Fergus O'Dowd (Louth, Fine Gael)

I am pleased the Dáil has given time to debate this important Bill. However, I am disappointed the debate will end at 2 p.m. today. This is an occasion to reiterate what happened in nursing homes throughout the country. I will read from a report on an investigation into a nursing home in Cork. When I am finished I will explain why it is different from Leas Cross and Bedford House.

A number of complaints were made about a nursing home in Cork city. At the time, the registered owner was a medical doctor. The home changed ownership in January 2006. I want to stress that since then it has not been in the ownership of the former proprietor. Today, I asked the health board for a report on the home under its new ownership, which will be provided as soon as possible. Everything I state involves a nursing home operated by a Cork doctor between 1994 and January 2006.

Complaints were made about this nursing home, as a result of which a special inquiry board was established by the HSE. This is different from the nursing homes I spoke about previously as it is the result of an inquiry by the HSE into what happened in 2003 and 2004. Many people might say it is a long time ago but it is in the lifetime of this Dáil. It came to light after the Government made the promise in 2002 that it would introduce the legislation which is now before the House.

The delay in introducing this Bill is exacerbated by the knowledge the HSE had of this nursing home, the report on the nursing home and the fact it was sent to the Minister for Health and Children in September 2004, which happens to be the month the Minister for Health and Children, Deputy Harney, took up her present position.

I will read quickly from the report and make it available to the press afterwards:

The purpose of the investigation is to carry out an investigation under the Health (Nursing Homes) Act 1990 and the Nursing Home Regulations made thereunder, into the operation of this Nursing Home; to review the existing standards, policy and procedures in the home and to recommend any action or changes in existing arrangements necessary.

Membership of the investigation team comprised Mr. Conal Devine, chairperson; Dr. Catherine Murphy, senior area medical officer; Ms Regina Eviston, matron at Dunmanway Community Hospital; Ms Mary Falvey, principal environmental health officer and Ms Deborah Harrington, section officer, Southern Health Board. These are all suitably and highly qualified people. The proof they said they would apply to an allegation would be similar to that which would apply in a civil case. In other words, they would need a standard of proof to prove whether an allegation was true.

They conducted a number of interviews from 4 May 2004 to 29 July 2004. The report stated that the complaints officer of the former Southern Health Board, Ms Bridget O'Brien, investigated three separate complaints relating to the care of residents in this home. Two of these complaints related to a period in 2003, while the other complaint went back to December 2002. I am taking salient points from the report.

What were the findings of the environmental health officer, Ms Mary Falvey? In respect of the kitchen facilities she found:

The main kitchen was maintained in a clean condition; however, a large amount of boxes of washing detergent were stored in the kitchen area. These should be stored in a cleaning chemicals store. Delivery check records were available as were cooking and refrigerator temperature checks. The cooked food refrigerator was not maintaining food at 5° Centigrade. A variety of temperatures ranging from 7° Centigrade to 13.5° Centigrade were noted during the inspections.

The report stated that the cooking of lunch immediately prior to service is recommended. It also recommended the provision of a catering fan. It stated: "annual calibration of thermometer as temperature readings at 4 p.m. on records did not reflect readings noted by myself" and, a very important recommendation, that "the cook employed at weekends should receive food hygiene training." In respect of the service kitchen, the report said:

The wash hand basin was inaccessible due to the use of a wooden board, which covered the basin area. Both milk dispensers were dirty in the area from which milk was dispensed, and in my opinion had not been recently cleaned. Coagulated milk was visible on this area. The base of one of the dispensers was rusted. The microwave was not properly cleaned and the interior top surface was dirty. Cleaning records showed these units, microwave and milk dispensers, had been cleaned on a daily basis. The evidence indicated inadequate cleaning.

The report recommended the supervision of staff, that the cover on the wash hand basin be replaced and that the proprietor carry out and make adequate arrangements for the prevention of infection, infestation, toxic conditions or spread of infection.

In respect of the dining area for more dependent patients, the report said that "the timber surfaces supporting the formica tops were dirty with food debris as was the wall surface adjacent to the tables". It also said: "in several showers a white powdery deposit was noted on the surface of the tiles." In room 13, the report stated:

A gap between the door of the toilet and the end wall was visible. A lengthy crack was visible between tiles on the end wall. A large hole was visible in the ceiling.

In respect of the laundry, the report stated:

There were large holes with daylight clearly visible at the base of the external wall where holes had been provided to facilitate venting from drying equipment. The open end of ducting and the gaps around the vent ducting must be rodent-proofed to prevent access by rodents. Accumulation of piping and debris in corners of the laundry could provide harbourage for rodents. A small room in the centre of the laundry housing a water cylinder contained cardboard boxes. This area should be cleared of non-essential items as such undisturbed areas can provide harbourage.

It also stated: "openings in walls and ceiling for pipe work should be closed to prevent rodents' access." In respect of hand washing facilities, the report stated:

The patient w.c. facilities adjacent to their dining room were not supplied with warm water for hand washing. The staff toilet was provided with a communal towel. This is unacceptable and must be replaced with a single use facility e.g. paper towels.

The report stated that the waste storage area should be cleaned and that the ground area around the waste storage area was not kept clean. It recommended that the proprietor and the person in charge of the nursing home shall take adequate precautions against the risk of fire, including the provision of adequate means of escape, and make adequate arrangements to secure by means of fire drill and practices that the staff, and so far as is practicable, dependent persons in the nursing home, know the procedure to be followed in the case of fire. The report went on to state:

An exit from the office to the car park area, which had a fire exit sign overhead, was locked on the 16 June 2004. Its key was not available. Loose mats, potential tripping hazards, were noted on the floor of the fire escape near the entrances from the corridors.

Large items i.e. a bath, a commode and a mattress, were stored along the fire escape.

The nursing practice findings make very serious reading. The report stated that there was an insufficient number of nursing staff on duty and that waterlow pressure sore risk assessment carried out on all patients demonstrated that 22 of the 29 patients were at risk of developing pressure sores. It stated that "of those 22 patients, 9 are at high risk and 3 are at very high risk of developing pressure sores." The report goes on to identify issues relating to high, medium and low dependency. It contains a very important comment which I emphasise. The Investigation Team noted that the SHB [the former Southern Health Board] Complaints Officer, Brigid O'Brien, stated in her report of 30/12/2003 to Dr. Claire O'Sullivan, SAMO that "in my view ill old people should not be referred to this nursing home."

The report stated that adequate accommodation must be provided and that the dividing curtains in twin rooms are too small. In respect of the unfortunate patient in room 2, the report stated:

Room no. 2, resident's mattress is on the floor. This practice, which was advised upon at last inspection (02/03/04) is still not appropriate. At the announced inspection the mattress was on the bed and during the unannounced inspection it was found to be on the floor again.

The report went on to state that railings are required in the grounds to prevent injury and window restrictors are required on all first and second floor windows to prevent falls. It stated that all radiators throughout the nursing home should have radiator covers. It stated that the place should be made secure from interference by unauthorised persons, children or scavenging animals and that health care risk waste must be kept separate from non-risk waste. It stated that clinical waste was not stored or disposed of in accordance with Department of Health and Children policies.

Inadequate daily recording of patient's activities of daily living and conditions were found. The report stated that narrative notes should be written frequently enough to give a picture of the patient's condition and care to anyone reading them. There was no evidence of this in the examination of specific case notes. In respect of records of any accident or fall involving a dependent person, the report states that records of known incidents were not recorded.

It stated that recording of controlled drugs are in breach of An Bord Altranais guidance and that policy and procedures should be in place for checking a stock balance at each transaction. It stated that at changeover of shifts, a nurse from each shift should complete the count of these scheduled drugs. Drugs had not been checked for four days on inspection.

Many of the findings in the medical officer's report repeat what was stated earlier, but I will read some I have highlighted. The report stated that on the day of the unannounced inspection the mattress was placed on the floor in room 2 in the west wing, while on the day of the unannounced inspection, the mattress was placed on the floor. It stated: "This situation is inappropriate", which is a rather weak comment. It stated that the light in the en-suite room should be repaired, that toilet seat covers should be replaced in rooms 14, 16 and 17 in the west wing, that gaps and holes in walls should be filled in and that the cloth towel in the staff toilet in the west wing should be replaced with paper towels and so on.

The report goes on to state that the bound register should have all details recorded as per regulations, including the date of discharge and death, and that there should be one entry per page. It states that all drugs administered by nursing staff should be prescribed and written in drug charts.

What were the findings in respect of complaints made regarding individual residents in the nursing home? Have I much time left?

See this speech in context