41-page HIQA report details non-compliance in four areas of Western Care

THE findings of the Health Information and Quality Authority (HIQA) report into registered residential centres operated by Western Care Association in Mayo has found four areas of non-compliance.

Serious failings were identified in Governance and Management, Protection, Positive Behavioural Support and Risk Management Procedures.

The HIQA inspectors were complimentary of the workers they encountered and said in each residential centre, persons in charge and staff were committed to meeting the needs of residents and engaged in a respectful and kind manner.

However, inspectors also found that Western Care had inadequate oversight and support arrangements for persons in charge and staff. Inspectors found that this was having a negative impact on the delivery of consistent, good quality support to people with disabilities who lived in these centres.

As of March 1, 2023, Western Care Association was operating 36 residential registered designated centres in Mayo, providing 144 residential places. Sixteen of the registered centres were inspected between November 2022 and February 2023 and an inspection report was issued in relation to each of these inspections. The remaining 19 registered centres were inspected over a two-week period in March 2023.

One centre had only recently opened and subsequently was not included in the inspection programme. During a two-week inspection programme undertaken between March 13 and 21, inspectors met with 54 residents and 74 staff members, including persons in charge. In addition, inspectors spoke with both middle and senior management in Western Care Association. This process was completed on March 29.

Inspectors identified four key areas of non-compliance in Western Care Association designated centres in Mayo:

Governance and management

Inspectors found that Western Care did not have consistent and effective oversight arrangements to ensure that people with disabilities were being provided with a good quality support service.

They found that there was a variance in the levels of responsibility of persons in charge and area managers. In one case, a person in charge had responsibility for 17 services which significantly impacted on their ability to effectively manage the designated centres under their remit.

Positive behaviour support

Restrictive practices impacting on the quality of life and freedoms of residents were not subject to objective review to ensure residents’ rights and wellbeing were protected. Inspectors observed a range of restrictive practices such as use of video and audio monitoring devices, locked cupboards and restricted access to parts of the premises which were being implemented based on local management decisions. Other examples that inspectors saw included restrictions on access to televisions, radios, personal computer tablets and staff were unable to provide a reason for such restrictions or identify when they had been implemented or reviewed.

Protection

Overall, while the inspectors did not identify any significant instances of abuse, they did identify situations where the actions of some residents were impacting on the safety and quality of life of other residents through peer-to-peer interactions.

Inspectors found that Western Care was failing to ensure their arrangements for responding to safeguarding concerns were being implemented consistently and ensuring a timely response to safeguarding residents.

Staff did not know who to contact outside of office hours if there was a significant safeguarding concern. The policy guided staff to contact the An Garda Síochána, which may not be appropriate under all circumstances. Gaps in Western Care’s safeguarding arrangements increased the risk that there would not be an appropriate and timely response to safeguarding issues that may arise.

Risk Management Procedures

Shortly after arriving in a number of centres, inspectors identified risks to the safety of residents that had not been identified previously and consequently no actions were in place to safeguard residents against their impact. These practises were widespread. In summary, inspectors found significant shortcomings in the effective and consistent management of risk by Western Care across their centres.

The full report can be downloaded here: https://www.hiqa.ie/reports-and-publications/key-reports-investigations/overview-report-governance-and-safeguarding