A scabies outbreak in a nursing home in Co Kilkenny was likely exacerbated by several infection prevention and control failures, the Health Information and Quality Authority (Hiqa) has said.
An unannounced inspection took place at Brookhaven Nursing Home Limited in Donoughmore, Ballyraggett, on September 24th last.
The inspection found several areas of noncompliance.
The scabies outbreak ongoing at the time was likely worsened by “the lack of resident isolation when symptomatic, unclear guidance for staff, improper management of laundry and non-washable items as well as potential errors in the application and administration of treatments”, a report noted.
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A number of residents told the inspectors there was a shortage of bed sheets and blankets or duvet covers were sometimes used to cover mattresses as a substitute for sheets, according to the report.
There were 67 residents at the facility at the time of the inspection. The scabies outbreak was mainly confined to one wing of the centre, with an isolated case in another wing.
The report said medication for use in the treatment of scabies “was not always administered in line with prescriber’s directions”.
“There were inaccurate records for the administration of prescribed medication, ie eye drops and the medication used for the treatment of scabies. Nurses were not adhering to best practice procedures when counting control drug medications,” the report said.
“These gaps contributed to continued transmission and highlight the need for enhanced staff training, standardised procedures and improved oversight of infection prevention and control procedures.”
Poor practices identified during the inspection in relation to infection prevention and control “have been addressed directly with staff through immediate feedback and follow-up supervision”, the document said.
The report was one of 50 published by Hiqa on Monday following inspections in residential centres for older people in recent months.
Several areas of noncompliance were also observed at St Theresa’s Nursing Home in Thurles, Co Tipperary.
There were 26 residents in the centre at the time of an unannounced inspection on October 28th. Inspectors found significant noncompliance in relation to governance and management.
“Prior to this inspection, the chief inspector had been notified of several incidents whereby a resident with enhanced supervision needs, had left the centre without the staff’s knowledge of their whereabouts,” the report said.
“Following each of these incidents, the provider had committed to implementing risk-mitigating measures, including weekly audits of safety checks.
“This inspection found that the number of residents who required continuous supervision had increased, however, there were inadequate staffing resources available to meet the residents’ care and support needs.”
A review of the centre’s staffing roster on the day of the inspection found “the staffing levels and skill mix were not appropriate to meet the assessed health and social care needs of the residents, in particular residents with complex needs who required continuous supervision”.
Following the inspection, care planning compliance is “now monitored through a monthly audit programme, with findings reviewed through governance meetings and escalated where noncompliance or risk is identified”.
“Corrective actions arising from audits are assigned to named owners, tracked to completion and overseen by management,” the report added.
Of the 50 reports published, 26 centres were either fully compliant or substantially compliant with regulations under the Health Act 2007.
Levels of noncompliance varied in the remaining inspection reports, with 13 centres non-compliant with three regulations or fewer, and 11 centres non-compliant with four or more regulations.
Noncompliance was identified in areas including staffing, infection control, individual assessment and care plans, fire precautions and residents’ rights.
Where noncompliance was identified, providers were required to submit compliance plans to demonstrate how they will make improvements and come into compliance with the regulations.
