Camphill Communities of Ireland (CCoI), which has facilities at Duffcarrig and Ballymoney, has come under the spotlight after the most recent Health Information and Quality Authority (Hiqa) report showed a large level of ‘non compliance’ to guidelines.
Hiqa inspectors reported serious concerns in relation to resident safe guarding, staffing, management of residents’ finances, infection control and the overall governance and management of the centre at Duffcarrig.
In Ballymoney, inspectors said that governance and management of this centre was found to be poor, and oversight systems were not effective and did not ensure the delivery of safe and quality care to residents.
In a statement issued to this newspaper, CEO Ann Sheehan explained that issues had arisen out of a cultural change within Camphill, with Duffcarrig being one of the longest running facilities.
‘The issues highlighted by Hiqa in Ballymoney and Duffcarrig relate to Camphill’s ongoing journey on two fronts. Firstly, moving from what was largely a volunteer-led model of service to one that is led and run by people with specialised professional skills and secondly, transitioning from a highly devolved structure in terms of management and operations to a more centralised model.
‘We have been working to do this while also maintaining the strong community ethos which has been central to our way of working and which community members and their families have placed such a strong value on. In a nutshell, we in Camphill have been on – and are still on – a journey moving from one way of working to another and the issues identified by HIQA capture some of the issues that we have been and are addressing as part of this transition,’ she said.
Although protection against Covid-19 was criticised by Hiqa in the reports on both the Ballymoney and Duffcarrig sites, a spokesperson for Camphill said that there has been no positive cases of the virus to date.
He was also keen to stress that both reports highlighted that residents seemed content in how they were being cared for and had a good quality of life, and that families of residents also echoed those sentiments.
The inspection by Hiqa took place in July, and since that date a number of the issues have been rectified. These include a new rostering system and checks on staff being carried out on a consistent basis; all records and files sorted, with new contracts of care and the personal asset register – for community members’ valuables – completed on August 14. Protection of community members’ finances is now in hand.
Camphill said it has since appointed a new Person in Charge for the centre and have also advertised for a Day Service Co-ordinator.
Camphill said that training was carried out on August 31 on face-masks and PPE, with Camphill doing spot checks along with new auditing systems in place to ensure compliance.
One particular issue was highlighted in relation to food safety, and the spokesperson said that twice daily refrigeration temperature checks are now being carried out along with other checks.
According to the report, on arrival at Duffcarrig, inspectors observed a list of house rules that had been written and put up by the 23 residents due to unhappiness with certain behaviours in the house. It outlined that there should be ‘no hitting, no spitting, no kicking’.
The inspector spoke with the residents about this and they said that they were not happy with these things happening in their home. The inspector assured the residents they would follow up the matters raised.
Overall, the inspectors held serious concerns in relation to resident safe guarding, staffing, management of residents’ finances, infection control and the overall governance and management of the centre on the day of inspection.
They noted that volunteer co-workers were working significantly greater hours than other staff members, independently covering shifts such as sleepover care at night, but this was not reflected on the rota.
A safeguarding reported indicated that there were 24 incidents in 2020 up until July 6, and 11 of these were open cases on the day of inspection.
These were peer to peer reported incidents, that ranged from cases of physical, psychological, sexual, financial abuse and neglect that were being managed by the provider at the time. They noted that, having had 51 safeguarding cases in 2019, and said to inspectors that progress was being made in the area.
A new centre catchphrase had been developed, ‘make it known, pick up the phone’, to encourage staff to report abuse, and this was highlighted as concerning by inspectors given the already high levels of safeguarding cases.
Inspectors noted the limited access to residents’ finances, cause for concern including that the amount of money in residents’ wallets did not consistently tally with records kept and envelopes of residents’ money found were not accounted for.
In some cases, staff were not aware who owned money or where it came from, and the money was not being kept in a safe and locked location.
With regard to Covid-19 safety, it was noted that residents and staff were seen sitting very close together sharing a meal, and on a number of occasions staff spoken with had differing interpretations of when and how to use PPE and masks while supporting the residents.
They noted uncleanliness as well as food preparation and storage areas that were visibly unclean. There had been an inadequate cleaning schedule in place or checking mechanisms for fresh produce like meat, eggs and milk.
It was agreed with Hiqa that Camphill would carry out an annual review of the quality and safety of care and support in accordance with standards.
It was noted that some staff did not have up-to-date garda vetting, but information was submitted to inspectors soon after the inspection.
Two staff members were identified as having no references and one staff member had no contract while six staff members were identified as needing either initial or refresher fire safety training. However, it was noted that Covid-19 was a contributing delay factor here.
The report concluded that non-compliance with regulations was ‘having a significant impact on the safety and quality of care being delivered to the residents’.
In Ballymoney, where there are significantly less residents (five in total), inspectors found practices relating to the safeguarding of residents personal possessions to be inadequate.
Ballymoney had less non-compliance than Duffcarrig, but inspectors raised a number of concerns. Inspectors said that governance and management of this centre was found to be poor, and oversight systems were not effective and did not ensure the delivery of safe and quality care to residents.
They observed incidents where staff had recorded residents’ spending on pieces of paper and post-it notes and had not obtained receipts in line with the organisational policy.
They noted that it was unclear as to the extent of some residents’ involvement in decisions around their own finances and whether they had been consulted about who would take responsibility in managing their money.
Safe systems for the management of residents’ personal possessions were not in place.
It was noted that the houses in Ballymoney were clean, with hand washing facilities, alcohol gels and PPE readily available in the houses.
At the beginning of the pandemic it had been agreed that one of the houses would be vacated so it could be used as an isolation location, if required.
However, guidance in place for staff on the use of face masks was not in line with national guidance and staff members were observed by inspectors to be working within two metres of residents without donning face-masks.
Following a review of staff files, it was identified that three staff members did not have up to date An Garda Síochana vetting in place, but this has since been rectified.
Two staff members were also identified as having no references in place and one staff member had no contract or details of their commencement date.
A number of fire doors throughout the centre that supported areas of containment were not closing as required.
Camphill confirmed that it has been working with Hiqa since this inspection to address the issues highlighted, with all outstanding issues being addressed.
Both Ballymoney and Duffcarrig received formal warnings from Hiqa regarding its concerns and were told to rectify issues by certain dates.