An inspection at a Cork nursing home, which was experiencing a significant Covid-19 outbreak at the time, identified a number of issues that it said, if not addressed, would increase the potential for the spread of the virus 19 in the centre.
The Health Information and Quality Authority (HIQA) carried out an unannounced inspection at CareChoice Ballynoe last February in light of an extensive outbreak of Covid-19 in the designated centre.
Prior to the inspection, it said that four unsolicited concerns had been received between February 1 and 8 in relation to “the high rate of infection with Covid-19 among residents and staff, the lack of availability of adequate staff numbers to care for the residents, the lack of adequate and available personal protective equipment (PPE) and reported ineffective interaction and communication practices between the provider of Ballynoe Nursing home and family members.”
While the facility had remained Covid-19 free during the first waves of infection throughout 2020, the report said that between January 7 and January 31, 45 residents in the centre contracted Covid-19 and 19 residents passed away in the centre in the weeks leading up to the inspection of 11 February 2021.
The nursing home provides accommodation for up to 51 residents over two floors.
On the day of the inspection it said that the upper floor of the centre was closed and that 28 residents were living on the ground floor.
A number of residents were still very ill with Covid-19 and as a consequence, all residents remained in isolation.
The report said that the inspector observed that staffing levels were sufficient to meet the needs of the residents in the centre and staff also reported receiving good support and direction from the general practitioners (GPs) who attended the centre.
The majority of nursing and health care staff, who usually worked in the centre, were still isolating at home and the inspector found that all five of the nurses on duty and the ten health care assistants on duty were agency staff or had been co-opted in from other CareChoice centres to ensure staffing of the centre at a time when the centre's own staff were unable to work.
It said that the person in charge described communication difficulties associated with having new, co-opted staff and agency staff on duty, “explaining that as the staff did not personally know the residents and their families, effective communication was sometimes not optimal.”
During the unannounced inspection the inspector found that the management team in the centre had undergone significant change in the months leading up to the outbreak.
The report noted that the CareChoice crisis management team failed to adequately recognise and address the adverse impact that the absence of regular staff, who knew the residents, would have on maintaining effective communication with families.
It said that “the registered provider did not have sustainable or effective operational arrangements in place to ensure effective communication at a time when the person in charge in the centre was newly appointed and only beginning to build relationships with residents and families and significant numbers of regular staff were unavailable necessitating a reliance on a large number of new and unfamiliar staff to provide care and support to the residents."
It said that on the day of inspection, the person-in-charge acknowledged that: “communication was ineffective at the beginning of the outbreak, staff were not always available to answer the phone when the receptionist was not present, and compassionate visiting had not always been facilitated at the beginning of the outbreak.”
The person-in-charge told the inspector that communication had improved and that she now maintained daily communication with relatives by phone or email.
The inspector observed several measures the provider had in place to support the care of residents during this Covid-19 outbreak.
However, the report said that the inspector also identified a number of issues which if unaddressed, increased the potential for the spread of Covid-19 in the centre.
These included observations that staff were seen congregating in the narrow hallways without appropriate adherence to social distancing; a room, which was used for staff changing and staff breaks was cluttered with staff outdoor wear, coats and personal items and items were not stored appropriately; and a double door from a communal room leading into one isolation corridor was left open which resulted in staff, wearing full PPE, entering this room to retrieve boxes of gloves and other items, on a number of occasions.
The report also highlighted a number of other infection control related issues including that there was no signage on the bedroom doors of those who were isolating and it was not clear to the inspector which residents had passed the infective phase as all residents were still isolating.
Serious issues of concern in relation to medicine management were also raised and the inspector issued an urgent action plan to the provider.
The report also noted that on a number of occasions the person-in-charge did not notify the Chief Inspector of the unexpected death of a resident within the three-day time frame set out in the regulations. Nine such notifications were submitted outside of this time frame.
While the report noted that the severity of the Covid-19 outbreak in the centre was devastating for residents, their loved ones and the staff working in Ballynoe, it said that throughout the inspection the inspector observed that the care and support given to residents was kind and respectful.
Out of 17 areas assessed, three areas were ‘substantially compliant’, eight areas were compliant, and six areas were deemed ‘non-compliant’
A second inspection was conducted at the facility in April.
All CareChoice staff had returned to work at this point and the centre was no longer reliant on agency staff or staff from other centres within the CareChoice group
The report noted that overall, inspectors observed improvement in the centre since the inspection in February 2021.
Inspectors spoke with several residents in the day room and in their bedrooms throughout the day and said that feedback from residents was positive about the care they received. Residents said that staff were kind and helpful, and that 'every one is so good and 'better than the next'.
The report said that while improvement was noted with regulations relating to medication management, risk management, infection prevention and control (IP&C), visits and maintaining residents' personal possessions, judgement of non compliance remained for governance and management, training and staff development, records, and notifications; additional non-compliance was identified regarding fire safety and the complaints procedure.
Of 22 areas assessed in the second inspection, seven areas were identified as being substantially compliant, 10 areas were compliant and five areas were non-compliant.
The two inspection reports were among 45 separate reports published by HIQA on Friday on residential centres for older people.
Of the 45 reports published, inspectors found evidence of good practice and compliance with the regulations and standards on 20 of the inspections.
In general, these centres were found to be meeting residents’ needs and delivering care in line with the national standards and regulations.
Inspectors found evidence of non-compliance on 25 inspections. On these inspections, non-compliances were identified in areas including governance and management, infection control, premises, protection, fire precautions, residents’ rights, healthcare, medicines and pharmaceutical services, notification of incidents, individual assessment and care plan, and risk management
The reports are available here.