Ban in place on new arrivals at Clara nursing home

A nursing home in Offaly has been banned from admitting new residents, due to "consistently poor" regulatory compliance during a series of inspections carried out by the Health Information and Quality Authority (HIQA).

Esker Ri Nursing Home (pictured), at Kilnabin, Clara, was, in recent months, instructed by HIQA not to admit any new residents until it had established "a governance and management structure and personnel with the knowledge, competence and skills required to supervise the delivery of care to residents".

The prohibition on admitting new residents is currently in place, at the time of writing.

A report on an inspection carried out by HIQA in May of this year, which was published last week, stated that the inspection was arranged in order to follow-up on regulatory compliance issues identified during five previous inspections of the centre between June 2023 and February of this year.

HIQA said its inspection in May found that the registered provider of Esker Ri Nursing Home had "failed to put effective management structures and systems in place to ensure that the service provided was safe and appropriately monitored."

"The unclear organisational structure, and ineffective management systems of monitoring and oversight, continued to impact on the quality and safety of the care provided to residents," stated the report. It went on to say that following the initial inspection in May, a second inspection day was scheduled in order to "review unsolicited information" that had been received by the HIQA's Chief Inspector.

This information "pertained to concerns regarding resident referral and access to medical professionals, and the high incidence of residents being transferred to the acute health care services," the report said.

It added that the information received by the Chief Inspector "was substantiated on this inspection". HIQA stated in its report that Blackden Limited was the registered provider of Esker Ri Nursing Home. It said that "following consistently poor regulatory compliance over repeated inspections," its Chief Inspector of Social Services had issued notice of proposed decision to attach a condition to the nursing home's registration.

The purpose of the condition "was to stop new admissions to the centre until the Chief Inspector was satisfied that the provider had in place an effective governance and management structure and achieved compliance with key regulations that underpin the quality and safety of care provided to residents," it said.

HIQA's report said the registered provider of the nursing home "made representation within 28 days of the notice being issued," detailing actions which were taken to "address the non-compliance relating to the governance and management, and the quality and safety of the service".

The representation from Esker Ri "outlined a revised organisational structure, and the action being taken to bring the centre into compliance with the regulations," said the HIQA report.

However the HIQA inspectors found that the proposed organisational structure "had not been fully established," and that the actions taken were "not sufficient to meet the requirements" of the regulations.

"These persistent failings had a significant impact on the safety and quality of life for residents," it said.

The conditions attached to the registration information currently available for Esker Ri on the HIQA website state that it is not to admit any new residents until it has met a number of requirements.

These requirements include conditions relating to care plans for residents, the supervision of resident care, and "the provision of appropriate and timely access to medical and health care for residents, including a high standard of evidence-based nursing care in accordance with professional guidelines".

When contacted by the Offaly Independent last week, a HIQA representative said the registration information on its website was "accurate and reflects the current registration of Esker Ri Nursing Home".

Esker Ri has a capacity of 143 residents, and had 137 at the time of the inspection carried out by HIQA in May.

The report said residents at the facility in Clara told the inspectors they felt "safe and comfortable" living there, and also complimented the staff, whom they described as "courteous, helpful and kind".

HIQA said there was "a busy, but friendly atmosphere" in the nursing home during its inspectors' visit in May, and that staff were seen to respond "promptly" to residents' requests for assistance.

"During the inspectors' conversations with residents, they confirmed that they felt they were listened to by staff, but that some of the issues they raised were not always addressed to their satisfaction," said the report.

The "ineffective systems of governance and management" identified by HIQA included that, "the lines of accountability and responsibility for the oversight of care and safety of the residents were not clear".

The report said a revised weekly monitoring report had been implemented to monitor aspects of the service including residents' referral and access to medical practitioners, care delivery, incidents, complaints, and transfers to hospital.

However, HIQA found that the information collated for the weekly report "was not accurate and was therefore not effective in identifying deficits in the quality and safety" of the service.

It also said that the nursing home provider had "failed to ensure that there was adequate documentation of adverse incidents" involving residents.

"A review of adverse incident records found that incidents in which residents may have suffered harm were not documented or investigated in line with the requirements of the regulations," HIQA said.

In conclusion, HIQA found the nursing home to be 'not compliant' with eight of the ten regulations under which it was assessed during the inspection in May.

In response, the nursing home provider outlined a number of actions, some of which it had taken and some of which it planned to take, in order to achieve compliance.

These included that, by late July, it would have in place a "revised governance and management framework" for the nursing home, which would detail "roles, responsibilities, reporting relationships and reporting arrangements for each grade of staff".

It also said that, by the end of September, clinical nurse managers would have reviewed documentation, including "incident forms, assessments and care plans" for residents who had recently been admitted, had suffered a fall or another safety incident, or whose condition had deteriorated.

This documentation would be assessed "to ensure that incident forms are complete, that assessments and care plans have been updated as required, and any referrals needed have been made."