HIQA finds Kilbrew nursing home non-compliant with six health regulations

The Health Information and Quality Authority (HIQA) has found that Kilbrew Recuperation and Nursing Home in Curraha was non-compliant in six regulations of the Health Acts.

The HIQA Chief Inspector has today issued a report into a short notice inspection of the facility carried out on 4th June last.

The Kilbrew facility has been the focus of attention since the passing on 16th June of Ultan Meehan, who had been a resident there, and whose widow, Mary Bartley Meehan, had been raising issues about his care at the centre.

Inspectors found that some areas of practice were ineffectively monitored by the management team. The report states: “There were no clear systems in place to monitor some areas of practice. This had resulted in the management team not having a clear oversight of all aspects of the service provided. The lack of oversight resulted in non-compliances identified under the following headings: Complaints; Policies and Procedures; Health care; Risk Management; Premises.

“The poor management of complaints was also reflected in the fact that HIQA had been contacted a number of times by relatives since the last inspection of the centre in July 2019,” the report continues.

“These concerns related to the quality of the care and services being provided to residents living in the centre. Key policies and procedures had not been reviewed and implemented in line with the most up-to-date infection and prevention control guidance, 'Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units.'

HIQA says that the number and skill mix of nursing and care staff was good during the day and night. Residents told the inspectors that their needs were met and that they were satisfied with the standard of care they were receiving. However, inspectors noted that there were no house-keeping staff rostered on duty after 2.30pm each day. This left the centre with no housekeeping or cleaning staff on duty for a long period of time which could increase the risk of the centre being exposed to a second outbreak of Covid-19.

“Staff spoken with had a clear awareness of the signs and symptoms of Covid-19 and identified a clear pathway to report any concern regarding a resident. They had all received training in standard precautions, including hand hygiene, respiratory hygiene and cough etiquette, transmission-based precautions and the appropriate use of personal protective equipment. Residents had also received training on hand hygiene, respiratory hygiene and cough etiquette. However, staff informed inspectors that the channels of communication between the management team and staff did not always ensure that they had up-to-date information and guidance to support them in their work.”

Prior to the recent Covid-19 pandemic Kilbrew Recuperation and Nursing Care had a good history of regulatory compliance, HIQA says.

“Leadership and management of the centre made every effort to ensure that a good quality and safe service was being provided to residents. Where regulatory compliance had not been fully achieved, management and staff were willing to initiate the necessary improvements to ensure full compliance. There was a clearly defined management team which included the provider, the person in charge and an assistant director of nursing, who all worked full-time in the centre. They appeared to work well together. The centre had recently recovered from a COVID-19 outbreak which had resulted in the death of a number of residents. It was clear to inspectors that the consequences of this outbreak had a profound negative impact on the remaining residents living in the centre, their relatives and all staff working in the centre.”

Residents' views

Residents told the inspectors about how their daily and evening routines had changed due to the COVID-19 outbreak. They said they were aware that staff wanted to make every effort to ensure that they were safe and comfortable. They said that nurses and carers visited them in their bedrooms to have chats about the pandemic and provide up-to-date information to reduce their anxieties. Some residents commented that while it was initially very frightening because they did not know what to expect, now, they have got used to the way things are. For example, they and their carers wearing masks. For others, they considered that as time passed and the pandemic continued it became more frightening because they did not know what the future would be like.

Some residents were familiar with all the new terminology associated with the pandemic; social distancing, hand hygiene, cough etiquette, isolation and lock down. Some residents said that they still had lots to do during the current restrictions and told the inspectors that staff were making extraordinary efforts to engage with them and to create situations for recreation and fun. Overall, the consensus was that isolation was the most difficult thing to deal with during the current situation. Residents missed their usual activity plans especially their interactions with the local community, family and friends. They described a range of opportunities that had been created in order to facilitate their relatives to communicate with them, including technologies such as video calling and having a window visit either in communal viewing areas or outside their own bedroom windows. A number of residents expressed a strong desire for the restrictions to be over and things to go back to the way they were. Other residents were very optimistic considering that they will soon be free to do all the things that they previously enjoyed. Residents confirmed that they felt safe in the centre and they put this down to the dedication and commitment of the entire staff team.

Residents who had recovered from Covid-19 described the attentiveness of staff when residents showed signs and symptoms. They confirmed that staff did everything in their power to make them feel well again. A number of residents expressed their gratitude to the committed staff who had cared for them successfully in their home without the necessity of having to be transferred to hospital.

The Kilbrew centre was found to be 'Substantially Compliant' on the training and staff development regulation. On the day of inspection, two staff completed training on how to collect a sample for testing of Covid-19.

Staff spoken with told inspectors that the communication systems between managers and staff during the recent COVID-19 outbreak did not ensure that staff were kept up-to-date at all times with the infection prevention and control guidance. Inspectors found that communications had since improved but further review was required to ensure that staff had the information and support they needed to provide safe and effective care.

As the risks are in the orange and yellow category as opposed to red, the Kilbrew centre has to set a date for compliance.

A spokesman for Kilbrew Nursing Home tonight said: "We note the publication today of the report by HIQA following its inspection process. Kilbrew has noted the areas of required improvement as set out by HIQA, we also note the positive view by HIQA as to the good quality of care provided to our residents. While we welcome the fact that the report has been published, it is not appropriate to comment, as we first need to properly review the report ahead of making any further decisions or responses. However, we have already completed and implemented many of HIQAs requirements as set out in the Compliance Form."

HIQA has renewed the nursing facility's licence for a further three years, until August 2023.

HIQA has also published a report into a visitation on 7th July to Millbury Nursing Home, Navan, which was found to be fully compliant.