Concerns over 'chemical restraint'
A resident at a care home for severe and profoundly disabled people was restrained with a sedative-type drug 13 times in just a few months, inspectors have warned.
The Health Information and Quality Authority (Hiqa) said the case raised serious concerns about the use and oversight of medications and what it called "chemical restraint" at Cregg House in Co Sligo, a home for more than 100 adults and children.
The watchdog found sedatives had been used to deal with challenging behaviour despite the resident suffering from a pressure sore and not being checked for problems like incontinence, discomfort or boredom before the drugs were given.
One nurse told inspectors it was "better to give the chemical restraint at the start of the outburst otherwise it could go on for up to two hours".
A series of inspections from December to February this year revealed a high rate of injury among residents from other residents, with concerns raised over self-harm and aggression towards staff, visitors and among patients.
The Health Information and Quality Authority (Hiqa) said its inspectors warned the crux of the issues at Cregg House came down to a lack of staff, inadequate training, the challenging behaviour of severe and profoundly disabled residents, lack of stimulation, boredom among the residents and poor management.
In the first visit last December two residents had lacerations to their faces after an incident involving a third resident in which one resident was pulled off a chair onto the floor by another resident in what was said to be a regular occurrence and another was said to regularly push other residents to the ground from behind.
Staff said some of these events occurred because certain residents needed constant one-to-one care which was not being provided, while Hiqa identified one resident who was at considerable risk from these actions.
Emphasising the scale of the problem, one of the inspectors was injured by a resident in what was described as "an incident of challenging behaviour".
The reports revealed few social activities for residents and limited time outside, with a follow-up inspection in January revealing that several residents had not left the complex for several months.
Hiqa said this contributed to the many instances of challenging behaviour and self harm.
One of the few outdoor activities was a bus trip, but even then the residents could not get off to enjoy a takeaway because there were not enough staff to supervise them, the inspectors revealed.
Despite the failings identified, Hiqa said the frontline staff were calm, competent, patient and respectful to those in their care and sought to alleviate residents' anxieties where they could.
But the inspectors warned their work was constantly reactive and they did not have time to engage on a one-to-one basis with residents without leaving another alone.
Cregg House, part of which was said to have the appearance of an old institution, was told to do more to identify alternatives and limit the use of sedatives.
Other issues with medication included doctors making changes to prescriptions for warfarin over the phone and contradictions over the suitable dosage for an anti-psychotic drug.
Mistakes were also identified in how drugs were administered, including a nurse failing to sign forms that medication had been given only for another to come along and effectively double the dose.
In the children's unit, Hiqa warned that assurances could not be given to ensure consistent care.
There were issues over children being late for school, the design of the unit was inappropriate, while the recurrent issue over lack of staff was highlighted by children being left in bed until 1pm on the day of an inspection in February as there were not enough nurses to look after them.
Not all staff at Cregg House were garda vetted, Hiqa found.
On fire risks, hoses needed to be replaced, evacuation plans were poor, fire doors were either not fitted or closed and ordinary exits and escapes were routinely locked to avoid patients getting out.
Elsewhere, the choice and standard of food was described by one member of staff as "residents eat whatever comes up from the kitchen", while lunch time was at midday and dictated by the time staff took their breaks, not the needs of residents.
Hiqa acknowledged a number of changes were made to the staffing levels and how Cregg House was being run and managed since the first inspection took place in last December.
The home had been criticised in the past over poor staffing levels and lack of activities for residents when it was operated by the Daughters of Wisdom, a religious order.