‘Significant focus and effort’ needed at Ramelton Community Hospital - HIQA

A Health Information and Quality Authority (HIQA) report has highlighted failings in patient safety, comfort and social engagement at Ramelton Community Hospital.

The report noted: “Overall, the inspector found significant focus and effort were now required to bring this designated centre into regulatory compliance and to ensure that the care and services provided for the residents were safe and of good quality.”

The report was published on December 1 and related to an unannounced inspection carried out on August 4. 

Ramelton Community Hospital is a single storey building designated to provide health and social care to 30 male and female residents primarily over the age of 65. There were 21 residents present when the inspection took place.  

Accommodation is in single and double rooms and there are several communal areas.. 

According to the report: “Overall, those residents who spoke with the inspector were positive about the care and support provided by the staff in the centre. 

“However, a number of residents told the inspector that the arrangements that were in place to support their social care needs were insufficient and that there were not many activities happening in this centre to keep them occupied.”

The inspector noted that the reception area was also used by the general public attending the physiotherapy outpatient department.

“This created an unacceptable risk to residents as the members of the public attending the physiotherapy department had access to some of the residents' areas,” reported the inspector.

It was noted that some doors leading to corridors in the centre’s various sections were locked. This meant staff assistance was required for the residents to access the reception and the dining room. 

The report continued: “The dining room was a pleasant space that overlooked the entrance to the building and the road outside the designated centre. Some residents told the inspector that they would like to be able to sit in this area to watch what was happening outside but said that they were not able to access the area outside of meal times.”

The inspector also drew attention to the poor state of repair of the centre’s physical environment, which had previously been highlighted in an inspection in 2021. Walls and skirting boards in communal areas were visibly damaged, and areas of the centre were visibly dirty. The inspector noted dirt and grit accumulated in cracks and small holes in floor linings in several bedrooms and clinical areas and along the corridors. 

The inspector went on to say that overall, the atmosphere of the centre was dull and lacked colour and interest. 

In addition, the inspector observed that the doors of some rooms were not closing properly, and were not scheduled for repair. 

There were handrails along the corridors throughout the building. However, equipment was stored along some corridors and in communal rooms. 

“This arrangement posed a risk of injury to residents who accessed these areas,” reported the inspector.

On a more positive note, the inspector found that the corridors were adequately lit and well-ventilated, and the temperature of the centre was comfortable.

Day Rooms

The inspector spent time in the day room and noted that while staff interactions with residents were kind and respectful, they were mostly task-oriented and brief. As a result, the residents spent long periods of time without any social engagement either with staff or with each other. 

Some residents told the inspector that they often felt lonely. 

The inspector noted that the communal areas were noisy, with chair alarms frequently activated to alert staff to attend to the day rooms when residents stood up or attempted to move away from their chairs. 

The inspector said: “This was an overly restrictive practice, especially as there were enough staff on duty to allow staff to be present in the day rooms to engage with residents and supervise the movements of those residents who may be at risk of falls.”

Physiotherapy in Corridors

The inspector observed that during the morning, some physiotherapy sessions were held in corridors and in communal rooms. This meant that the resident did not have privacy whilst working with the physiotherapist. 

It was noted that there was no activities schedule available, and staff were not allocated to provide activities in line with the residents' preferences and capacities. 

Bedrooms

Privacy curtains were provided in multi-occupancy rooms, which supported the privacy of residents.

Televisions were available in the bedrooms, and some residents were enjoying the television in their rooms. 

However, the layout and design of single bedrooms did not support the needs of the residents with higher dependencies. 

The inspector observed that even though several vacant rooms with en suite facilities were available on the day of inspection, a resident with a high level of mobility needs was accommodated in a single room that was not suitable for them. 

Dining

The inspector noted that the dining room had seating arrangements for ten residents at a time. Menus were displayed at each table, and dining tables were nicely set out. However, only those residents who needed minimal assistance were facilitated to eat there. 

Those who needed one to one support at meal times ate in their bedrooms, or on tables set out along the link corridor, or in communal day rooms. They did not have menus.

Some of these residents told the inspector that they would prefer to eat in the dining room but were not offered that choice. 

Governance

In terms of governance, areas deemed to be compliant included Staffing, Records, Statement of Purpose, Written Policies and Procedures, Personal Possessions.  

Substantial Compliance was recorded in Training and Staff Development, Individual Assessment and Care Plan, Health Care, Managing Behaviour That Is Challenging. 

Non-compliance was noted in Governance and Management, Notification of Incidents, Complaints Procedure, Premises, Infection Control, Fire Precautions, Medicines and Pharmaceutical Services, Protection, Residents’ Rights.