The future for nursing homes inspection

This year new care and welfare regulations will be introduced for nursing homes, while HIQA will also be revising its standards, writes Phelim Quinn.

Phelim Quinn, HIQA Director of Regulation
Phelim Quinn, HIQA Director of Regulation

The Health Information and Quality Authority recently published its first annual overview report of its regulation of nursing homes, covering from January 1, 2013 to December 31, 2013. One of the key messages emanating from the report is that our experience of services as a regulator is one of compliance with standards and regulations when compared with almost five years ago when we commenced regulation.

However, the report does identify a number of specific areas that we would see as challenging for service providers; these include issues in respect of medicines management and risk management. As a regulator, we will be working within the next number of months on a programme that will deal with these and other areas highlighted through our experiences in the first half of 2014.

This report also details our regulatory activity in respect of registration, inspection, other monitoring activities and necessary enforcement actions carried out in 2013. It provides an analysis of the action plans arising from our inspections of centres.

The year 2013 marked the beginning of the second three-year registration cycle for designated centres for older people. Renewing providers’ registration is a public confirmation that they have maintained their fitness to carry on the business of running a nursing home.

In 2013 we carried out 814 inspections of 565 centres, 78% of which were unannounced

During 2013 we processed 82 registration-related applications. Fifty two of these applications were in respect of registration renewals, as each registration expires at the end of the three-year registration cycle. The remainder related to new registration and amendments to the details and status of current centres.

We also recognise the need to ensure that new beds get into the system and operate a priority system for the registration of new buildings. Providers who plan to apply to register a new designated centre are referred to our Registration Office, while timelines are shortened to facilitate the swift introduction of quality beds into the system. We granted 21 new registrations in 2013. All registration decisions resulted in an increase of 65 beds in total.

Our inspections take place to assess providers’ continuing compliance with the regulations and standards and to gather evidence on which to make judgments regarding the ongoing fitness of the provider. In 2013 we carried out 814 inspections of 565 centres, 78% of which were unannounced, while 22% were announced. These inspections can take place on any day and at any time of the day.

While good practice was observed in the majority of the centres, the report sets out an analysis of the action plans contained in 697 inspection reports, separate from the thematic inspections. In the main, these action plans reflect deficits or areas of non-compliance in services and provide a framework for providers to outline prescribed actions aimed at making their service compliant.

Two key areas identified last year related to health and safety and risk management, and medicines management. Health and safety and risk management was considered in 97% of the inspections. Inspectors identified 1,807 actions required to address non-compliance under this outcome measure in 417 of the centres inspected. This represents 21% of all actions required across a significant percentage of designated centres.

Under health and safety, 90% of actions required a number of providers to put in place policies and procedures for residents, staff and visitors. This included updating and reviewing safety statements. Some examples noted within the report show that in relation to fire safety precautions, 27% of actions highlighted deficits in areas such as fire drills and practices, and ensuring that staff and residents are aware of the procedures to be followed in the event of fire.

On the issue of medicines management, deficits were noted as requiring action in 325 of the centres inspected. These actions related to providers being required to put in place practices and written operational policies on ordering, prescribing, storing and administering to residents, handling and disposing of unused or out-of-date medicines, and ensuring that staff working within centres were familiar with these policies.

Separately, providers notified us of 5,362 adverse or potentially harmful events in 2013. We also received 355 items of unsolicited information relating to 213 centres. We use this information and the outcomes of our inspections to inform our future regulatory activity and the guidance we issue to providers. In 2013, we issued guidance and regulatory notices on issues such as risk management, residents’ finances, the use of restrictive behaviours, and the provision of intimate care.

Under health and safety, 90% of actions required a number of providers to put in place policies and procedures for residents, staff and visitors

The reportalso outlines our evolving approaches to the regulation of nursing homes, reflecting the need to use regulation to influence and drive systemic improvements. To this end, in quarter 4 of 2013, we introduced the concept of thematic inspections, starting in the key areas of end-of-life care and food and nutrition and how they are provided in centres.

Last year we carried out 52 thematic inspections with our findings indicating that the centres inspected were continually improving the care provided to residents. In 2014, we will extend our programme of thematic inspections of food and nutrition and end-of-life care to other nursing homes in order to continue to promote improvements in these two areas of care.

Meanwhile, 2014 will also see the introduction of new care and welfare regulations for centres. We are also revising our standards. Having engaged extensively with providers in 2013 on our thematic inspections, we will be seeking their opinions and public feedback on our revised national standards during the year. Working with providers, our inspectors want to ensure we continue to focus on areas that require improvement and improve the quality of life for residents of nursing homes.

Phelim Quinn, Director of Regulation and Chief Inspector of Social Services, Health Information and Quality Authority