Page 1 of 13
Report of an inspection of a
Designated Centre for Older People
Name of designated
centre:
Atlanta Nursing Home
Name of provider:
Atlanta Nursing Home Limited
Address of centre:
Sidmonton Road, Bray,
Wicklow
Type of inspection:
Unannounced
Date of inspection:
22 March 2018
Centre ID:
OSV-0000010
Page 2 of 13
About the designated centre
The following information has been submitted by the registered provider and describes the service they provide.
The centre is based in a town with access to shops and other amenities such as restaurants and cafes.
The centre was originally two private residences and has been converted in to a three- storey centre offering places for up to 43 residents. The centre offers a service to male and female residents over 18 years of age, following an assessment to
ensure their needs can be met in the centre. it can support residents with low and medium dependency needs for full time residential care, respite care, convalescence and post-0perative care.
There are a mixture of single rooms with en-suite, double rooms, and one triple room. There are 10 rooms on the ground floor, eight on the middle and 10 on the top.
There are no day services provided in the centre.
The following information outlines some additional data on this centre.
Current registration end
date:
15/12/2019
Number of residents on the
date of inspection:
Page 3 of 13
How we inspect
To prepare for this inspection the inspector or inspectors reviewed all information about this centre. This included any previous inspection findings, registration information, information submitted by the provider or person in charge and other unsolicited information since the last inspection.
As part of our inspection, where possible, we:
speak with residents and the people who visit them to find out their experience of the service,
talk with staff and management to find out how they plan, deliver and monitor
the care and support services that are provided to people who live in the centre,
observe practice and daily life to see if it reflects what people tell us,
review documents to see if appropriate records are kept and that they reflect practice and what people tell us.
In order to summarise our inspection findings and to describe how well a service is doing, we group and report on the regulations under two dimensions of:
1. Capacity and capability of the service:
This section describes the leadership and management of the centre and how effective it is in ensuring that a good quality and safe service is being provided. It outlines how people who work in the centre are recruited and trained and whether there are appropriate systems and processes in place to underpin the safe delivery and oversight of the service.
2. Quality and safety of the service:
This section describes the care and support people receive and if it was of a good quality and ensured people were safe. It includes information about the care and supports available for people and the environment in which they live.
Page 4 of 13
This inspection was carried out during the following times:
Date
Times of
Inspection
Inspector
Role
22 March 2018 09:00hrs to
Page 5 of 13
Views of people who use the service
Residents’ views about the service being provided to them was positive. Those who spoke with the inspector said that staff were very kind and caring, and that the quality of the meals was good.
The inspector observed staff using a range of communication skills to support residents to be involved in the day-to- day activity in the centre, and to make choices and decisions about their day. Residents were seen to be enjoying the programme of activities being delivered during the inspection. There was time for social engagement as well as completing the practical care and support tasks for individual residents.
The provider has systems in place to check whether residents remained satisfied with the service. Residents' meetings were used to ask questions about whether their decisions, privacy and dignity were respected. Feedback was positive when responding to those questions, both in the meeting records and when asked by the inspector.
Capacity and capability
There were effective governance and management arrangements in place to ensure good outcomes for residents living in the centre. This included recruiting effective staff, providing an ongoing programme of training to further develop staff skills, and clear feedback processes for residents in relation to the quality of the service.
Improvement was required in relation to notifying HIQA of certain events.
The person in charge and their assistant carried out a range of reviews and audits each month to check the quality of service being provided and to ensure residents individual needs were being met. The format being used followed the guidance set out in the national standards for residential care settings for older people. They described using the process to support their aims to provide a person- centred service, and to support learning while focusing on quality improvement.
Page 6 of 13
and the reporting arrangements for any incidents or concerns.
There were arrangements for staff supervision at all times with a senior nurse and senior healthcare assistant to support the staffing teams and provide advice and guidance as required. The person in charge also carried out annual appraisals to review staff performance, identify any training needs, and also ask for their views on whether the service could be improved.
The staff training programme included formal training sessions on subjects such as safeguarding, fire safety, manual handling and dementia care. The provider then carried out weekly information sessions for all staff covering topics such as ‘what is restrictive practice?’, managing specific infections, responding to allegations of abuse, and use of psychotropic medication. Staff felt these were very informative and had a positive impact on their practice.
There was a clear process for residents and their relatives to raise issues in the centre. The inspector found that where issues had been raised they had been addressed quickly and the person raising the issue had been kept informed of progress and the outcome. There was also regular access to advocacy with an independent person visiting the centre twice a week to observe practice and have discussions with residents about their experiences in the centre and their quality of life.
One area that required review was in relation to identifying possible abuse
in concerns raised, the definition of abuse set out in the organisation's policy. In one example a concern had been raised and followed up, but this was not
completed following the safeguarding procedure and HIQA had not been informed of the concern. In discussion with the provider and person in charge they
understood that although this matter had been looked in to and there was no risk to the resident this should have been done using the preliminary screening process as set out in the policy.
Regulation 15: Staffing
The numbers of staff and their skills and experience met the needs of the residents. Nursing staff were available at all times.
Judgment: Compliant
Page 7 of 13
Staff had access to appropriate training including fire safety, safeguarding, and supporting residents with dementia. Staff were observed putting their training in to practice.
Judgment: Compliant
Regulation 21: Records
One incident was identified that should have been notified to HIQA when it occurred but was not.
Judgment: Substantially compliant
Regulation 23: Governance and management
The management team had clear roles and responsibilities that included the oversight of how the centre was operating. Quality of the service was assured through supervision of staff, regular audits against the regulations and standards, and feedback from residents to ensure they were satisfied with the service being provided to them.
Judgment: Compliant
Regulation 34: Complaints procedure
There was a clear complaints policy available for residents and visitors. Any
feedback or complaints that had been received had been responded to in a timely way and the satisfaction of the person who made the complaint was recorded.
Page 8 of 13
Quality and safety
Residents were receiving care that met their health and social care needs. They were treated with dignity and respect, and were able to influence the way the centre operated. The national policy was followed for the use of restrictive practice
including ensuring that the least restrictive solutions were identified. A review of a small number of care plans was required, and the provider must address an issue in relation to the availability of accessible bathrooms.
Prior to admission to the centre residents needs were assessed to ensure their
needs could be met appropriately in the centre. When residents arrived at the centre a comprehensive assessment was completed and care plans were developed for each need identified. Each care plan focused on the residents’ preferences, likes and dislikes. Staff asked the resident to provide information about their life, and then used this to engage in a meaningful way with them, supporting reminisance of important events and memories for those residents with dementia and cognitive impairments.
Residents were supported by a staff team who knew them well and provided care as described in their care plans. This resulted in positive outcomes and low levels of clinical incidents such as falls. Communication between residents and staff was seen to be effective in supporting residents to make choices and decisions and providing a good outlet of social interaction and fun. In a small number of cases the
information included in care plans required review to ensure that guidance was clear for staff, including if there was an emergency situation.
Regular residents meetings focused on seeking feedback about their experience in the centre, and checking their privacy was maintained, they felt respected and their rights were upheld. Feedback was positive when these questions were asked. There was an advocate available in the centre regularly and they raised issues on behalf of residents if requested to do so. The advocate ,also fed back any comments on practices in the centre to support the person- centred ethos implemented by the provider. The activity programme in the centre provided a range experiences including games, quizzes, exercise, and sporting events on the television in the smaller lounge. However some residents preferred to arrange their own routines and this was respected by the staff team.
There was good access to healthcare professionals including general practitioners (GPs) who visited the centre and specialists via the local hospitals and community services. There was a physiotherapist employed for two days in the centre who focused on supporting residents to maintain their mobility and independence. Residents felt that when their health needs changed, staff responded quickly and they were put in touch with the relevant professional. Residents felt they were involved in the decisions about their lives, and care documentation recorded resident’s consent where they were able to give it.
Page 9 of 13
for example bed rails. Where a recommendation to use the restriction was made an assessment was carried out and the decision was made with the GP, physiotherapist and person in charge. The resident agreed to their use where possible or family members were consulted on their behalf.
The premises provided three communal rooms in the centre and an enclosed garden. The areas were well presented and provided comfortable environments for residents to enjoy. Bedrooms also provided a comfortable environment and
residents were seen using them to relax and enjoy time away from the busier areas of the centre. Some bedrooms were only accessible by a number of steps, and only residents who were able to mobilise on the steps were accommodated in those rooms. An area that required improvement was the availability of accessible showers and toilets in the centre. While there was a sufficient number of showers and toilets in the centre, some were located up a number of steps which meant residents with reduced mobility or wheelchair users would not be able to access them. For example residents on the first and second floor would need to use the accessible shower on the ground floor. The visitors' room was being used as a staff room so at times was not available for use by the residents. These matters have been raised in previous inspections, and the provider has submitted a plan to address the issue. However at the time of the inspection the plan had not been implemented.
Regulation 17: Premises
There were ongoing improvements being made to the centre. Flooring was in the process of being replaced in some part of the centre, and there was a programme of work in progress to upgrade residents’ bedrooms.
However, there were insufficient accessible showers in the centre.
Judgment: Substantially compliant
Regulation 20: Information for residents
Additional information had been added to the document, it now included information on the facilities to be provided in the centre and the terms of residence.
Page 10 of 13
Regulation 26: Risk management
There was a risk management policy in place that clearly set out how risk was to be identified, responded to and addressed. The risk register in the centre covered all main hazards, and the person in charge maintained a log of issues that were raised through day- to- day practice. There was clear evidence that risks were being addressed when they were identified.
Judgment: Compliant
Regulation 5: Individual assessment and care plan
Clear arrangements were in place to assess residents needs prior to admission to ensure it was the right service to meet their needs. On admission care plans were developed to set out how residents individual needs were to be met. All documents were person centred in their approach, and staff were seen providing care that matched the residents preferences, as set out in the care plans.
In a small number of care plans improvement was required to ensure clear guidance was provided to staff on how to manage healthcare needs.
Judgment: Substantially compliant
Regulation 6: Health care
There was good access to a range of healthcare specialists. Where directions had been given about how residents', needs were to be met these were seen to be put in to practice, and followed national guidance in evidence- based practice.
Judgment: Compliant
Page 11 of 13
Staff had the skills to support residents, and care was being provided in line with their care plans.
Where restrictive practice was identified as necessary for the safety of residents, for example the use of bed rails, a multidisciplinary team and the resident or their relative made the decision. They considered if it was the most appropriate action to take, and reviewed what alternative methods had been trialled. This procedure followed national guidance.
Judgment: Compliant
Regulation 8: Protection
Measures were in place to protect residents from harm. There were thorough
recruitment arrangements for staff, a clear policy describing abuse and what actions to take if people witnessed, suspected, or had abuse reported to them. Staff spoken with were very clear of the procedure and confirmed they had received both formal training and regular refresher sessions from the provider.
Judgment: Compliant
Regulation 9: Residents' rights
Residents’ rights were being respected in the centre by staff who knew them well including their communication style and their care needs. There were arrangements for activities and recreation to take place each day in the centre, and they reflected the preferences and skills of the residents. There were regular residents meeting where views were sought about the quality of the service and to ensure residents felt their rights, privacy and dignity were being respected. Records and feedback given to the inspector confirmed they did.
Judgment: Compliant
Page 12 of 13
There was not always a visitors room available for residents use, as the allocated room was also used as a staff room.
Page 13 of 13
Appendix 1 - Full list of regulations considered under each dimension
Regulation Title
Judgment
Capacity and capability
Regulation 15: Staffing Compliant
Regulation 16: Training and staff development Compliant
Regulation 21: Records Substantially
compliant Regulation 23: Governance and management Compliant Regulation 34: Complaints procedure Compliant
Quality and safety
Regulation 17: Premises Substantially
compliant Regulation 20: Information for residents Compliant
Regulation 26: Risk management Compliant
Regulation 5: Individual assessment and care plan Substantially compliant
Regulation 6: Health care Compliant
Regulation 7: Managing behaviour that is challenging Compliant
Regulation 8: Protection Compliant
Regulation 9: Residents' rights Compliant
Regulation 11: Visits Substantially
compliant
Page 1 of 5
Compliance Plan for Atlanta Nursing Home
OSV-0000010
Inspection ID: MON-0021568
Date of inspection: 22/03/2018
Introduction and instruction
This document sets out the regulations where it has been assessed that the provider or person in charge are not compliant with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2015 and the National Standards for Residential Care Settings for Older People in Ireland.
This document is divided into two sections:
Section 1 is the compliance plan. It outlines which regulations the provider or person in charge must take action on to comply. In this section the provider or person in charge must consider the overall regulation when responding and not just the individual non compliances as listed section 2.
Section 2 is the list of all regulations where it has been assessed the provider or person in charge is not compliant. Each regulation is risk assessed as to the impact of the non-compliance on the safety, health and welfare of residents using the service.
A finding of:
Substantially compliant - A judgment of substantially compliant means that the provider or person in charge has generally met the requirements of the regulation but some action is required to be fully compliant. This finding will have a risk rating of yellow which is low risk.
Page 2 of 5
Section 1
The provider and or the person in charge is required to set out what action they have taken or intend to take to comply with the regulation in order to bring the centre back into compliance. The plan should be SMART in nature. Specific to that regulation, Measurable so that they can monitor progress, Achievable and Realistic, and Time bound. The response must consider the details and risk rating of each regulation set out in section 2 when making the response. It is the provider’s responsibility to ensure they implement the actions within the timeframe.
Compliance plan provider’s response:
Regulation Heading Judgment
Regulation 21: Records Substantially Compliant
Outline how you are going to come into compliance with Regulation 21: Records:
All records as per Schedules 2, 3 and 4 will be kept in the designated centre and all issues / events notified to HIQA regardless of content or context and will be available for inspection in the centre.
Regulation 17: Premises Not Compliant
Outline how you are going to come into compliance with Regulation 17: Premises:
The inspection report states (Page 9) that there are a sufficient number of showers and toilets in the centre. In order to improve accessibility we are in the design stage as to the provision of a ramp or ramps on the second floor and the expansion of an accessible toilet on the first floor into an accessible shower and toilet.
Regulation 5: Individual assessment
and care plan Substantially Compliant
Outline how you are going to come into compliance with Regulation 5: Individual assessment and care plan:
Page 3 of 5
Regulation 11: Visits Substantially Compliant
Outline how you are going to come into compliance with Regulation 11: Visits:
Page 4 of 5
Section 2:
Regulations to be complied with
The provider or person in charge must consider the details and risk rating of the following regulations when completing the compliance plan in section 1. Where a regulation has been risk rated red (high risk) the inspector has set out the date by which the provider or person in charge must comply. Where a regulation has been risk rated yellow (low risk) or orange (moderate risk) the provider must include a date (DD Month YY) of when they will be compliant.
The registered provider or person in charge has failed to comply with the following regulation(s).
Regulation Regulatory
requirement Judgment Risk rating Date to be complied with
Regulation
11(2)(b) The person in charge shall ensure that having regard to the number of residents and needs of each resident, suitable communal facilities are available for a resident to receive a visitor, and, in so far as is
practicable, a suitable private area, which is not the resident’s room, is available to a resident to receive a visitor if required.
Substantially
Compliant Yellow 31/05/2018
Regulation 17(2) The registered provider shall, having regard to the needs of the residents of a particular
designated centre, provide premises which conform to the matters set out
Page 5 of 5 in Schedule 6.
Regulation 21(1) The registered provider shall ensure that the records set out in Schedules 2, 3 and 4 are kept in a designated centre and are available for inspection by the Chief
Inspector.
Substantially
Compliant Yellow Complete
Regulation 5(1) The registered provider shall, in so far as is reasonably
practical, arrange to meet the needs of each resident when these have been assessed in accordance with paragraph (2).
Substantially
