An inspection of Lough Corrib Nursing Home near Headford by the Health Information and Quality Authority found “major non-compliance” with staffing requirements and no person in charge.

HIQA paid unannounced visits to the nursing home – which can cater for up to 26 residents – twice last May and again in June. At the time of the inspection there were 17 residents.

According to the HIQA report published this week, the authority received a tip-off regarding governance, staffing arrangements and care and welfare of residents.

At the first inspection, one nurse on duty was to care for the 17 residents and supervise care assistants.

“The staff nurse explained that she prioritised the care of residents and did not have sufficient time to carry out specific functions such as updating care plans, reviewing care practices or completing any audits,” the report reads.

At the time, the provider, Richard Keane, said he was in the process of arranging the discharge of all residents to the new ‘Caisel Geal Teach Altranais’ nursing home in Castlegar, which has capacity for 42 residents.

On the first day of inspection, there was no person in charge and the provider had failed to appoint a suitable deputy – inspectors met with the provider on two occasions during the inspection because of the seriousness of the findings, and he gave a written commitment to have a person in charge appointed within 10 days.

An experienced nurse who was previously a person in charge at the home was appointed to act as a deputy.

Inspectors also found incomplete records on residents’ health and condition. There were gaps in assessments, and consequently it was hard to track the resident’s clinical status.

The Directory of Residents did not contain all items specified in the regulations, such as next of kin addresses and contact numbers and residents’ GP’s details.

A sample of residents’ ‘end of life’ care plans was reviewed and inspectors found that most plans were blank, with only a small number of residents’ end of life wishes recorded.

In June, HIQA received further unsolicited information regarding end of life care, and carried out an inspection three days later. A sample of files of residents that had passed away were reviewed by the inspector, and most end of life carer plans were blank.

“The inspector noted that where a resident had passed away in the early morning, the priest had not been called,” the report reads.

Inspectors found that staffing levels were adequate on the days of inspection to meet the day-to-day needs of residents. However, the staff roster was not maintained accurately and on some part-time staff files, there was no evidence of Garda vetting, no references, no contract of employment or no full employment history.