HIQA Reports

For the purpose of HIQA registration and inspection regime, St John of God operate TWO centres on the campus of St Mary of the Angels. There have been a number of inspections and reports which are detailed below. Click on the dates to see the actual reports.

In July 2018, HIQA confirmed full registration of both centres on the St Mary of the Angels campus. This is a great achievement and in no small measure due to the positive influence and hard work of the Parents and Relatives Association which has been acknowledged in recent reports. Confirmation in newspaper articles as part of 50th Anniversary coverage.

Reports for Centre DC1:

    • October 2015
      • Four units on the grounds of a large campus in a rural area of Co. Kerry.
      • 33 residents
      • The report is favourable overall but lists two units as having privacy issues arising from the multi occupancy in bedrooms: St Fidelis and St Brendan's.
      • Page 24 shows the following action item on foot of the inspection, amongst others: "Consultation and agreement with the HSE to set up National Joint Task Group to progress the de-congregation of Saint Mary of The Angels as a national pilot site - St Fidelis in DC 1 is prioritised for phase one of this plan in agreement with HSE."
    • January 2017
      • a more organised, supportive and effective management system
      • access to allied health/specialist services such as dietetics
      • a review of the contracts of care
      • provision of appropriate staff training and refresher training.
      • Unannounced inspection over 3 days in January 2017
      • 31 residents (two less than in October 2015)
      • Since last inspection, no further admissions were being taken into the unit which had the reduction in resident numbers. This improved the living arrangements for those remaining in the unit. For example, no more than three residents occupied shared accommodation whereas in 2015 one room was shared by five residents.
      • Inspectors observed how staff interacted with residents, observed the general comfort of the environment and the atmosphere within the houses. Interactions were characterized by a relaxed, competent and caring approach from staff.
      • It was clear staff took pride in their work. They told the inspector they enjoyed their work and worked well with their frontline colleagues. However, staff were not always clear on the reporting structures. Inspectors concluded staff views were not always heard by managers and that systems were such that staff were not adequately supported.
      • Inspectors identified a number of areas of good practice. Staff members were seen to interact with residents in a kind and caring manner and residents appeared to be comfortable in their presence.
      • Since the previous inspection the provider had taken measures to improve the physical environment. A significant undertaking had taken place to bring the centre into compliance with fire safety requirements. Some further premises improvements were needed.
      • Major non-compliances were found in the following areas. All are related to poor management, under-staffing and under-funding:
      • Work was ongoing in identifying areas for improvement including the manner in which resident finances were managed. However, at the time of inspection, inspectors found deficits in this area.
      • There were weaknesses in the manner in which risk was managed. For example, some risks were not reviewed in a timely manner and the review of other risks did not adequately take into account factors that impacted on this risk.
      • Inspectors were not satisfied that there were adequate numbers of staff on duty at all times to meet the needs of residents. For example, access to activities/day services had been curtailed for some residents due to staffing arrangements. There were inadequate numbers of staff on night duty, taking into account the significant physical and psychological needs of the residents living in the centre.
      • Other improvements required included:
      • None of the proposed remedial actions mention anything about 'de-congregation'. This is in sharp contrast to the previous report of 2015 where St Fidelis in DC 1 was prioritised as a national pilot site for 'de-congregation'. Inspectors were informed that the centre was currently closed to admissions and residents were transferred from the main building to other houses when vacancies arose.
    • November 2017
      • Unannounced inspection over 3 days. 
      • In a short amount of time since the previous inspection, the number and severity of non compliances has reduced markedly: From 6 Major and 2 Moderate in January to 7 Moderate in November.
      • The positive impact of the fundraising and family involvement has been recognised by HIQA: "Monies raised by families through fundraising events, were directed to enhancing the quality of life for those residing in the centre."
      • (Further analysis to follow soon)

Reports for Centre DC2:

    • March 2014
      • Six units. All units were bungalows with the exception of one, which was located on the ground floor to the rear of the main administration building.
      • 38 residents, 2 vacancies
      • The report is generally favourable with some areas identified for improvement (i.e. under 'Safe and suitable premises': decor not up to scratch, unsuitable shared bathrooms and one unsuitable single bedroom).
      • Note that there is no mention of any overcrowding or other issues nor are there any plans for 'de-congregation'.
    • December 2015
      • the number of residents with complex behavioural needs in each of the units
      • the inadequate communal space for the number of residents living in the units
      • the extended period of time that residents spent in each unit due to inadequate access to activities external to the centre
      • some residents did not have access to their bedrooms with the assistance of staff.
      • Eight units on the grounds of a large campus in a rural area of Co. Kerry.
      • 42 residents, 3 vacancies
      • Again the report is generally favourable but the assessment of 'Safe and suitable premises' has changed dramatically - even though the reality on the ground would not have changed much since the first inspection. Now we read:
      • Inspectors were not satisfied that the premises were designed and laid out to meet the aims and objectives of the service and the number and needs of residents, due to:

      • In response, page 28 lists the following action item: "St John of God Kerry Services is part of a Joint Task Group with the HSE to progress the de-congregation of Residents within St Mary of The Angels. The service is currently progressing phase 1 of the de-congregation plan for the campus which primary focus is on the older building on campus."
    • August 2016
      • Overall, the inspector formed the view that the majority of residents were happy and comfortable in their homes.
      • A number of residents were provided with improved living arrangements (partly achieved by moving one resident to a community house and another resident to a self contained apartment on campus).
      • The inspector observed how staff interacted with residents, observed the general comfort of the environment and the atmosphere within the houses. Interactions were characterized by a relaxed approach from staff. The atmosphere in all houses was good humoured, caring and flexible.
      • The inspector was satisfied that staff and management were person centred in their approach to resident care. The inspector saw residents going on outings, being able to spend leisure time together and develop friendships. Residents were offered independence while safeguarding security.
      • Staff recognised the importance of having consistent staff working with residents. This helped to ensure both staff and residents understood each other.
      • The centre was managed in a way that maximised residents’ capacity to exercise personal autonomy and choice in their daily lives. For example, residents choose what time they got up and went to bed, where they went shopping and who they met. Residents were enabled to take risks within their day to day lives. For example, go for walks, go on holidays and enjoy a social drink.
      • Residents had opportunities to participate in activities that were meaningful and purposeful to them, and which suited their needs, interests and capacities. For example, watching particular television shows, attending a day service or chatting with staff. The inspector noted the level and variety of activities had increased significantly since the previous inspection. Activities appeared to be an integral part of the daily routine, tailored to individual needs and flexible.
      • Residents were provided with a social model of care. They engaged in community activities such as going to the cinemas, to concerts and other events. The activities programme was flexible. On the days of inspection the inspector saw residents going out to a fair in a local town, swimming, enjoying a foot massage, engaged in board games, going for walks, shopping, visiting the onsite church and visiting the onsite canteen.
      • There was a suitable outside areas for residents. Residents were seen to have easy access to these spacious grounds. Care was given to maintaining the grounds and gardens in an attractive state.
      • The care delivered encouraged and enabled residents to make healthy living choices. Residents were actively encouraged to take responsibility for their own health and medical needs.
      • Food was nutritious, appetising and varied and available in sufficient quantities. It was available at times suitable to residents. Residents were supported to prepare their own meals as appropriate to their ability and preference. The inspector saw that meal times were positive social events.
      • There were sufficient staff with the required skills, qualifications and experience to meet the assessed needs of residents at all times. The number of staff employed increased since the previous inspection. Staff reported this increase had positive benefits in that it allowed more time for staff to engage in meaningful activities with residents. The inspector saw that residents received assistance, interventions and care in a respectful, timely and safe manner.
      • Some residents were not best served by virtue of their living arrangements. Not all residents were able to articulate the difficulties they faced in their home such as risk of peer to peer hostilities, inadequate personal space and provision of a more community orientated environment. Financial resources appeared to be the primary reason for the matter not being adequately addressed thus far.
      • Some residents continued to live in houses which did not meet their needs. For example, in one of the mixed gender houses, a resident frequently engaged in undressing when they were not occupied. In another house access to bedrooms was restricted due to the behaviour of one resident.
      • It was identified that some residents were not suitable for communal living and would benefit from living alone or with one other person. While the solution to alleviating the risk, which had been rated high for a protracted period of time, had been identified, implementing the change was resource led and this posed challenges for the management team.
      • The centre was inadequately resourced. Some residents lived in a house where they had been assessed as being at high risk of intimidation from fellow residents. The management team informed the inspector that constraints on resources were identified as to the reason that alternative living arrangements had not been put in place.
      • There were insufficient resources to support residents achieving their individual personal plans. For example, one resident was assessed as requiring a quiet environment but was accommodated in a house with five others whose behaviours did not lead to a quiet environment.
      • Property identified for purchase - suitable to meet the needs of the residents highlighted
      • Emergency application for additional revenue submitted to the Local H.S.E. who are supportive of proposal
      • Through consultation and partnership with the HSE the registered provider has identified and submitted proposals for requirement of additional revenue to the H.S.E.
      • This was an un-announced inspection with the purpose to monitor ongoing regulatory compliance.
      • The report is favourable overall and has identified several improvements since the last report:
      • Any non-compliances identified where caused by lack of resources:
      • Proposed actions to address the major non-compliances center mainly on Community Living Transition Plans, completed for residents in line with National policies, “Time to move on from Congregated Settings- a strategy for Community Inclusion.”
    • November 2017
      • This was an inspection carried out to monitor compliance with the regulations and standards and to follow up on matters from the previous inspection.
      • Families were active advocates for the residents. Relatives engaged in the life of the centre with the aim of ensuring their family member's voice was heard. Monies raised by families through fundraising events were directed to enhancing the quality of life for those residing in the centre.
      • The inspectors noted that since the August 2016 inspection, a number of improvements had been made in relation to:
        • the decoration and upkeep of the premises
        • the focus on providing a meaningful day for residents and
        • the increased emphasis of maintaining a regular workforce, thus ensuring disruption to attachments were kept to a minimum.
      • There was evidence that, year on year, residents' quality of life had improved. This was primarily due to the increased focus on establishing what a meaningful day meant for each resident. What was particularly noticeable was the increased awareness by staff around facilitating a social model of care. Inspectors also noted the improved lines of communication between frontline staff and the management team and between the management team and family members.