A day in the life of Finbarr Colfer, HIQA inspector manager

In February 2010, another inspector and I visited a centre in our area. We were taken aback by many issues, but particularly by the day-to-day life for residents. For example, a third of the residents were restrained in old-style Buxton Chairs which were in a poor state of repair. None had a safety or therapeutic assessment or care plan for using these chairs, and none had been seen by an occupational therapist.

During the day, many of the residents were put sitting in the day room in rows facing the door to the hallway and the view they had was the back of another resident’s head. A lot of the residents did not leave their wards during the day. There were no arrangements to make the day interesting and staff did not have time to spend promoting social interaction amongst residents.

By the end of the inspection, we had identified significant improvements that were required across all six of the inspection domains, covering areas such as the quality of life and safety issues.

The providers (people in charge of the centre) stated that they had not familiarised themselves with the regulations or the national standards. They believed that they had three years to address the requirements and were waiting for inspectors to tell them how to do it.

Following the inspection, there were a number of challenging discussions with the providers about addressing their legal responsibilities and about improving the quality of life for residents in the centre.

These culminated in a meeting in our Dublin office. This meeting was a turning point at which the providers acknowledged their legal responsibilities and produced a detailed plan of how they intended to address the items identified on inspection. After the meeting, the providers sent us regular progress updates and a registration inspection was arranged for July 2010.

On that inspection, the difference in the quality of life for residents was immediately visible. Instead of rows, residents sat in small groups in the day room. Many were chatting with each other. A staff member was spending time with residents encouraging them to chat and to take part in various activities.

Residents told inspectors of the wonderful improvements in the way they spent their days, in the meals provided and in the physical décor of the building. Residents who had appeared withdrawn in the original inspection were animated and enjoying their day.

The providers still have a significant amount of work to do to meet their responsibilities and to provide a good quality service to residents but they have recognised this, have identified the work that needs to be done and are well on the way to addressing that work.

They and their staff have also recognised the improvements in the quality of life for residents since this work has commenced. They have developed a sense of pride in their achievements and developed an interest in continuously improving the service for residents.

In this situation, using influence to change the attitude of the provider allowed for significant improvements in the quality of life for residents of that centre. Because the attitude of the providers changed during the process, it was not necessary for inspectors to escalate their responses and to engage in enforcement action. The day-to-day lives of the people living in this home significantly improved: that’s part of what our inspection process is all about.