An inspection of a HSE-run disability centre in Donegal has found that serious allegations of abuse had not been appropriately reported to management.
The inspection by the Health Information and Quality Authority (Hiqa) at the Drumboe unit, near Stranorlar found that when reported, allegations of abuse had not been properly investigated in accordance with national safeguarding policies or procedures.
The inspectors found that this resulted in vulnerable residents not being adequately safeguarded and in one instance when they reported an allegation of abuse they were adversely affected by having their respite services changed.
Hiqa published four reports on disability centres in Donegal this week. Serious issues were also identified with the Drogheda Unit at Sean O Hare Unit, Stranorlar, which provides respite to children and adults with intellectual disabilities.
The latest reports come after a critical report which raised similar concerns was published on Ard Greine Court in Stranorlar.
Drumboe and Drogheda unit inspections
The inspections at the Drumboe and Drogheda units were carried out in April.
Inspectors found managers were not competent in managing allegations of abuse which posed a risk to residents.
More favourable reports were also published on Sliabh Glas, Community Group Home, Letterkenny and St Martin’s House, Falcarragh.
At the Drogheda unit, where seven residents with ages ranging from 37 to 78 years were accommodated, inspectors found managers were not competent in managing allegations of abuse which posed a risk to residents, there were inadequate fire evacuation procedures which could pose risks to residents in the event of a fire, accidents and incidents in this centre had not been appropriately identified or managed and residents' rights, privacy and dignity was not promoted.
At Drumboe, Hiqa found major non compliances in eleven of the eighteen outcomes inspected.
These related to residents’ rights, dignity and consultation, communication, family and personal relationships, admissions and contracts for the provision of services, social care delivery, safe and suitable premises, health and safety and risk management, safeguarding and safety, notifications of incidents, governance.
In a response the HSE said the reports on Drogheda and Drumboe units identified “areas of concern including safeguarding and management”.
The HSE said it has implemented a detailed action plan to address all of the areas identified in the reports.
Measures that have been taken include putting in place “a clearly defined management structure. The HSE also said single room occupancy was implemented in Drumboe unit,weekly residents' meetings have commenced, training of all staff in safeguarding and protection awareness and fire safety has taken place.
There is an ongoing programme of staff training on managing behaviours of concerns and managers have received training in risk management.
“Intellectual Disability services are moving from a model which is largely institutional to a community orientated inclusive model such as that represented by Sliabh Glas and St Martin’s,” the HSE said.
The HSE said a programme of improvement is being implemented within intellectual disability services across Donegal, Sligo, Leitrim, Cavan and Monaghan.
“This process will take time to implement fully in order to get from the kind of service that we are today to the new community orientated model. This will be done in partnership with residents, parents and carers to ensure success.
“We have a very dedicated and hardworking team of staff within the intellectual disability services in Donegal who are committed to meeting the HIQA Standards and the provision of a Quality Service.”
The Drogheda unit
There were seven residents accommodated, six full-time and one respite, at the time of the inspection, with ages ranging from 37 to 78 years. The majority of residents had been assessed as requiring maximum support.
Inspectors found that the provider had not put appropriate systems in place to ensure that the regulations were being met. The inspectors found that the failure to meet the regulations had resulted in inadequate safeguarding and safety systems which exposed residents to inappropriate risks.
The inspection found the premises were not fit for the purpose and the centre was institutional in design and routine and lacked the provision of individual choice and privacy.
Inspectors found poor governance and management arrangements due to inconsistent management of the centre. There had been five changes to the person in charge of this centre in the four months before the inspection. There was no effective complaints procedure for residents in an accessible and age appropriate format. Furthermore, complaints were not adequately managed and investigated.
Drumboe unit, community house, Stranorlar
The unit provides respite to children and adults with intellectual disabilities.
There were two houses in this centre, one house was not operational and the other house provided day and overnight respite services to up to sixty one adults and children.
Inspectors identified serious allegations of abuse that had not been appropriately reported to management or when reported, had not been properly investigated in accordance with national safeguarding policies or procedures.
This resulted in vulnerable residents not being adequately safeguarded and in one instance when they reported an allegation of abuse they were adversely affected by having their respite services changed.
Inspectors also found serious failings in the governance and management of this centre which impacted on the quality and safety of care provided to residents. There was limited evidence of on-going audits to inform and support decisions in regards to risk management. Six-monthly unannounced visits and an annual review by the provider had not been carried out.
Two other centres in the county had more favourable reports.
The Community Group Home, Letterkenny provides residential services to adults with an intellectual disability.
Overall, the inspector found that residents had a good quality of life in the centre, and the provider had arrangements in place to ensure the safety of residents.
Furthermore, the centre’s senior nurse demonstrated knowledge and competence during the inspection. However, the inspector found the provider and person in charge had not, at all times, ensured effective governance, management and administration at the centre, which resulted in poor experiences for residents.
The inspector found that a lack of governance and management systems meant residents’ personal plans were not reviewed annually, fire drills conducted at the centre did not show if all staff and residents had been involved and were conducted using minimum staffing levels, arrangements at the centre did not ensure the containment of fire, all staff had not received training reflective the needs of residents and out-of-date medication was not stored in accordance with regulation.
St Martin’s House provides residential and respite services to adults with intellectual and physical disabilities.
The inspector found that residents had a good quality of life at the centre, with needs such as healthcare being addressed in a timely and effective manner.
However, the inspector found that the layout of the house was not suitable for the needs of the residents at the centre. Although the person in charge demonstrated knowledge and competence during the inspection, and the inspector found them to be a fit person, a lack of governance and management systems at the centre existed.
This resulted in contracts of care being unsigned, and did not include total fees to be charged. Personal plan reviews did not evidence resident participation, and had not occurred annually.
The centre did not provide suitable bathrooms and facilities for visitors.
Fire safety arrangements did ensure effective arrangements for containment and evacuation in the event of fire. The centre did not maintain records of meals consumed. Emergency medication plans did not reflect residents’ needs.