A HIQA report released this morning has revealed a number of examples of poor practice at Castlebridge Manor Nursing Home.
In an unannounced visit in August 2023, Residents told the inspectors that they often experienced long delays waiting for assistance, frequent staff resignations and poor staffing levels, being left in wet clothes , not being able to shower when they want, as well as very poor social engagement.
Call bells were often left out of reach of residents and had to go to bed at 7pm because if they waited for the night staff they would not get to bed.
Since the previous inspection, the registered provider had further reduced the staffing numbers on the night shift. An inspector was informed that if a resident requires the assistance of two staff members in Slaney unit that there is no staff member available if a resident falls or requires assistance. The staff member stated they would not hear a resident fall if they were in a room with another resident. The staffing rosters on the day shift were also reviewed in Ferrycarrig unit and an inspector was informed that there were now six healthcare assistants on in the morning time which is an increase of one, however, there was a reduction in staffing in the evening time with four healthcare assistants on duty after 2pm
Inadequate staffing that was impacting on their ability to ensure oversight and monitoring of the service delivered. Care plans were not consistently completed in accordance with Regulation 5 requirements. Adequate arrangements were not in place for the supervision of staff resulting in a culture that was task orientated and not resident centred. There were poor outcomes for residents, particularly those of higher dependency.
Inspectors found that the provider had failed to organise and manage the staffing resource effectively within the centre. Consequently, the provider had failed to ensure that the designated centre had sufficient resources to ensure that safe care and services were provided, in accordance with the centre’s statement of purpose.
In line with findings from the inspection in June 2023, staffing levels in the centre remained unchanged. The statement of purpose which Castlebridge Manor Private Clinic Limited was registered against states that there should be 52 healthcare assistants and 20 staff nurses. The resident profile is of 18 high and 39 maximum dependencies residents in the centre.
Residents were not appropriately supervised at mealtimes. For example, a resident that was assessed as a risk from aspiration and hence needing supervision while eating was left alone in their room to eat their lunch.
Feedback to management highlighting the staffing concerns through staff meetings and residents meetings were not addressed.
Overall, inspector’s identified that a human-rights based approach to care in the centre was not evident. Residents were not afforded the right to fairness, respect, dignity and autonomy as a result of of poor governance and management, poor oversight and ongoing staffing deficits in the centre. The lack of effective governance and management in the centre was impacting on the quality and safety of care in key areas such as residents’ rights, healthcare, managing behaviours that challenge and individual assessment and care planning. Residents had highlighted a number of concerns in relation to staffing in the centre and the feedback from residents to inspectors was that the feedback was not taken on board by management. One visitor informed the inspector that there was no point highlighting issues as nothing changes.
Inspectors were informed that restraints such as bedrails were reviewed and released every two hours while in place. However, records reviewed indicated that it was not consistently documented that these checks were taking place.A resident informed an inspector that they went to bed at 7pm because if they waited for the night staff they would not get to bed.
Residents’ informed inspectors that they were not toileted at a time of their choosing as they had to wait for up-to 3-4 hours to be attended to. As a result residents wore incontinence wear when it was not required. In addition, a resident informed an inspector that they were frequently left wet having rang the call bell as staff did not get to attend the need on time.
A significant number of call bells were located beyond residents reach.
Residents did not have a choice to shower daily if they requested it. All residents were on a weekly rota. While management stated that the rota was to ensure that all residents had a shower weekly, a number of residents expressed that they would like a shower more frequently.
Ongoing issues with the laundry remained. This was raised at the residents’ meeting and residents raised the issue with inspectors. For example; clothes were going missing or were returned to the resident and were damaged.
In response to the report the nursing home said they will address the staffing issues and have introduced new practises within the facility to address further problems.
