Introduction
In April, HIQA published 50 inspection reports on nursing homes. Levels of non-compliance varied across those reports, with 14 centres non-compliant with three regulations or fewer, and nine centres non-compliant with four or more regulations. This article focuses on the findings from those nine centres with four or more non-compliant regulations. Across that nursing homes, the clearest pattern was not a single isolated issue, but a wider connection between weak governance and the overall quality and safety of the service provided.
What stands out from these reports is that many residents and families continued to speak positively about individual staff, kindness and personal care. But HIQA’s findings show that goodwill at the frontline does not remove the need for strong governance, clear accountability, effective escalation and reliable quality assurance systems. Where those systems were weak, inspectors found recurring issues around food and nutrition, supervision, residents’ rights, records, incident reporting, premises risks and, in one case, outbreak management.
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Governance and Management – The leading non-compliant regulation
The most significant and recurring issue across the nine reports was Regulation 23: Governance and Management. HIQA’s findings suggest that many of the more visible problems in care were symptoms of weak oversight rather than one-off failures.
Weak oversight and ineffective auditing
Under governance, inspectors repeatedly pointed to monitoring systems that were not robust enough to identify and address risks early. Findings included:
- The audit schedule was not available to view on the day of the inspection.
- Regular auditing and servicing processes that did not identify emerging fire safety or premises risks.
- The provider’s auditing and oversight systems had not identified risks and deficits concerning staff supervision, medication management, call-bell access, residents’ rights and complaints management, as found during this inspection.
- There was only one audit found that was completed within the last four months. There was no action plan in place following this audit and no learning identified.
- Audits viewed were not measured to inform ongoing quality and safety improvements in the centre.
- Auditing of residents’ care plans failed to identify that residents’ care documentation was not completed to the required standards, and this posed a risk that relevant information regarding each resident’s needs and care interventions would not be available to staff, and these needs would not be effectively met.
Poor escalation and weak communication
A second governance theme was failure to escalate known issues quickly enough. Inspectors identified:
- Staff awareness of urgent operational problems that had not been escalated to management for resolution.
- Weak communication systems that did not ensure concerns were reported upwards in time.
- Delays in escalating issues around breakfast service, medication administration, smoking safety and maintenance faults.
- Management meeting and audit systems that needed stronger accountability and clearer follow-through.
Governance failures with direct resident impact
The reports also show that governance failings were not abstract. They translated into tangible risks and poorer resident experience, including:
- Inadequate oversight of mealtime quality and nutritional follow-through.
- Insufficient attention to residents’ rights and complaints.
- Poor oversight of incidents and statutory notifications.
- Failure to ensure services were consistently safe, appropriate and effectively monitored.
- Incomplete assurance that essential fire safety work had been satisfactorily addressed.
- The number of unwitnessed falls had increased in the centre in the two months before the inspection. While tracking and trending of falls were occurring, these reviews did not explore the causal and contributory factors leading to the falls.
Management structure and accountability gaps
In several reports, HIQA’s concerns also touched on whether leadership arrangements were working as intended. Findings included:
- Management structures that were not clearly defined in practice.
- Deputising arrangements that were not fully understood by staff.
- Staffing and management resources that were not aligned with the statement of purpose or prior commitments to the Chief Inspector.
- Repeated gaps in on-site supervision and leadership presence.
For providers, that is the key takeaway: when governance systems are weak, the impact is felt across the whole service.
Residents’ rights remained a recurring concern
The second major theme was Regulation 9: Residents’ rights. In these reports, rights-related concerns were closely tied to dignity, privacy, meaningful activity, personal choice and the ability to live with autonomy rather than around institutional routines.
Inspectors identified findings such as:
- Residents not being supported to access breakfast in a way that reflected preference and dignity.
- Institutional, task-led routines shaping how meals were delivered.
- Residents being assisted with meals in a way that did not always respect dignity.
- Disposable clothes protectors being applied without consultation.
- Limited privacy in some shared rooms due to layout and curtain positioning.
- Some residents spending long periods without meaningful activation beyond television.
Food and nutrition continued to be a pressure point
Regulation 18: Food and nutrition also emerged as a significant theme. Where inspectors found non-compliance or serious concern, the issues were not limited to menu choice. They included timeliness, dignity, consistency, modified diets and whether food systems were actually working for residents in practice.
Key findings included:
- Residents not always being offered meaningful choice at mealtimes.
- Poor quality meals and failure to implement required actions following dietetic review.
- Delays in providing breakfast food and refreshments.
- Food and fluid needs not being met in a timely way.
- Hot food not always being served at an appropriate temperature.
- Residents on modified-consistency diets not always receiving equivalent choice.
- Mealtime practices that did not consistently support dignity and comfort.
Training and supervision was often about practice, not just attendance
Another important area was Regulation 16: Training and staff development. The reports suggest that the issue was often not the existence of training itself, but whether staff were being adequately supervised and supported to apply that training in day-to-day care.
HIQA identified issues such as:
- Staff supervision arrangements not matching prior commitments made to the Chief Inspector.
- Unfilled senior roles affecting effective supervision.
- Staff concerns not being escalated to management in a timely way.
- Incomplete assurance on mandatory training across all staff groups.
- Clinical staff not being sufficiently supervised in relation to documentation and medicines practice.
- Training and supervision gaps contributing to delayed outbreak recognition and management.
Premises and environmental safety still featured strongly
In several reports, HIQA also raised concerns under Regulation 17: Premises. These findings show how much the physical environment can affect privacy, dignity, safety and the delivery of care.
Inspectors found issues such as:
- Twin room layouts and bathroom access that did not support privacy or mobility needs.
- Narrow spaces that restricted the safe use of mobility aids and manual handling equipment.
- Bedrooms that were only suitable for certain dependency levels due to layout constraints.
- Mould, damp and unsafe decking.
- Drainage issues and maintenance defects.
- Inadequate storage leading to clutter in circulation areas.
Incident reporting and records management also appeared in the pattern
Under Regulation 31: Notification of incidents, inspectors identified cases where:
- Required notifications had not been submitted within the required timeframe.
- Retrospective notifications had to be submitted after inspection.
- Oversight of statutory notifications needed strengthening.
Under Regulation 21: Records, inspectors found examples of:
- Records not being kept in the designated centre and available for inspection.
- Important files being stored remotely.
- Complaints records not being available during inspection.
- Wider gaps in how records were maintained and accessed.
Infection control and clinical escalation remain critical
One of the clearest risk-based findings in this group related to outbreak recognition and response. In one report, HIQA found that residents with symptoms of acute respiratory infection were not isolated, transmission-based precautions were not in place, and there was no evidence of testing to establish whether residents had a viral infection. The report also linked failures in infection prevention and control to onward transmission of influenza infection.
What these reports tell the sector
Taken together, these nine inspection reports point to a clear message: the most serious failings were rarely isolated. They were usually part of a wider pattern involving governance, oversight, escalation and follow-through.
For providers, the lesson is straightforward. Compliance is not only about passing an inspection. It is about having systems that can identify concerns early, act on them quickly, and show clearly that risks are being managed before they affect residents’ safety, dignity and quality of life.
For the sector as a whole, these reports are a reminder that Regulation 23 is often the regulation behind the regulation. When governance is weak, problems begin to surface everywhere else: in residents’ rights, in mealtimes, in staffing supervision, in premises safety, in records, in incident reporting and in clinical escalation.
If your goal is to move from “inspection response mode” to continuous readiness, tools like Cloda can help services turn inspection themes into trackable actions, supporting governance visibility, audit follow-through, and evidence that improvements are actually embedded in day-to-day practice.
Introducing Cloda: A Smart Digital Assistant for Nursing Home Compliance
For nursing homes looking to strengthen HIQA compliance and support staff utilisation of the best practice policies you have invested in, Cloda is the compliance management system you need.
Cloda is the digital assistant available in staffs’ pocket to provide the answers they need to your policies and procedures — in their own language. In doing so, Cloda helps staff to deliver safer care, aligned with your best practice policies and procedures, and HIQA’s expectations. Because Cloda is mobile-friendly, staff can access her support instantly, when and where they need it.
Cloda helps translate HIQA regulations into day-to-day practice. As the regulatory landscape evolves with updates to standards, new thematic inspections, and revised national guidance, Cloda ensures staff are always working from the most current, organisation-approved policies and procedures. Her instant support allows staff to query information when required, helping confirm that their actions align with up-to-date regulatory expectations. With instant access to procedures, teams reduce variation in practice and improve consistency.
Built-in comprehension quizzes support managers to evidence that staff have read and understood key policies, while centralised training oversight helps streamline mandatory training requirements and highlight gaps before they become inspection findings. With real-time visibility of compliance, risk themes, and policy engagement, Cloda enables providers to move from retrospective inspection preparation to proactive governance — strengthening assurance under Regulation 23 and across the wider regulatory framework.
For more information or a demo of Cloda, contact info@cloda.ai or call 01 629 2559.
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