Dirty floors, chairs, bed tables, feeding pumps and nebulisers were among the findings of health inspectors when they paid an unscheduled visit to a private nursing home in Waterford a few months ago.
The inspectors, who visited Mowlam Nursing Home in Ballinakill, Waterford, in April found hygiene "a huge area of concern" and took pictures of the filth they found.
The breaches of nursing home regulations detected at this home are among a litany detected in the first six months of this year in nursing homes across the State. They have been documented in nursing-home inspection reports released to The Irish Times under the Freedom of Information Act.
The inspection team who visited Mowlam Nursing Home in April observed "an uncovered plastic urinal containing urine on the locker top next to a drinking glass"; there was "dried-in faeces on the toilet seat" in one room; in many instances residents had not been seen by a doctor since admission; and a total of 14 accidents, mainly involving patients falling out of bed between 8pm and 8am, had been recorded in April 2005.
"Patients had been found on the floor. There were no witnesses to these accidents," the inspectors noted.
They recommended that legal proceedings be brought against the proprietors, Mowlam Health Care Ltd, Limerick.
The proprietors wrote to the HSE in June stating that they had experienced difficulty in finding cleaning staff to satisfy their requirements. They said that contract cleaners had been brought in and significant improvements made.
Inspectors returned to the home in July and, while they found "a marked improvement in overall standards of hygiene", they still had concerns about dirty nebulisers and feeding pumps. They also found that four residents had been in the home longer than a month and had not been seen by a GP. One had been admitted 11 months before.
At another home - St Ursula's, Bettystown, Co Meath - inspectors who visited in March found a chair in one room "excessively urine-stained and then covered with a sheet and blanket".
A pop-sock had been used as an extension to the cord on the light above a bed in one room, and a length of orange baling twine had been used for this purpose in another. This was removed during a follow-up inspection.
Inspectors also found that the emergency call facilities in five rooms were not working, which posed an unacceptable risk to patients, they said.
They also noted the diffuser on the light in the sluice room "was filthy and appeared to be full of dead insects", and the notice-board frame in the wash-up area was particularly filthy.
The inspectors, in a letter to the proprietor, Michael Browne, identified maintenance of the home as a "major problem" and warned that failure to deal with the issues raised could result in prosecution.
Many of the breaches had been attended to when the HSE carried out another inspection of the home in May.
However, the inspectors noted then that the head-rest on a bed in one room had been secured "using two plasters and two pieces of twine".
Meanwhile, inspection files reveal that officials also wrote to Mowlam Healthcare Ltd in June expressing concern about staffing levels at the Archersrath Nursing Home in Co Kilkenny.
"There is only one nurse on duty at any time in the 24 hours . . . It is not acceptable that the person in charge works [ a] 42/54-hour week on an ongoing basis to ensure that there is a nursing presence in this nursing home."
Inspectors also questioned the practice at the Rios Aoibhinn Nursing Home, Bunclody, Co Wexford, of serving breakfast to some patients at 6am.
At the Ratoath Nursing Home in Co Meath inspectors, who visited in June, found that a number of emergency call bells were out of order, while the general condition of storage cupboards in one kitchenette suggested "a lack of adequate day-to-day cleaning".
The proprietors of the Blackrock Abbey Nursing Home in Co Louth, were warned, following an inspection in May, that an accurate nursing record of each resident's health condition and treatment given had to be completed daily and signed and dated by the nurse on duty. "This was not done in relation to persons with intellectual disabilities."
When the Blackrock Retirement Home in Foxford was inspected in May inspectors found that nurses had been dispensing medication to one resident for a period of two weeks without any authorisation.
In March, when inspectors called to the Ballinamore Nursing and Convalescent Home in Kiltimagh, they found "quite a strong smell" in some bedrooms. "Greater frequency and intensity of cleaning, ventilation and management of incontinence, either individually or in combination, may be required," they said.