Residents' quality of life 'compromised' at care centre in Kilkenny

The Health Information and Quality Authority (HIQA) has highlighted many shortcomings in the care being offered to the residents of Comeragh Residential Services in Kilmacow, County Kilkenny.

Comeragh Residential Services is a designated centre operated by Brothers of Charity Services Ireland CLG that aims to provide a 'high support residential service for up to eight adults, of both genders with intellectual disabilities'.

According to HIQA, 'the quality of life of residents in this centre was found to be compromised' and there were concerning levels of non-compliance noted in a number of areas, notably 'staffing', 'governance and management', 'general welfare and development' and 'residents' rights'.

When HIQA inspectors visited the facility in January, they noted that the quality of life of residents 'was found to be compromised and was not observed to be of a good enough standard'.

"Overall inspectors observed a centre that was not particularly homely and found that a number of issues pertaining to resident compatibility and staffing were continually impacting on the lived experience of all residents living in this centre," HIQA stated.

"Inspectors observed the majority of residents in this centre had very limited opportunities for appropriate levels of social activation and stimulation and spent large periods of time lying on their beds or sitting in chairs.

"Residents living in this centre were not assessed as compatible to be living together. For example, residents with dementia, autism and other mental health presentations were clearly and frequently triggering each others behaviours resulting in incidents, outbursts and a general approach/culture of keeping residents away from each other. A number of residents were observed as having very little to do and very little meaningful engagement in their lives.

"Some staff members spoken with could not identify residents' specific care needs such as residents with dementia, diabetes and specific modified dietary requirements. Given these staff members were providing direct care and support to these residents, this was a particular concern.

"Residents' rights were impacted due to the ongoing compatibility issues. They had limited choice and control to where they could spend their time in the home. Meal times were staggered. Although these issues had been well identified by staff and management and measures had been put in place to keep residents safe there was an ongoing impact to a number of residents within the home.

"The number and skill mix of staff in this centre was inadequate based on the evidence reviewed on this inspection. Furthermore there was a deficit in staff training in the areas including managing challenging behaviour and first aid. Due to residents' specific assessed needs, specific training was required in a number of areas such as diabetes and epilepsy. Not all staff had received training in these areas.

"Residents assessed as requiring quiet/low arousal environments were not being provided with this as they were living with residents who screamed/shouted at regular intervals. On arrival to this centre, inspectors met one resident who was kept between emergency doors to await a bus to leave the centre as their presentation was reportedly so loud and disruptive to the other residents."

HIQA also noted that the Chief Inspector of Social Service had previously issued formal caution to the registered provider regarding ongoing poor compliance levels in this centre in 2022 and that this inspection found that appropriate levels of improvements had not occurred.

According to HIQA, 'the lack of progress in this centre to address a number of the previously identified issues did not demonstrate good governance and management. The ongoing issues of resident compatibility and the lack of provision of a consistent and core staffing team was impacting on residents care and support. This needs to be addressed at registered provider level'.

When contacted by The Kilkenny People, Brothers of Charity Services Ireland acknowledged the issues raised in the HIQA report.

"A comprehensive action plan to address the issues raised in the report has been submitted to, and accepted by HIQA," they stated.

"Substantial progress has been made on addressing the issues highlighted and the services are committed to ensuring all remaining actions are addressed in line with the timeframes outlined in the plan."

Elements of the action plan submitted to HIQA in a bid to address the issues raised include:

- The appointment of two new fulltime care assistants

- A new roster to further reduce reliance on agency staff use

- The service manager to complete fortnightly visits to the centre to provide further onsite support to the staff team and monitor the implementation of the centre's compliance plan

- A review of the lay out and use communal areas is to be undertaken with the facilities manager to maximize the potential use of areas for the benefit of the people supported.

- Alternative accommodation is to be explored for one resident who is impacted by the compatibility issue.

- A medical review for one resident is currently being carried out to investigate an undiagnosed medical condition which may be exacerbating elements of the residents presentation including loud vocalisations.

- The provider is to seek permission from Kilkenny County Council and the HSE to close off one funded vacancy/bed within this centre. Should this be approved, the installation of a sensory room to enhance the space available for residents will be developed in conjunction with occupational therapy guidance. 

It is worth noting that 'substantial compliance' at the centre was noted in areas including quality and safety of the premises, protection against infection, fire precautions and protection.

Also, 'compliance' was noted under the categories of 'medicines and pharmaceutical services' and 'health care'.

It remains to be seen how many elements of the submitted action plan will be followed through.