Nursing home resident left in physical discomfort while another left waiting to use toilet due to lack of staff

The unannounced inspection took place at Ave Maria nursing home in Tooreen in Ballyhaunis, Mayo last December.

“There were no staff available in the room to respond to these requests for support. Another resident was exhibiting a responsive behaviour and was repeatedly calling out for help,” the report from the Health Information and Quality Authority (hiqa) revealed.

“This appeared to be distressing some of the other residents sitting nearby. When the inspector spoke to this resident, their interaction appeared to deescalate this verbal responsive behaviour and the resident became less agitated and stopped calling out.

The inspector sought staff to come to attend to the residents. One resident told the inspector “there are no staff in here” and described the room as being ”very noisy”.

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“On the day of the inspection, an activity coordinator was present in the centre and the inspector observed activities including bingo taking place during the afternoon of the inspection. However, the activity coordinator was also allocated to supervise,” it said.

The inspector observed that residents enjoyed a good quality of life and were generally happy with their life in the centre.

However, this inspection found that improvements were required to ensure that all residents received appropriate support to make choices about aspects of their daily lives including menu options and social activities and that these choices were followed up by staff.

“The inspector found that some residents who exhibited responsive behaviours were not adequately supported by staff when they became anxious or agitated, due to insufficient numbers of staff on duty. This was an unannounced inspection,” it said.

“Throughout the day of the inspection, the inspector met with residents and staff, observed life in the centre, staff practices and staff interactions with the residents. The person in charge was not present in the centre when the inspector arrived but they attended the centre after a short period later that morning.

“An introductory meeting was held with the person in charge, followed by a walkabout of the premises. This gave the inspector the opportunity to meet with residents and staff, to observe the residents in their home environment and to observe staff practices.”

Residents’ visitors spoke positively of the nursing home and described the centre as a ”home from home”.

During the morning of the inspection, the inspector observed that twelve residents were sitting in one of the communal rooms. There were no staff in the room with these residents during this period of time as staff were busy assisting other residents with their toileting needs.

The inspectors said the allocation of one activities co-ordinator to provide activities for 38 residents and provide support and supervision of all residents using the communal areas was not adequate, and did not ensure that all residents were provided with the opportunity to participate in meaningful activities in line with their interests.

The inspector observed that residents who spent a lot of time in their bedrooms had little to no meaningful interaction with staff outside of care interventions and meal times.

Most staff interactions were respectful; however, during the latter part of the day, the inspector observed a staff member interacting with a resident who was expressing a wish to go outside.

The staff member told the resident that they ”could not go outside” and that they ”must sit down”.

The staff member did not make any attempt to take the resident outside in line with their request and did not provide any explanation as to why the resident’s request could not be facilitated.

This was an overly restrictive practice which did not uphold the rights of the resident involved. During mealtime, residents appeared to socialise well together.

The inspector observed that meals were served on small side plates, rather than standard dinner plates.

The portions of food provided were small. This was discussed with staff and it was evident that these portion sizes did not reflect each resident’s dietary needs or preferences.

Furthermore, the high dependency residents who were eating their lunch in the large communal area were not offered a choice in what they would like for dinner. The inspector observed staff transferring meals from a trolley and placing the meals in front of residents or assisting them to eat.

When the inspector asked staff how they were aware which choice of meal the resident wanted, they were told the residents are given ”whatever comes on the trolley”.

Furthermore, the majority of the meals being provided to these residents had been modified in line with each residents’ specific dietary needs.

This made the items on the plate difficult to recognise visually which meant that it was even more important that the residents were told what the meal choices were and their preferred choice provided for them.

This inspection found that although staff were trained in the safeguarding of vulnerable adults, the provider had not ensured that all staff had the appropriate knowledge and skills to recognise and report safeguarding concerns or incidents.

As a result some incidents were not reported and followed up promptly and effectively to ensure that all residents were protected.

An action plan to address the issues was agreed with the provider.