An inspection of a HSE-operated facility in Dublin has questioned 'Do Not Resuscitate' orders found for three residents.

The unannounced inspection on Cherry Orchard Hospital was carried out on two days in January by the Health Information and Quality Authority (HIQA).

HIQA said it found three files which identified each resident was not for resuscitation.

On this, it said: "The process was unclear in relation to the decision making framework for do not resuscitate orders and collaboration with residents was not documented within their files in relation to the decision made."

Inspectors said they requested to view the process which led to this decision.

"This was unclear, as no documentary evidence was available in relation to the discussion which was held with family members except for the fact that a discussion took place.

"No evidence was present that the resident themselves were involved in this significant decision making process."

Inspectors were told that all three residents would be able to participate in such a discussion.

Access to money

Inspectors said they were not assured that residents were consulted with regarding their finances.

"Some residents within the centre had restricted access to their finances, as this was managed through the campus manager's office.

"Some residents could only access their money at specific times when the office was opened."

HIQA added that the hospital must ensure "insofar as is reasonably practicable" that each resident has access to and retains control of personal property and possessions and, where necessary, that support is provided to manage their financial affairs.

'Major non compliance'

Overall, 11 outcomes were found to be major non compliant at the centre.

These were residents rights, dignity and consultation, social care needs, safe and suitable premises, health and safety and risk management, safeguarding, notifications, general welfare and development, medication management, healthcare, governance and management and records and documentation.

Inspectors also found two actions identified at a previous inspection had not been implemented.

However, they acknowledged the timeframe for one of the actions was the end of January 2018 - in relation to the access to snacks outside of designated mealtimes.

Inspectors said they requested to view plans of care in place for specific healthcare conditions, but these were not available.

This was also identified this during the previous inspection.

Inspectors said they were therefore "not assured that staff members were guided effectively and consistently in relation to the management of all healthcare conditions."

Breakfast case study

Inspectors observed breakfast in one unit and found residents' needs were not adequately met nor was the experience of mealtimes "homely."

One resident was sitting at the table for 10 minutes before a staff member acknowledged them.

During this time three staff members passed through the dining room.

The inspector spoke with each of the individuals, but two of these staff members were not working in the centre.

One was a member of the activity staff and the other was a member from the physiotherapy department.

HIQA found that "the practice of staff members from other departments using the back door of the designated centre to gain access and walk through the resident's dining room was not contributing to a homely atmosphere for residents when eating."

The third member of staff was from the catering department who did not know the names of the staff who had just walk through the dining room.

Inspectors saw a fourth staff member get breakfast for the resident and place cutlery with the meal in front of the them.

A fifth staff member removed the utensils and told another staff member to feed the resident.

This started at 9:40am, and from 10:00am to 10:28am the resident was left on their own in the dining room with the same cup of tea which was given to them at 9:40am.

The resident was then taken to physiotherapy with the cup of tea, at which point the inspector checked the temperature of the tea - which was cold.