Ms Carol Grogan:

I thank the Senator for her questions. Governance and management constitute the cornerstone of any safe service. We find that where there are poor levels of governance and management, it affects many other regulations because there is a lack of oversight and a lack of the provider identifying these issues for itself. We do not want to go and identify issues. We want to go in and find that the provider has already identified those and has measures in place and we then monitor those measures.

Again, we found that the level of compliance was poor in congregated settings. In many cases, it was probably as a result of remote oversight arrangements put in due to the pandemic. In that case, providers put in written reporting from the designated centres because prior to that, they would have been going out. Understandably, during the pandemic, they were nervous and were trying to protect residents living in these centres. However, this had a knock-on effect, not just on governance and management but on other areas such as privacy, rights, quality of care and safety of care. We have highlighted many of those in the report.

The other issue relating to poor governance and management and remote oversight is the fact that providers are not speaking with residents directly. In our report and the report we published on Tuesday, we point out that the most important part of our inspection involves speaking with people who live there to hear their lived experiences. The residents' forum, where we meet residents outside the regulatory process, is also hugely important. The feedback from residents to us is that they do feel comfortable talking to us and think HIQA coming in is a good thing. In some cases, they say things do not change and we then follow up as to why they are not changing. Residents gave examples where they were part of the advocacy group. One resident described how they were training to become an advocate so that they could support other people with whom they were living. Residents talked about having a charter of their rights and being able to articulate and stand up for those rights and to call it out where staff or the provider was not supporting the rights of residents.

We are very careful when speaking to residents. First, most centres are very small so it can be difficult to find a private place in which to talk to residents. We are very keen to talk. If a resident does not want to talk to us, we will not do so but we will observe. We will observe interactions between residents and staff and interactions among residents because not everybody gets on with everyone they live with and that can have a significant impact on the quality of life in centres.

Privacy issues are much more profound in congregated settings. Residents told us they did not have a quiet place, they did not have a sitting room, the kitchens were locked and they could not use them, whereas when they moved to community-based settings, they had a sitting room and could watch television in their own room if they wished. They could do the things you and I take for granted and do every day. I might ask Ms McShane to outline how we find poor governance in centres because she goes out on inspections quite frequently.