On 16 July 2009 the Commission of Investigation into Leas Cross Nursing Home published its long-awaited Report. Leas Cross Nursing Home was closed in 2005 by the HSE and removed from the Register of Nursing Homes following allegations of improper standards. In its Report the Commission identified a number of factors which culminated in inadequate standards of care at the home. The following is a summary of the conclusions of the Report.
Registration of Leas Cross Nursing Home
The Commission does not fault the initial registration of Leas Cross Nursing Home, but concludes that from 2000 onwards the Northern Area Health Board did not perform re-registration adequately. In particular it states the home was re-registered in 2002 with inadequate consideration. The decision to approve the expansion from 38 to 111 beds was taken without considering the implications of such a large expansion, such as staffing ratios. The Commission notes the re-registration should have been subject to conditions, such as a limit on the percentage of high dependency residents, and that following the expansion, the Health Board should have monitored the home. The Commission also criticises the re-registration of the home in 2004. Re-registration was approved notwithstanding there being a serious complaint of which the inspectors and Health Board were aware.
Staffing of Leas Cross Nursing Home
The Commission unsurprisingly concluded there was a sustained pattern of inadequate care at Leas Cross Nursing Home from September 2003 until the closure of the home in August 2005. It stated that this was primarily due to inadequate staffing. Given the high dependency of many residents, there was an inadequate ratio of nursing staff to care attendants, and many care attendants lacked the appropriate training. The Commission notes, and regrets, that the Nursing Homes Regulations 1993 do not mandate standards in this regard. However, it is satisfied the HSE or Health Board did have sufficient powers under the legislation to take action where they identified a failure to meet sufficient staffing levels.
Supervision and Inspections of Leas Cross Nursing Home
The Commission recognises that nursing home inspections from 2000 did not adequately include the residents of Leas Cross, resulting in delay in addressing the problems. This was due to both inadequate inspection practices, and an absence of legal requirements relating to residents’ wellbeing. The Commission held the HSE accountable, as it laid down policy and practice, rather than individual inspectors. In the Commission’s view the HSE should have required the examination of residents during inspections, which would have identified care-related problems, such as dehydration of residents. Further, policies for following up visits were inadequate, as most inspectors simply waited until the next bi-annual inspection to follow up matters.
The Closure of Leas Cross
The Commission notes that while the HSE’s decision to close Leas Cross may have been correct, the manner it did so may not have been in the residents’ best interests. It notes the HSE stated the need for twenty extra nurses in a sudden and unfair manner. Further, some of the HSE’s grounds for removing the Home from the Nursing Homes Register were not borne out by the evidence. The HSE’s actions suggest it was keen to close Leas Cross quickly following the Prime Time documentary.
Complaints made by or in respect of residents of Leas Cross Nursing Home
The Commission notes there were serious problems in respect of dealing with complaints, both on the part of Leas Cross and the HSE. First, the Commission criticises Leas Cross for lacking a formal policy for dealing with complaints, and for failing to keep any records. The absence of records in itself shows that residents’ grievances were not treated with the seriousness they deserved. A number of the complaints coincide with a large expansion, suggesting the home could not deal with the number and dependency level of residents. Allegations included unwarranted use of physical restraints and lack of regard for residents’ hygiene. The Commission also highlights two main failures on the part of the HSE. First, in several cases residents arrived at acute hospitals from Leas Cross with ailments such as dehydration, and there was no procedure for complaints to be made to the HSE regarding the home. Second, while generally the HSE responded to complaints efficiently, most cases were closed once the complainants had been notified of the outcome, and there was rarely adequate follow-up.
Transfers from St Ita’s Psychiatric Hospital to Leas Cross Nursing Home
The Commission criticises the transfer of 23 patients from St Ita’s Psychiatric Hospital to Leas Cross in 2003. First it notes the Health Board did not adequately assess the suitability of Leas Cross to accommodate 23 high dependency patients. Second, the Home did not make sufficient adjustments to accommodate their needs. Significantly, the intake coincided with a deterioration in standards of care.
Treatment of Leas Cross patients at Beaumont Hospital
Beaumont Hospital admitted a significant number of patients from Leas Cross. The Commission criticises the inadequate standard of care in considering their needs. A recurring pattern was witnessed of Leas Cross patients presenting with problems which indicated poor care at the home. However, only once did a member of staff raise concerns with Leas Cross. Despite the lack of a reporting procedure, the Commission opines that the hospital’s staff still had a duty to follow up on any concerns regarding the care afforded to patients in the nursing home from which they were admitted.