health information and quality authority social services...

Health Information and Quality Authority Social Services Inspectorate Inspection report Designated centres for older people

Centre name:

Bushy Park Nursing Home

Centre ID:

0410 Bushy Park Borrisokane

Centre address:

Co. Tipperary

Telephone number:

067 27442

Fax number:

067 27965

Email address:

[email protected]

Type of centre:

Private Voluntary Public

Registered provider:

Bushy Park Nursing Home Ltd

Person in charge:

Catherine Treacy

Date of inspection:

23 November 2010

Time inspection took place:

Start: 09:30 hrs Completion: 16:30 hrs

Lead inspector:

Finbarr Colfer

Support inspector:

N/A

Purpose of this inspection visit

Application to vary registration conditions Notification of a significant incident or event Notification of a change in circumstance Information received in relation to a complaint or concern Follow-up inspection

of 24

About the inspection

The purpose of inspection is to gather evidence on which to make judgments about the fitness of the registered provider and to report on the quality of the service. This is to ensure that providers are complying with the requirements and conditions of their registration and meet the Standards, that they have systems in place to both safeguard the welfare of service users and to provide information and evidence of good and poor practice. In assessing the overall quality of the service provided, inspectors examine how well the provider has met the requirements of the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 (as amended) and the National Quality Standards for Residential Care Settings for Older People in Ireland. Additional inspections take place under the following circumstances:

to follow up on specific matters arising from a previous inspection to ensure that

the action required of the provider has been taken following a change in circumstances; for example:

following a notification to the Health Information and Quality Authority’s Social Services Inspectorate that a provider has appointed a new person in charge

arising from a number of events including information received in relation to a concern/complaint or notification to the SSI of a significant event affecting the safety or well-being of residents

to randomly “spot check” the service. All inspections can be announced or unannounced, depending on the reason for the inspection and may take place at any time of day or night. All inspection reports produced by the Health Information and Quality Authority will be published. However, in cases where legal or enforcement activity may arise from the findings of an inspection, the publication of a report will be delayed until that activity is resolved. The reason for this is that the publication of a report may prejudice any proceedings by putting evidence into the public domain.

of 24

About the centre Description of services and premises

Bushy Park Nursing Home has 38 residential places for older people, some of whom have dementia. There were 20 residents on the days of inspection. Two of the residents were under 65 years of age and chose to live in the centre for additional support. Residential services are provided on the ground floor of the building. There are 23 bedrooms, comprising of nine single rooms, 10 twin rooms and three triple rooms. Eighteen of the rooms have en suite toilet, shower and wash-hand basin. Two of the rooms share an en suite toilet, shower and wash-hand basin, two rooms have an en suite toilet and wash-hand basin and one room has a wash-hand basin only. The upstairs consists of the general manager’s office, a staff changing room and store rooms. The upstairs is accessible by stairs only. The entrance leads to a hallway which has two bedrooms and the staff office. The corridor to the right leads to the kitchen, the dining room and staff toilets. The first day room can be accessed through the dining room or the corridor. It has a variety of seating and two tables which are used for activities. The room is brightly decorated with wall hangings and the art work of residents. The second day room is spacious and homely. It has a large screen television, a fire place, plants and a variety of wall hangings. Across the corridor are a disability access toilet with wash-hand basin and a visitors’ toilet with wash-hand basin. There are two single bedrooms on that corridor. The remaining bedrooms are on the corridor to the left of the entrance. This corridor also has a number of storage areas, the sluice room, the laundry room and a linen cupboard. There is also a treatment room and a small oratory. The grounds of the centre are nicely landscaped and residents told inspectors that they enjoyed spending time in the gardens during fine weather. There was plenty of parking to the front of the building.

Location

Bushy Park Nursing Home is located in a residential area, a short distance from the centre of Borrisokane, Co. Tipperary.

Date centre was first established:

1988

Number of residents on the date of inspection

20

Number of vacancies on the date of inspection

18

of 24

Dependency level of current residents

Max High Medium Low

Number of residents

0

12

1

7

Management structure

The Provider is Bushy Park Nursing Home Limited, and the designated contact person is the Managing Director, Vincent Kinsella. His son, also Vincent Kinsella, is a Director of the company and is involved in the day-to-day operation of the centre. The Person in Charge was Catherine Treacy and she reports to the Managing Director. The staff nurses, care assistants, chef, kitchen staff and household staff report to the Person in Charge.

Staff designation

Person in Charge

Nurses Care staff

Catering staff

Cleaning and laundry staff

Admin staff

Other staff

Number of staff on duty on day of inspection

1* 0 3 1 Chef 1 Kitchen Assistant

1 Laundry 1 Cleaning

1 2**

*The person in charge was covering nursing duties due to staff absence on the day of inspection **The Provider, Vincent Kinsella and his son, Vincent Kinsella

of 24

Background

The Health Information and Quality Authority (the Authority) have undertaken two previous inspections of this centre. The first inspection was a registration inspection in March 2010 and the centre was found to be non compliant with a significant number of the Regulations. The second inspection was a follow up inspection in September 2010 to examine the progress on the action plan from the initial inspection. Both of these reports are available on the Authority’s website - www.hiqa.ie and the centre’s identification number is 0410. The unannounced follow up inspection in September 2010 found that the provider had made significant progress on actions that had been identified in the initial inspection. However, there were still a number of areas requiring improvement, including:

the appointment of a suitably qualified person in charge appropriate professional assessments for residents who were using specialist tilted

seating the provision of specific therapeutic care for residents with dementia the care planning process meaningful activities and social interaction for residents the medication management system the security of personal information about residents infection control in the laundry and sluice rooms fire drills and mandatory fire training for staff arrangements for moving and handling of residents staff access to the policies and procedures that guide work practices staffing levels and skill-mix staff recruitment and ensuring that staff were suitable to work with vulnerable older

residents a process for reviewing information to identify trends and improve the safety and

quality of life of residents the directory of residents

The provider appointed a new person in charge, Catherine Treacy at the beginning of October 2010 and inspectors conducted a fit person interview with the new person in charge on 14 October 2010. Inspectors found that she met the requirements for a person in charge contained in the Regulations. She was a qualified nurse and had sufficient experience working in older peoples’ services in the United Kingdom, including management roles. She was knowledgeable about the provision of residential services to older people and had familiarised herself with the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 (as amended) and the National Quality Standards for Residential Care Settings for Older People in Ireland. She had reviewed the action plan from the previous inspection and informed inspectors that she was developing a work plan to address all of the care issues identified.

of 24

http://www.hiqa.ie/

Summary of findings from this inspection

This unannounced inspection was scheduled to examine the progress made on the action plan from the follow up inspection in September 2010. Overall, the inspector found that further progress had been made in meeting the requirements of the Regulations but areas for improvement were also identified. Since her appointment, the person in charge had taken a number of measures to improve the quality of life for residents. She had arranged with the provider to change and refurbish the entrance area, day room and activities room so that they were more homely and comfortable for residents. To promote privacy and respect for residents, she had arranged for them to have personal care supplies such as incontinence pads stored in their bedrooms rather than using a communal supply trolley. With the provider, she had organised a coffee morning for relatives and residents as a way to encourage them to express their preferences and views of the service and to encourage them to participate in the newly established residents and relatives committee. Improvements in the management of infection control had reduced the risk of infection for residents. She had also ensured that all personal information on residents was stored securely. The person in charge had made progress on actions relating to dementia care, activities for residents, fire precautions and staff files. She had also undertaken a review of the medication management arrangements and introduced a number of changes to reduce the risk of medication error. Some work remained to be completed on these actions. In relation to staffing, she had arranged mandatory training in fire safety and manual handling for all staff. She had reorganised the policies and procedures and staff could now access them easily. She had also reviewed the staffing levels and skill-mix and made changes to ensure that they were based on the assessed needs of residents. She had introduced a new staff appraisal process to support staff in the development of their skills. However, the inspector found that significant improvements were required in care planning, particularly for the needs of residents who required seating supports, the management of restraint and the management of behaviours that challenge. The person in charge was aware of these issues and was planning to address them. Further improvements were also required in staff documentation, quality reviews and the directory of residents. These improvements are discussed in the body of the report and are included in the action plan at the end of the report.

of 24

Actions reviewed on inspection:

1. Action required from previous inspection:

Assess the needs of residents who are restrained in specialist seating and put suitable and sufficient care in place to maintain their welfare and wellbeing, having regard to the nature and extent of the resident’s dependency levels.

Progress had been made on this action. The inspector reviewed the assessments that the person in charge had undertaken and the new seating arrangements for residents. The person in charge had been trying unsuccessfully to obtain the services of a private occupational therapist to assess the needs of these residents. As an interim measure, she had assessed all residents using a recognised seating assessment tool. Only one resident now used specialist seating. The assessment indicated that she did not require the specialist seating. However, the resident stated that she wished to continue to use the chair and the person in charge accepted her choice. The inspector saw other residents who had used special, tilted seating on previous inspections sitting in armchairs in the day room. They appeared to be satisfied with their new seating arrangements. However, some of them required the support of cushions and one was listing to the side in her chair. The person in charge stated that she was aware that access to an occupational therapist had been an issue on the previous two inspections and that she continued to seek the services of a private occupational therapist. She said that this was proving difficult but that the provider had made funding available to have this done. In the interim, she had asked the provider to purchase a new armchair for one of the residents and he had done so. The inspector spoke with this resident and she said that she found the new armchair very comfortable.

2. Action required from previous inspection: Put suitable and sufficient care in place to maintain the welfare and wellbeing of residents with dementia, having regard to the nature and extent of the resident’s dependency and needs as set out in their care plan.

The newly appointed person in charge had started to respond to this action. She had worked in dementia specific services previously and demonstrated good knowledge of the care needs of residents with dementia. She stated that the previous care plans did not capture adequate information to plan for the care needs of these residents. She was in the process of developing new care plans. She had introduced a draft planning form for dementia care but it was generic, was not personalised, and contained a number of general typed statements with the residents name handwritten into the spaces provided. She had not yet developed any specific therapeutic care for residents with dementia. The person in charge stated that she intended to continue to develop appropriate care plans, to make more information available to staff on dementia care and to identify dementia care training for staff.

of 24

3. Action required from previous inspection: Set out and address the health, social and personal needs of residents in individual care plans developed and agreed with each resident or representative and available to each resident or representative.

The inspector reviewed the care planning process and found that improvements had been made but further improvements were required. All residents had individual care planning folders. They contained validated assessment tools covering such areas as falls risks, continence management and pressure sore risk assessments. The inspector reviewed a number of residents’ folders and found that care plans had been developed for all identified clinical risks. One of the folders also contained a section entitled “Getting to know you” which had been completed with the resident. It provided a history of the resident and information on her interests and hobbies. The person in charge explained that this was a trial assessment and that she intended to develop it further and extend its use to all residents. However, the inspector reviewed the care plan of a resident who presented with behaviours that challenge. The inspector noted that the resident had been included more in the day-to-day life of the centre since the previous inspection and was now participating in activities and communal meals. The care plan gave some brief directions to staff on how to respond to particular incidents. But such behaviour was not being managed in a way that promoted the safety and quality of life of the resident. Incidents were referred to briefly in the nursing notes and there had been no tracking, identification of triggers or review of care plans to ensure that intervention were being implemented consistently and were effective. The inspector reviewed the policy on the management of behaviours that challenge. It provided a lengthy description of different types of behaviour that may occur and the possible reasons for such behaviour. It provided staff with some guidelines on the immediate response to behaviours that challenge such as “remain calm” and “do not be judgemental”. It did not provide guidelines for staff on how to identify triggers or how to record incidents and how to use that information to improve the quality of life and well being of the resident. While discussing care plans with the person in charge, the inspector noted that bed rails were used for nine residents. This restraint was not managed effectively to ensure the safety of residents. The person in charge acknowledged that the use of bed rails was not recorded in residents’ care plans, the care plans did not provide directions to staff on how they should be used, there had been no exploration of alternatives to the use of this restraint and there had been no risk assessment for the use of this restraint. The person in charge stated that she was intent on promoting a restraint free environment and that the bed rails were now the only form of restraint being used. She said that she would prioritise this area for action following the inspection. Some of the language used in the “Getting to know you” section of the care plan was not respectful or appropriate and included such descriptions as “behaving in a childlike way”.

of 24

4. Action required from previous inspection: Identify each resident’s previous routines, expectations and preferences and provide him or her with opportunities to participate in activities appropriate to his or her interests and capacities that satisfy his or her social and recreational interests.

Some work had been completed on this action, but further improvements were required. The inspector found that there was a more sociable atmosphere in the centre. Many residents were moving about the centre during the day. The inspector spoke with one resident who had been staying in her room until recently. She stated that the person in charge had arranged for staff to help her out of bed with a hoist and she now spent the morning in the sitting room watching television and chatting with others. Chairs in the day room were no longer lined against the wall but were in a semi circle which promoted social interaction. The dining room had been reorganised and arranged in a way which encouraged residents to chat with each other. Tables had been put together to accommodate up to four residents comfortably and each table was dressed with a table cloth and floral centrepiece giving a nice ambience. However, although a programme of activities had been developed and the new person in charge had started to identify the leisure preferences of residents, the range of activities available to residents was limited and some were not appropriate. For example, a number of residents were doing art on the day of inspection. The session consisted of residents using crayons to colour in pages taken from children’s colouring books. Residents with dementia were encouraged to join in the scheduled activities, but no meaningful plan of activities had been developed to respond to their needs. The person in charge stated that she intended to continue developing a range of meaningful activities for residents and promoting social interaction. She stated that her first priority had been to encourage residents in a respectful way to use the communal areas more and encourage them to meet and chat with each other. She said that this had been a challenge because residents had become accustomed to remaining on their own in their bedrooms.

5. Action required from previous inspection: Implement the written operational policies relating to the ordering, prescribing, storing and administration of medicines to residents. Ensure that staff are familiar with such policies and procedures.

Progress had been made on this action. The new person in charge had conducted an audit of the full medication management process. She had identified a number of areas of potential risk for medication error. As a result, she had introduced a new medication management policy and a new medication administration system. The inspector joined the person in charge on the medication administration round and found that she was implementing the professional guidelines of An Bord Altranais.

of 24

However, the inspector found that nurses were transcribing medication into the new medication prescription and administration sheets. Each medication was being individually signed by the general practitioner (GP), but the medication policy did not provide directions on transcribing to ensure consistency and accountability, and to reduce the risk of error. Nurses who transcribed medication were not signing the medication sheets. The person in charge stated that the new medication sheets were on trial and that this information would be included on all sheets going forward. She also intended to continue with monthly audits of the medication management process to ensure that it promoted the safety of residents and minimised the risk of drug error. The person in charge stated that the medication trolley was not fit for purpose. The inspector saw that it was compact and did not have enough work space on top for dispensing and recording the administration of medication. The provider said that he would review this with the person in charge.

6. Action required from previous inspection: Put a process in place to ensure that all residents’ files are kept in a safe and secure place.

This action had been met. Residents’ information was being stored in locked cabinets in the nurses’ station. The inspector could only access the information by asking the nurse on duty to unlock the cabinets.

7. Action required from previous inspection: Develop and implement written operational policies and procedures relating to the health and safety of residents, staff and visitors, including infection control procedures for the laundry and sluice room.

This action had been completed. The inspector visited the laundry and interviewed the laundry worker. The laundry worker was knowledgeable about infection control and had recently completed Further Education and Training Council (FETAC) Level 5 training which included a module on infection control. The laundry was organised with separate areas for processing soiled and clean laundry. A new laundry trolley had been acquired to collect soiled laundry and transport it to the laundry room. The open weave baskets for soiled laundry had lining bags and were kept separate to the baskets for clean laundry. The clean laundry baskets were clearly labelled. Alginate laundry bags were available for the clothing of residents with an infection. The inspector visited the sluice room. It was kept locked to promote the safety of residents. It was no longer used to store assistive equipment and staff could get easy access to the sluicing sink when required.

of 24

8. Action required from previous inspection: Provide and record fire drills and practices at suitable intervals, ensuring that staff and, insofar as is reasonably practicable, residents, are aware of the procedure to be followed in the case of fire.

Significant progress had been made on this action. The provider had engaged the services of an external contractor to review all of the fire precaution arrangements in the centre. The provider gave a copy of the new fire safety guidance for the centre, dated November 2010, to the inspector. This document indicated a thorough review of fire precautions and contained recommendations on improving them. The inspector spoke with staff and they were knowledgeable about the fire plan and what they would do in the event of a fire. They told the inspector of a planned fire training day on the day following the inspection. The inspector saw an invoice from the external contractor to demonstrate that this fire training and future training dates had been booked. The person in charge stated that a simulated evacuation drill would form part of the training.

9. Action required from previous inspection: Put training in place to ensure that staff engage in the safe moving and handling of residents where required. Ensure that any requirement for moving and handling is documented in the residents’ care plan.

This action had been completed. The new person in charge had provided staff with instructions on how to move residents safely. In addition, the inspector reviewed an invoice from an external trainer who had been booked to provide training to all staff on 8 and 9 December 2010. The inspector observed staff using a hoist to move a resident. The staff member was attentive to the resident, explained what she was doing and ensured that the resident felt safe. The inspector spoke with a resident who had used the hoist. The resident said that although the staff worked hard, when they had previously helped her they either used an old hoist which she did not like or they put their arms under her shoulders and that used to hurt her. She was very pleased with the new arrangements and said that it was easier for her to get to the sitting room during the day as a result.

10. Action required from previous inspection: Develop and implement all of the written and operational policies listed in Schedule 5 in the Regulations, including a communications policy, and ensure all staff members use the policies to inform practice. Review all policies and procedures at least every three years or on the recommendation of the Chief Inspector.

of 24

This action had been met. The new person in charge had organised all of the policies and procedures into three folders which were available to staff in the nurses’ station. Staff were aware of the policies and were in the process of reading them. The inspector saw a sign off sheet for staff at the beginning of each folder. All of the policies were signed by the provider and the person in charge and were dated. The person in charge stated that she was in the process of reviewing the policies to ensure that they provided clear direction to staff and reflected best practice. She envisaged further reviews and adaptations to the policies in the coming months.

11. Action required from previous inspection: Put a process in place to ensure that at all times the numbers of staff and skill-mix of staff are appropriate to the assessed health, social and personal needs of residents, and the size and layout of the centre.

This action had been met. The inspector found that there were adequate numbers of staff on duty to respond to the needs of residents in a timely manner. Due to unforeseen sick leave and annual leave, the person in charge was working as the nurse on-duty on the day of inspection. The inspector reviewed the rosters and found that this was not the usual arrangement, that the person in charge did not normally work front line and she usually had sufficient time to attend to her governance and clinical leadership duties. The person in charge had undertaken a review of staffing levels based on the assessed dependency levels of residents and on her own observations. Some practices such as reducing the staffing levels at weekends had been eliminated. The person in charge stated that she was supported in making these changes by the provider.

12. Action required from previous inspection: Put arrangements in place to ensure that all staff members are fit to work at the designated centre by obtaining all of the information and documents specified in Schedule 2 of the Regulations.

Although the provider stated that this action had been completed, the inspector found that all of the required documentation for staff had not been obtained. The provider told the inspector that Garda Síochána clearance had been sought through an external organisation for all staff but had no evidence to support this. The inspector reviewed three staff files and found that all items required by the Regulations to demonstrate that staff are fit to work in the centre had not been obtained. One file did not have a full employment history, others had no photographic evidence of identity and others had no evidence of medical and physical fitness.

of 24

13. Action required from previous inspection: Establish and maintain a system for reviewing and improving the quality and safety of care provided to, and the quality of life of residents at appropriate intervals.

The person in charge had started to address this action. She had initiated audits of the medication management process and was submitting the results to the provider. Actions had been taken to improve the safety and wellbeing of residents as a result of gathering this information. The person in charge stated that she intended to identify other areas for auditing with the provider and that these would be introduced in the New Year.

14. Action required from previous inspection: Review the directory of residents and ensure that it contains an up-to-date record in relation to every resident and includes all of the required information specified in Schedule 3 of the Regulations.

While the person in charge had ensured that the directory of residents was up-to-date, she had not ensured that all of the required information was in the directory such as the address and phone number of the GP. The person in charge and the provider spoke about introducing a new directory of residents and were exploring the introduction of a computer based directory.

of 24

Report compiled by:

Finbarr Colfer Inspector of Social Services Social Services Inspectorate Health Information and Quality Authority 6 December 2010

Chronology of previous HIQA inspections Date of previous inspection Type of inspection:

24 March and 30 March 2010

Registration Scheduled Follow up inspection

Announced Unannounced

7 September 2010

Registration Scheduled Follow up inspection

Announced Unannounced

of 24

Health Information and Quality AuthoritySocial Services Inspectorate Action Plan

Provider’s response to additional inspection report*

Centre:

Bushy Park Nursing Home

Centre ID:

0410

Date of inspection:

23 November 2010

Date of response:

24 January 2011

Requirements

These requirements set out what the registered provider must do to meet the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 (as amended) and the National Quality Standards for Residential Care Settings for Older People in Ireland.

1. The provider has failed to comply with a regulatory requirement in the following respect: Staff had not been provided with mandatory fire training and the provider had not completed the planned fire drill as stated in the previous action plan. Action required: Provide suitable training for staff in fire prevention. Action required: Ensure, by means of fire drills and fire practices at suitable intervals, that the staff and, as far as is reasonably practicable, residents, are aware of the procedure to be followed in the case of fire, including the procedure for saving life.

* The Authority reserves the right to edit responses received for reasons including: clarity; completeness; and, compliance with legal norms.

of 24

Reference: Health Act, 2007

Regulation 32: Fire Precautions and Records Standard 26: Health and Safety Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: On the day of inspection, the person in charge informed the inspector that there was fire training set up for 24 November 2010 (which was the day following the inspection) and the person in charge can confirm that this fire training did indeed take place. This was the first stage of the fire training which is being carried out by an independent fire consultant. The fire consultant has devised an evacuation plan specific to Bushy Park Nursing Home which was the second stage of the plan. The third stage is to carry out a simulated evacuation according to the new evacuation plan which the person in charge hopes to have completed within the coming weeks

Complete Complete 28/02/2011

2. The provider has failed to comply with a regulatory requirement in the following respect: Restraint was not managed effectively to ensure the safety of residents. Action required: Put in place suitable and sufficient care to maintain the resident’s welfare and wellbeing, having regard to the nature and extent of the resident’s dependency and needs. Ensure that their care plan is based on a high standard of evidence based nursing practice, and that the use of restraint measures reflects this. Action required: Maintain a record of any occasion on which restraint is used, the nature of the restraint and its duration. Reference:

Health Act, 2007 Regulation 6: General Welfare and Protection Regulation 25: Medical Records Standard 21: Responding to Behaviour that is Challenging

of 24

Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: Following the inspection the person in charge has devised a new restraint policy specific to bed rails which they believe this action is referring to. There has been a new assessment used with each resident who use bed rails and there has also been consent forms signed in relation to each resident.

Complete

3. The provider has failed to comply with a regulatory requirement in the following respect: The services of an appropriate professional such as an occupational therapist had not been obtained to identify the appropriate seating supports for residents who required them. Action required: Facilitate each resident’s access to physiotherapy, chiropody, occupational therapy, or any other services as required by each resident. Reference:

Health Act, 2007 Regulation 9: Health Care Standard 13: Healthcare Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge has sought the advice of a private Occupational Therapist and they are booked to review these residents regarding the specialised seating on 28 January 2011. The person in charge would hope that following these assessments this action will be complete.

31/01/2011

4. The provider has failed to comply with a regulatory requirement in the following respect: The behaviour management policy and practice did not provide guidelines for staff on how to identify triggers or how to record incidents and how to use that information to improve the quality of life and well being of the resident.

of 24

Action required: Put suitable and sufficient care in place, founded on a high standard of evidence based nursing care to maintain the welfare and well being of residents who present with behaviour that challenges Reference:

Health Act, 2007 Regulation 6: General Welfare and Protection Standard 21: Responding to Behaviour that is Challenging Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge is currently reviewing this policy and current practice relating to same.

28/02/2011

5. The provider has failed to comply with a regulatory requirement in the following respect: The medication policy did not provide directions for nurses on transcribing and nurses who transcribed medication were not signing the medication sheets. The medication trolley was not fit for purpose. Action required: Put in place suitable arrangements and appropriate procedures and written policies in accordance with current Regulations, guidelines and legislation for safe prescribing and administration of medicines and ensure staff are familiar with such procedures and policies. Reference:

Health Act, 2007 Regulation 33: Ordering, Prescribing, Storing and Administration of Medicines Standard 14: Medication Management Standard 15: Medication Monitoring and Review

Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge is currently arranging a meeting with the local GP and Pharmacist in order to discuss the current policy and practice of transcribing of medication. This meeting is to be held on 16 February 2011.

07/03/2011

of 24

6. The person in charge has failed to comply with a regulatory requirement in the following respect: The person in charge had not developed specific therapeutic care for residents with dementia. Action required: Put suitable and sufficient care in place to maintain the welfare and wellbeing of residents with dementia, having regard to the nature and extent of the resident’s dependency and needs as set out in their care plan. Reference:

Health Act, 2007 Regulation 6: General Welfare and Protection Standard 11: The Resident’s Care Plan Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge is currently working on the above and believes it to be an on going action which is very in-depth. The person in charge will focus on this group of residents in the coming months and develop therapeutic care to adhere to their cognitive needs. The person in charge will engage in more Dementia training for staff in order to provide optimum care for this group of residents. The person in charge will review dementia led units and day centres to learn more about the therapeutic care required to meet residents’ needs. The person in charge will then integrate the training and visits into care plans specific to each resident.

30/04/2011

7. The person in charge has failed to comply with a regulatory requirement in the following respect: Although a programme of activities had been developed and the new person in charge had started to identify the leisure preferences of residents, the range of activities available to residents was limited and some were not appropriate.

of 24

Action required: Identify each resident’s previous routines, expectations and preferences and provide him or her with opportunities to participate in activities appropriate to his or her interests and capacities that satisfy his or her social and recreational interests. Reference:

Health Act, 2007 Regulation 6: General Welfare and Protection Standard 18: Routines and Expectations Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge plans to get an insight into devising activities again by research and visiting designated centres. A new record has been devised already to learn each resident’s preference with activities, which is a follow up of our “Getting to Know You” assessment. Once these are completed for all residents the person in charge will devise activity programmes specific to each resident as opposed to a group activity only. When new residents come this paperwork is part of their admission so that staff are aware of the importance of psych-social needs as well as physical and medical.

30/04/2011

8. The provider has failed to comply with a regulatory requirement in the following respect: All items required by the Regulations to demonstrate that staff are fit to work in the centre had not been obtained. Action required: Put in place recruitment procedures to ensure no staff member is employed unless the person is fit to work at the designated centre and full and satisfactory information and documents specified in Schedule 2 of the Regulations have been obtained in respect of each person. Reference:

Health Act, 2007 Regulation 18: Recruitment Standards 22: Recruitment Please state the actions you have taken or are planning to take with timescales:

Timescale:

of 24

Provider’s response: The person in charge can confirm that all staff files are now within the Regulations and will ensure that future employees are recruited within these guidelines.

Complete

9. The provider has failed to comply with a regulatory requirement in the following respect: The auditing and review process was confined to one area and did not provide a range of information which would allow the provider to identify trends and improve the quality of life and safety of residents. Action required: Continue to establish and maintain a system for reviewing the quality and safety of care provided to, and the quality of life of, residents in the designated centre at appropriate intervals. Reference:

Health Act, 2007 Regulation 35: Review of Quality and Safety of Care and Quality of Life Standard 30: Quality Assurance and Continuous Improvement Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The person in charge is constantly reviewing practices within the nursing home but needs to devise visual aids such as graphs etc, in order for staff, residents and relatives to observe the changes and improvements being made within the home. Auditing is continuous and covers a wide range of topics. The person in charge intends to pick the topics that she has worked on and provide evidence of these audits on such topics as infection control, medication management, dementia care, challenging behaviour and various elements of nursing care, which will be used to provide optimum care for our residents.

30/05/2011

10. The person in charge has failed to comply with a regulatory requirement in the following respect: The person in charge had not ensured that all of the required information was in the directory of residents.

of 24

Action required: Ensure that the directory of residents includes the information specified in Schedule 3 paragraph (3) of the Regulations. Reference:

Health Act, 2007 Regulation 23: Directory of Residents Standard 32: Register and Residents’ Records Please state the actions you have taken or are planning to take with timescales:

Timescale:

Provider’s response: The new person in charge can now confirm that this action has been completed in accordance with the Regulations.

Complete

of 24

Recommendations

These recommendations are taken from the best practice described in the National Quality Standards for Residential Care Settings for Older People in Ireland and the registered provider should consider them as a way of improving the service.

Standard

Best practice recommendations

Consider changing the language used to describe residents in care plans.

Standard 4: Privacy and Dignity

Provider’s response: The person in charge has looked at the language used and has addressed the comment highlighted by the inspector

of 24

of 24

Any comments the provider may wish to make:

Provider’s response: After reading the report I understand that there has been a lot of work done but that there is still room to improve on our services to our residents. I hope to improve on these services in conjunction with the person in charge. Provider’s name: Vincent Kinsella Date: 24 January 2011

health information and quality authority social services...

Documents