Frequently asked questions

Questions about Nursing Homes

For residents, their families and the public

Q. What is the inspection and registration of nursing homes and residential centres about?

As from 1 July 2009, the Social Services Inspectorate within the Health Information and Quality Authority is responsible for the registration and inspection of all public and private nursing homes and residential care services for older people. The Social Services Inspectorate registers and inspects to see if nursing homes are safe and that residents are being cared for properly. For the first time, HSE-run centres, as well as, private and voluntary nursing homes are subject to independent registration and inspection.

Q. Do all nursing homes have to be registered?

Yes. By law, all nursing home services in the public, private and voluntary sectors have to be registered (to ensure they are able to provide such services in the first instance) and inspected (in order to ensure they are maintaining standards required to operate and are continuously upholding high standards) by the Social Services Inspectorate of the Health Information and Quality Authority.

Q. Why are you conducting inspections?

Inspections occur to check that residents in nursing homes are safe and are well looked after. Inspections also provide information to residents, their families, and the general public about the standards of care in individual nursing homes. The aim of inspection is to make sure that poor services are not allowed to operate, and to support those nursing homes that provide good, person-centred care.

Q. Are there standards of care that nursing homes and residential centres should comply with?

Yes. The Health Information and Quality Authority has developed specific standards for the operation of nursing homes and residential centres in consultation with those who use services and those who provide them. These are called the National Quality Standards for Residential Care Settings for Older People in Ireland, and they have been mandated by the Minister for Health and Children. We inspecting against these standards and against regulations set by the Department of Health and Children.

Q. Who carries out the inspections?

Inspections are carried out by inspectors from the Social Services Inspectorate of the Health Information and Quality Authority. All inspectors are fully trained staff of the Authority and have a wide range of relevant professional experience.

Q. How are inspections carried out?

Inspections are announced or unannounced and can be held during the day or night. Inspectors talk with managers, staff and interested people and also talk with residents (residents who do not wish to speak to inspectors do not have to) and their families. Inspectors focus on the experience of the resident living in the nursing home and what it is like to live there. An inspection report is produced by the Authority after each inspection.

Q. Is the inspection process totally independent of the Health Service Executive and private nursing home operators?

Yes, inspectors report to the Chief Inspector of Social Services within the Health Information Quality Authority.

Q. What kind of information is contained in inspection reports?

Inspection reports give factual information and highlight where standards of care are well met, as well as where improvements are required. They are published on the Authority's website. Inspection reports give the residential care centre’s location, and outline the number of places there and general facilities. They also outline the findings of the inspection and comment on all areas of the service. Any necessary actions required on the part of the provider are clearly indicated in the report. The reports are fair and reflect all aspects of the service that is being provided. These inspection reports provide information to the residents themselves, their families and the general public about the standards of care in individual centres.

Q. Can I read your inspection reports?

Inspection reports are published on the Health Information and Quality Authority’s website, www.hiqa.ie. They are published shortly after each inspection.

Q. What actions can be taken if a nursing home is not meeting your standards or the regulations?

As outlined in the Health Act 2007, we have the power to seek legal enforcement of our recommendations and sanctions in the event of non-compliance. Actions which can be taken in the interests of the residents living in the nursing home include:

Requiring that changes to the service be made and then checking that these improvements are carried out.
Changing the operating conditions of that centre (the number, type or category of resident they may accommodate).
Prosecuting for offences under the Health Act 2007, such as failing to comply with a condition of registration.
Cancelling registration of a centre - so it is no longer be able to operate.

If inspectors come across a situation which poses an urgent risk to residents, which the owner is unwilling or unable to correct urgently, the Authority can take emergency action to address the situation. Every effort is made to ensure residents of nursing homes are not inconvenienced. However, if a nursing home does not comply with laws, arrangements may have to be made for residents to be moved to a different nursing home, which does comply with these laws and provides safe quality care.

For nursing home providers

Who’s who during registration?

Q. Who is the registration body?

The Health Information and Quality Authority was established under the Health Act 2007 to drive quality, safety, accountability and the best use of resources in our health and social care services. Under the Health Act 2007, responsibility for the regulation of the quality of residential care in designated centres for children, older people and people with disabilities rests with the Office of the Chief Inspector. The Chief Inspector’s team within the Authority is known as the Social Services Inspectorate or “SSI”.

Q. What is a “fit person”?

Under section 50(1)(a) of the Health Act 2007, registered providers and others who participate in the management of the designated residential care service for older people must be fit to do so. Providers must demonstrate to the satisfaction of Authority that they are suitable or fit for the role. It is vital that the registered provider understands the requirements of operating a nursing home, and ensures that staff have the necessary and appropriate skills to care for residents.

Q. Who is the registered provider?

The provider of services, referred to in the Health Act 2007 as “the registered provider”, is the person with overall responsibility for the residential service. The registered provider is legally responsible for the designated centre and is held accountable for any faults with the services.

Q. Who is the applicant?

The applicant is the person who is responsible for the registration application.

In the case of an individual/sole trader, the individual will be the applicant.
In the case of a partnership, one nominated partner will be the applicant and will be responsible on behalf of the partnership for the application.
In the case of a company, one nominated director will be the applicant and will be responsible on behalf of the company for the application.
In the case of an unincorporated body, one nominated member of the committee of management or other controlling authority will be responsible on behalf of the unincorporated body for the application.
In the case of a statutory body, one nominated person will be responsible on behalf of the statutory body for the application.

The person responsible for the application must be a senior member of the organisation involved in supervision of the management of the designated centre, sufficiently senior to make decisions and implement recommendations arising from an inspection of the designated centre.

Q. Who is the “person in charge”?

The person in charge is distinguished from the registered provider and is sometimes described as the “manager”. The person in charge of the residential service is the person with responsibility for the day-to-day running of the centre. The person needs to be an appropriately skilled member of staff suitable to the responsibilities of the role. The person in charge could be the same individual who is the registered provider or another to whom functions have been assigned.

Services covered by the new system

Q. Which services must be registered?

Under the Health Act 2007, all designated centres (residential care centre for older people) must be registered. There are three categories of residential services for older people, which are required by law to register with the Social Services Inspectorate of the Health Information and Quality Authority:

Residential services for older people that have been previously registered by the Health Service Executive (HSE)
Existing residential services for older people that have not been registered by the HSE
New residential services for older people applying for first-time registration.

Q. If I need to register, are there deadlines I need to be aware of?

If an applicant wishes to apply for first-time registration, they must do so six months prior to the time they wish to commence operating. The person wishing to be named as the registered provider should apply to be registered.

Fit-person Entry Programme

Q. What is the Fit-person Entry Programme (FPEP)?

The Fit-person Entry Programme is based on the National Quality Standards for Residential Care Settings for Older People in Ireland and is a tool for providers to self-assess their fitness to provide the service. Under section 50(1)(a) of the Health Act 2007, registered providers and others who participate in the management of the designated centre must be fit to do so. As a provider you must demonstrate to the satisfaction of the Authority that you are suitable or fit for the role. The Fit-person Entry Programme is in the format of a programme with defined learning outcomes and self-assessment activities and is designed to be used without the need for any specialist training or additional resources. The Programme takes a participative approach by encouraging the provider to reflect on and consider their experience, competence and knowledge, together with their staff and residents. Its purpose is to prompt the provider, to:

Consider the National Quality Standards for Residential Care Settings for Older People in Ireland as a guide on how to provide, and continually improve care services.
Assess the way in which the centre is operated.
Identify gaps in the services of the centre or areas of learning.
Increase awareness of changes that need to be made to some areas of practice.

Applications for registration

Q. How long do we have to complete and return the Application to Register form?

The applicant must complete and return the Application to Register form within four weeks of receipt. Providers have to apply to register their centre six months prior to the expiration of their current registration once they have gone through the first registration process with the SSI.

Information on fees

Q. What is the fee structure?

The Minister for Health and Children has decided that the regulation of residential services for older people is largely self-financing. Fees payable in respect of designated centres are as follows:

application fees
- to register or renew your centre’s registration
- if you want to apply to vary a condition of your registration (the amount depends on the variation applied for and the complexity of the method of assessment required in respect of the variation).
annual fees.

There is an annual fee in respect of each centre. These are set by the Department of Health and Children and the fee structure is set-out in the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2009 and the Health Act 2007 (Registration of Designated Centres for Older People) (Amendments) Regulations 2010. .

The inspection process

Q: What does the registration inspection involve?

The inspector meets with the applicant and carry out a fit-person interview with you and the person in charge. The interview is designed to assess your fitness, some aspects of which already have been assessed by documentation you have provided as part of your application. The interview assesses your understanding of, and capacity to comply with the requirements of the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2009, , the Health Act 2007 (Registration of Designated Centres for Older People) (Amendment) Regulations 2010, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) (Amendments) Regulations 2010 and the National Quality Standards for Residential Care Settings for Older People in Ireland. A full inspection of the premises is also undertaken including reviewing documentation, observing practices and speaking with staff and residents. The SSI may also ask the applicant for certain documentation to be provided for review in advance of this inspection.

Q. How do you assess my service?

Inspectors gather evidence in a number of ways. They read documents, observe activities and listen to the people in the centre. Inspectors spend a considerable amount of time speaking to residents, if they wish to speak to inspectors, during an inspection, which informs them of what it is like to be a resident in that centre. They also spend time around the service in order to get a good understanding of what that service is like as a whole.

Q. Are inspection reports published?

Yes, inspection reports are published on the Authority’s website.

Concerns and complaints

Q. What can I do if I am not happy with the findings of an inspection report?

The inspection report is sent to the provider in advance of it being published on the website. They are asked to comment on factual accuracy and are also given an opportunity to comment on the report findings. The provider's response is appended to the report when published on the website.

Q. How do I make a complaint about an inspector?

All inspectors are expected to work in accordance with the Authority's Code of Conduct for staff conducting statutory inspections, investigations or reviews. Service providers who are unhappy with the conduct of an inspector, should, in the first instance, contact the inspector directly. If the matter remains unresolved or if the provider wishes to bypass the initial step, you should contact the inspector’s line manager who will review the matter. He/she can be contacted at either (Cork) 021 240 9300 or (Dublin) 01 814 7400 or you can email us at inspections@hiqa.ie.

New service planning

Q. I am considering building or operating a nursing home. Where can I look for advice?

For providers who are considering building or making an extension to their centre we would recommend that they speak with a member of the SSI who may be able to offer advice. Contact the dedicated SSI advice line: 021 2409660. Details on room requirements are contained in the National Quality Standards for Residential Care Settings for Older People in Ireland, Standard 25: Physical Environment. Standard 25 sections A and B refer to existing buildings and section C refers to new builds, new extensions and first time registrations. Please note that the criteria are indicative and not prescriptive.

Questions about Residential Services for People with Disabilities

Q: Why were these standards produced?

A: The standards have three functions:

They provide guidance to service providers on how to provide a good quality and safe services.
They inform service users and their families as to what they can reasonably expect of a residential service.
Once they have been approved by the Minister of Health and Children they will be used in the registration and inspection of residential services for people with disabilities.

Q: How were the standards developed?

A: The Authority developed the standards with the assistance of a standards advisory group made up of those involved in the relevant services: those who use the service and their representatives and advocates, those who provide the service, the professionals who deliver the service and others such as the Department of Health and Children and other relevant bodies. This group assisted the Authority in drawing up a set of standards which were then made available to the public for comment and suggestion. Feedback from this public consultation was considered by the standards advisory group and the standards were amended and then finalised by the Board of the Authority. All standards that are developed by the Authority have to be approved by the Minister for Health and Children.

Q: What do these standards cover?

A: The standards are based on the seven key principles that cover quality of life, staffing, protection, health and development, rights, the physical environment, governance and management. This means:

People who live in residential services for people with disabilities should have a good quality of life.
For people in residential services to enjoy a good quality of life, there should be staff that understand and support them.
People who live in residential services for people with disabilities should feel safe.
The rights of people with disabilities who live in residential services should be protected and promoted.
The services should be person centred.
The standards should encourage community integration.
Residential services for people with disabilities should be well run.

Q: Who is covered by these standards?

A: The standards cover residential services for people with disabilities. These standards are not intended for day services or services that accommodate children with disabilities.