The Health Information and Quality Authority (HIQA) has today published the Forvis Mazars Review of Regulatory Inspection Process - Designated Centres for Older People (opens new webpage) report. HIQA is also publishing 54 inspection reports (opens new webpage) on its findings and actions in nursing homes operated by the nursing home group, Emeis Ireland and an Overview Report (opens new webpage) prepared by the Chief Inspector for the Minister of State for Older People which reflect a comprehensive programme of inspections across the Emeis group.

Following the broadcast of a television programme about two nursing homes owned by Emeis Ireland, the Minister for Health and the Minister of State with responsibility for Older People requested that an independent review be carried out. The purpose of the Review, which was conducted by Forvis Mazars, was to provide an independent assessment of the regulatory processes of HIQA’s Chief Inspector of Social Services, to identify areas where the Chief Inspector could improve and to consider whether the regulatory framework should be strengthened to reflect changes in the operating environment.

The Review found that overall HIQA’s Chief Inspector’s regulatory and inspection processes are effective, in line with its powers under the Health Act 2007 (as amended) and regulations. The Review confirmed that the Chief Inspector’s registration and inspection activities follow a standardised and consistent approach, and are carried out in a fair and proportionate manner. It noted that the Chief Inspector placed a significant emphasis on safeguarding residents through its specific programme of safeguarding inspections and, in line with its legal remit, it sought to hold service providers directly to account given their primary responsibility for ensuring safe and effective care for all residents.

The Review also identified a number of areas where improvement is required, including:

• The inspection approach to culture and staff behaviour within nursing homes should be strengthened, particularly in relation to its relevance in terms of the lived experience of residents.
• A strengthened focus in all inspections on those areas that matter most to residents and their families. Areas for renewed focus include assessing
  residents’ involvement in decisions about their own care, promoting residents’ independence, and ensuring that the care and support for residents upholds their rights.
• Requirement for regulatory reform in key areas, including ensuring that parent companies or nursing home groups can be held to account by the Chief Inspector.

HIQA CEO, Angela Fitzgerald has welcomed the recommendations of the Review, commenting:

“People living in nursing homes have a right to feel safe in their homes and enjoy a good experience and quality of life. Our role as a regulator is to ensure that providers meet their responsibilities to deliver safe, quality services and to protect residents. Where providers fail to do this, we use our powers to ensure that providers take action in the best interests of residents.

 

“As a regulator, we must always be open to critically evaluating what we do and how we do it. For this reason, we very much welcome this independent Review about our regulatory processes and how we do our work. We fully accept the findings and are committed to fully implementing themrecommendations. We hope that the positive findings about our processes and our regulatory model and approach will provide assurance to those using services, their families and the wider public. We fully accept that the Review also identifies where we need to improve and work is already underway in this regard.

 

“In particular, we are committed to reviewing how best we continue to hold providers to account. In this context, we are redoubling our efforts tomevaluate how providers support and enable positive staff culture and behaviour in their services to ensure positive outcomes for people using services.

 

“We are looking at how we plan and carry out different types of inspection and strengthening how we use information to enhance our understanding of the quality of service being delivered by providers on an ongoing basis. We will engage with providers as part of this process so that we secure their direct input and ownership.

 

“We are also actively working to improve the information we make available to residents, families and the public about our role and ensuring that the most up-to-date regulatory status of nursing homes is available. The views and feedback from residents and families will be critical to the success of this work.

 

“The Review also highlights priorities for regulatory reform, particularly in the context of the changing nursing home sector, and we are continuing to engage with the Minister for Heath and the Minister of State for Older People on areas for improvement in the regulatory framework.”

Today, HIQA is also publishing 54 inspection reports of nursing homes owned by Emeis Ireland. Following the airing of the RTÉ Investigates Programme on two nursing homes within the Emeis Group, which highlighted examples of poor and unacceptable staff behaviours and practices, HIQA’s Chief Inspector of Social Services undertook a significant programme of regulatory action. The Chief Inspector conducted a programme of targeted inspections in all nursing homes owned by Emeis Ireland and required the directors of the individual nursing homes to take urgent action with immediate effect to address the safety and wellbeing of residents. The Chief Inspector also engaged with Emeis Ireland and requested that they stop admissions to all centres owned by Emeis Ireland with immediate effect while a review of quality and safety of care for residents was being undertaken by HIQA.

The regulatory programme included an increased number of targeted inspections and monitoring of all nursing homes operated by the nursing home group over time to ensure ongoing safety and sustained improvements for residents. It found
evidence that a number of the centres were operating to a good standard and providing safe and effective care. The inspection programme also identified that seven centres had significant challenges in delivering safe and effective care. This required additional regulatory action which included undertaking additional inspections, placing restrictive conditions on those nursing homes, including a requirement to restrict the admission of new residents until further notice and
requiring the provider to increase staffing. The Chief Inspector also made referrals to An Garda Síochána as appropriate. HIQA also engaged directly with residents and families on their feedback and concerns. As part of this, HIQA’s CEO and Chief Inspector visited the nursing homes that were the subject of the programme to hear directly from all residents and families.

The two centres that were the subject of the RTÉ Investigates television programme were among the Emeis Ireland centres which required increased regulatory action.

The inspection reports for these centres are not being published at this time as HIQA is awaiting the outcome of legal proceedings seeking access to all video footage relating to the programme. These reports will be published at a later date.
HIQA is fully committed to implementing the recommendations of the Forvis Mazars Review to ensure that providers deliver consistent high-quality, safe and effective care and support for residents. HIQA is working with the Department of Health to publish regular updates on progress in these matters.

ENDS

Notes to Editor:

• HIQA’s Chief Inspector of Social Services has statutory responsibility for
  independently regulating designated centres for older people for compliance with the regulations under the Health Act 2007, to ensure that the people living in these services are safe and well cared for.
• Emeis Ireland is not a registered provider of any nursing home and as such is not regulated by the Chief Inspector of Social Services. Instead, Emeis Ireland owns the companies that are the registered providers of 26 nursing homes across the country.
• HIQA has published 54 inspection reports on 23 nursing homes operated by the nursing home group featured on the RTÉ Investigates Programme last summer, detailing its inspection findings and regulatory action taken over the past year in those services.
• Last year, following engagement with RTÉ and in the interest of safeguarding all residents of the nursing homes featured in the programme, HIQA’s Chief Inspector initiated legal proceedings to seek access to all of the footage that RTÉ has in relation to the nursing homes featured in the RTÉ Investigates programme. HIQA is awaiting the High Court decision. The inspection reports on the two nursing homes featured in the programme will be published following receipt of the Court order.
• Anyone with any feedback on the care or support delivered in nursing homes can contact HIQA at: concerns@hiqa.ie or 021 240 9646. More information can be found at: Report a Concern or Give Feedback | HIQA. All information received by HIQA is used to inform its regulation. Information is reviewed, risk rated, followed up with the service provider as required to ensure that residents’ needs are met, or referred to another body for review.

About HIQA

The Health Information and Quality Authority (HIQA) is the independent body that promotes safety and quality in the provision of health and social care services in Ireland.

Through its regulation, standard setting and evidence to inform decision-making functions, HIQA supports health and social care services to consistently deliver excellent standards of care and the best possible health and social care outcomes for all.