughout store rooms. A treatment room had multiple boxes and clinical equipment stored on the floor and the hand wash sink was inaccessible as a result. A table was stored in an assisted bathroom with mobility aids. Hoists were observed to be stored in bedrooms occupied by residents.
Improvement was required to ensure that each resident was offered a choice of appropriate recreational and stimulating activities to meet their needs and preferences. Many residents were observed in their bedrooms during the inspection and were not provided with meaningful activities. Residents and staff reported that staffing levels impacted on the provision of consistent activities and residents reported spending long periods in their bedrooms without being engaged in meaningful activities when staff were redeployed to other roles.
Residents in multi-occupancy bedrooms were observed receiving visitors at their bedside when other residents occupied the room. This did not support the residents' rights to receive visitors in private or support other occupants' privacy