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Report of an inspection of a
Designated Centre for Older People
Name of designated
centre:
Drumderrig House
Name of provider:
Drumderrig House Nursing Home
Limited
Address of centre:
Abbeytown, Boyle,
Roscommon
Type of inspection:
Unannounced
Date of inspection:
02 & 03 October 2018
Centre ID:
OSV-0004457
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About the designated centre
The following information has been submitted by the registered provider and describes the service they provide.
Drumderrig House Nursing Home is a purpose-built facility that provides care for 107 male and female residents who require long-term care or who require care short periods due to respite, convalescence, dementia or palliative care needs. Care is provided for people with a range of needs: low, medium, high or maximum
dependency. The centre is located approximately 2 kilometres outside the town of Boyle, Co. Roscommon and is a short drive from Lough Key Forest Park. The centre provides an accessible and suitable environment for residents. Bedroom
accommodation consists of 55 single and 26 double rooms all of which have ensuite facilities. There are additional toilets including wheelchair accessible toilets located at intervals around the centre and close to communal rooms. There are four sitting areas where residents can spend time during the day. There are dining rooms in two locations and an oratory, visitors’ rooms and conservatory areas provide additional spaces for residents’ use. In the statement of purpose the provider describes the service as aiming to enhance the quality of life of residents by providing good standards of health and social care within a peaceful and tranquil setting. The staff seek to develop, maintain and maximise the full potential of each resident.
The following information outlines some additional data on this centre.
Number of residents on the
date of inspection:
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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.
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This inspection was carried out during the following times:
Date
Times of
Inspection
Inspector
Role
02 October 2018 13:30hrs to
18:30hrs Geraldine Jolley Lead 03 October 2018 08:30hrs to
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Views of people who use the service
The inspector talked to seven residents about their experience of living in the
centre. They said that they had a good quality of life and that staff were attentive to their needs. Several described how they spent their day. They outlined the regular activities and said they enjoyed bowls, bingo and card games. Some residents said that they did not take part and preferred to spend their day reading, listening to the radio or watching television. All said that they had freedom to choose what they did and said that staff respected this.
Staff were described as kind and caring. All said that there was plenty of staff around however some residents said that there were times when it was difficult to locate staff particularly in the mornings. They said that they had choices about when they got up and went to bed and that when they changed their mind or routine this was respected by staff.
Residents described the food as good and said that there was a varied menu
available with alternatives provided if they did not like the options offered. They also said that they could have meals alone or with others. Visitors said they were
welcomed to assist at meal times if they wished to visit at a scheduled meal time.
Residents said that they had good care and saw doctors when they were unwell and at other times when reviews of their care were undertaken. They said that staff informed them of appointments and at the time of the inspection said that they had been advised of the upcoming influenza vaccination programme.
Capacity and capability
There was a clear management structure in the centre that outlined the lines of authority and accountability. This was understood by staff who knew who to report to and the responsibility of the provider representative and person in charge. The centre has had a positive regulatory history with actions identified during inspections completed in a timely manner.
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demonstrated a wide range of knowledge that supported the delivery of suitable safe care to residents. The provider representative was based on site and was
actively involved in the day to day running of the centre. She was familiar with staff, residents and visitors. There was evidence of regular oversight of the delivery of care and the overall service provided to residents. For example, there were regular audits of aspects of the service that included complaints management and incidents. The provider representative confirmed that all staff had suitable Garda Síochána (police) vetting in place. Registration details with An Bord Altranais agus
Cnáimhseachais na hÉireann (Nursing and Midwifery Board of Ireland) for nursing staff for 2018 were available and viewed by the inspector.
The provider representative and the person in charge had arrangements in place to meet with staff and with residents. Minutes of these meetings were maintained. The person in charge had a number of initiatives in place that were aimed at driving resident-focused person-centred care. She described for example how advocacy was being promoted for residents which had had good outcomes in a number of
situations enabling residents to have meaningful choices about their lives. There was an ongoing training programme for staff and this included statutory training in
moving and handling, fire safety and adult protection. The person in charge was well known to residents who told the inspector that they could see her whenever they wished and were always welcomed in the office if they had something to discuss or to have a chat. Staff described the person in charge as an approachable manager, who was focused on residents’ care and also ensured the staff team was supported.
The inspector found that the provider representative had a suitable complement of staff and a varied skill-mix to meet the assessed needs of the residents taking into account the size, design and layout of the centre. However the deployment of staff to communal areas required review as there were times particularly during the morning when residents said they found it difficult to locate staff. The inspector reviewed a sample of staff files and the majority included the information required under Schedule 2 of the regulations however some were noted to lack a full
employment history. All staff received an induction when they started work and spent a period of time working alongside an experienced carer or nurse to ensure they were familiar with the layout and residents’ routines. Concerns relayed to The Health Information and Quality Authority that described deficits in care practice were reviewed and were not evidenced during the inspection.
Registration Regulation 4: Application for registration or renewal of
registration
The application for registration renewal did not contain all the required
information. A request to supply the outstanding documents was responded to and the application process was completed.
Page 7 of 25 Judgment: Compliant
Regulation 14: Persons in charge
The person in charge worked full-time in the centre. The inspector found that she was well known to residents and staff who knew she was in charge and responsible for the day to day business of the service. During the inspection days the person in charge demonstrated good knowledge of the legislation and of her statutory
responsibilities. She displayed commitment to providing a person-centred, good quality service. She had kept her knowledge and skills up to date by attending
relevant education and training sessions that including a post-graduate management training course. There were arrangements for a senior nurse to replace the person in charge when she was off duty and during holiday periods.
Judgment: Compliant
Regulation 15: Staffing
At the time of the inspection there was a good allocation of staff on duty to meet the needs of residents however the inspector observed that at times during the day there was an absence of staff in communal areas which made it difficult for
residents to access help. The inspector observed that staff interacted positively with residents and engaged with them when they met or when they entered rooms. Staff the inspector talked to were well informed about residents' health and personal care needs, their preferred routines and their likes and dislikes.
Judgment: Substantially compliant
Regulation 16: Training and staff development
Records viewed by the inspector confirmed that there was a varied training programme provided for staff. Mandatory training was ongoing and all staff had completed training in areas such as fire safety, moving and handling and
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Judgment: Compliant
Regulation 19: Directory of residents
The directory of residents was up to date and contained the prescribed information.
Judgment: Compliant
Regulation 21: Records
The required records were maintained. Schedule 2 staff records were not all complete as a full employment record was not available for all staff employed.
Judgment: Substantially compliant
Regulation 23: Governance and management
Overall, there was evidence of good governance and there were systems in place to monitor and review the service. The audit programme in place ensured that aspects of the service were reviewed and monitored to ensure the quality and safety of care and residents' quality of life met good standards. There were for example regular audits of incidents, complaints, the information recorded in the directory of residents and in staff files.
Following the completion of audits and incident reviews, there was evidence that the person in charge and the provider representative communicated the outcome to staff and put in place remedial measures where deficits were found. These
arrangements gave assurance that residents were safe and the quality of care was being monitored and that deficits were addressed.
There was a clear staff structure that was known to staff and residents. The provider representative and person in charge worked full time in the centre.
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Regulation 24: Contract for the provision of services
All residents were issued with a contract that described the services and facilities provided and the fee to be charged. The resident's contribution and any charges for additional services were outlined. A sample of contracts were reviewed and were found to convey the required information except in some instances the room to be occupied was not specified.
Judgment: Substantially compliant
Regulation 3: Statement of purpose
The statement of purpose conveyed the required information and described the services provided and the facilities available to residents.
Judgment: Compliant
Regulation 31: Notification of incidents
Incidents and events were notified within the required time limits.
Judgment: Compliant
Regulation 34: Complaints procedure
The centre had a procedure for the management of complaints. All matters raised were recorded, investigated and the outcome including if the complainant was satisfied was described.
Judgment: Compliant
Regulation 4: Written policies and procedures
The required policies and procedures were available and were accessible for staff if they needed to refer to them.
Page 10 of 25 Judgment: Compliant
Quality and safety
Residents’ health and social care needs were met by good access to doctors, allied health professionals and to specialist services such as old age psychiatry. There was a varied social activity programme available and residents said they enjoyed the activities provided. The spacious environment also contributed positively to how care was delivered and to residents’ quality of life. There were spaces for residents to sit together to socialise and watch television and other more private areas were
available if residents wanted to spend time quietly.
There were care plans for all residents and these were based on a range of
assessments that identified residents’ health and social care needs. There were good descriptions of residents’ backgrounds and lifestyles recorded to inform how care was delivered. Care needs and changes in health were regularly reviewed by nurses and medical staff. Residents told the inspector that staff enquired about their health and arranged that they were reviewed promptly if they were unwell. Other changes such as weight loss or behaviours also prompted reviews. There were varied
assessments completed including falls risk assessments and where risk or
vulnerability was identified, there were care plans that described the measures to be taken by staff to promote health and prevent deterioration. A third of residents were over 90 years of age and many residents had complex health problems including dementia. The daily life patterns and interests of residents were recorded to inform care practice. There were details on lifestyle, occupation, hobbies and interests available to enable staff plan care in a way that reflected their routines and lifestyles. Residents told the inspector that they could choose how their care was provided and said that they could select when they get up and go to bed and how often they have showers and baths. End of life care plans had been completed for many residents and there was information recorded on how residents wished their care to be delivered and their funeral arrangements.
Residents’ and family members were informed about the admission procedure and were given information about the centre to help them make decisions about moving to residential care. They said that they had been given the opportunity to visit and that their queries about the service and documentation to be completed had been answered comprehensively.
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The building has been extended and refurbished over the years and provides an accessible environment that meets appropriate standards of privacy. There is plenty of natural light throughout and it is maintained to a good decorative standard. There were features that enhanced the accessibility of the environment for people with dementia or sensory problems. Hallways were wide and unobstructed and there were readily visible handrails to support residents as they walked around. There was access to outdoor courtyard garden areas where flowers and shrubs had been planted and some residents took a great interest in how the plants were growing and viewed them regularly. Residents’ rooms are single or double occupancy. Rooms viewed were organised according to residents’ preferences and were personalised with furniture, books, plants and ornaments belonging to residents.
There were systems in place to keep residents safe and protected from harm; and risk was minimised by the arrangements in place. For example, water was dispersed at a safe temperature and call bells were accessible to residents in all areas.
Equipment including fire alert and control equipment was serviced regularly and records confirmed this. Orientation to the fire safety system was provided for all new staff and fire training was supported by fire drills that were scheduled regularly. The inspector saw records that confirmed this however fire drills were scheduled during day time hours and needed to be varied to ensure staff could manage situations at different times.
There was a system in place to prevent and detect possible abuse situations. Residents said they felt safe and well cared for in the centre. Staff could describe the actions they would take if they suspected abuse or if an incident took place and all had received training and information on this topic during the last three years. The person in charge and persons participating in management had completed advanced training and were the designated persons to assess and manage an incident of abuse.
There was a safety statement and risk management procedures in place. Risk assessments were completed for varied activities and events that included missing persons, slips, trips and fall, responsive behaviours, dementia and aggression. The topic of abuse was not included in the risk procedures as required by regulation 26- Risk Management.
Regulation 10: Communication difficulties
There were good descriptions of the problems residents had in relation to
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Judgment: Compliant
Regulation 11: Visits
The centre had an open visiting policy with no restrictions and visitors were welcomed throughout the day. The inspector saw some family members come in during the morning, others assisted their relatives at meal times and some visited in the late evening.
Judgment: Compliant
Regulation 12: Personal possessions
All residents had adequate space to store their personal items safely and to keep a reasonable amount of clothing and personal effects in their rooms. Clothing
was identified to prevent loss.
Judgment: Compliant
Regulation 13: End of life
Care plans that described residents' end of life wishes had been completed where possible. The inspector saw a sample of care records where residents had described how they wished to be cared for at end of life, who they would like with them and the funeral arrangements to be followed.
Judgment: Compliant
Regulation 17: Premises
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Judgment: Substantially compliant
Regulation 18: Food and nutrition
Residents described the food as very good and said they enjoyed their meals. They said that alternatives are made available if they do not like the main dishes.
Nutrition needs are monitored and residents are referred for specialist advice promptly if there are fluctuations in weight.
Judgment: Compliant
Regulation 20: Information for residents
There was a resident's guide available that contained information on the service however the small print format should be reviewed so that the information is readily accessible to all residents.
Judgment: Substantially compliant
Regulation 26: Risk management
There was a safety statement and a range of risk management procedures in place. Risk assessments were completed and reviewed. The risk management policy
included reference to the required topics except for the risk of abuse which is one of the required risk factors to be included.
Judgment: Substantially compliant
Regulation 27: Infection control
Staff had training on infection control and could describe the way laundry, cleaning routines and personal care was managed to limit any spread of infection. There were supplies of personal protective equipment readily accessible to staff. Staff were observed to be diligent about hand washing after they completed varied tasks.
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Regulation 28: Fire precautions
There were adequate fire protection arrangements in place that included fire fighting equipment, means of escape, emergency lighting and a fire alarm. The system was regularly serviced and maintained. Staff knew what to do if the fire alarm was activated and the support needs of each resident were
clearly documented and readily accessible in an emergency. The provider and person in charge confirmed that fire drills took place regularly and records reviewed confirmed this took place however the inspector noted that fire drills only took place during the day and some variations to this would ensure that staff became familiar with what to do at other times such as the late evening
Judgment: Substantially compliant
Regulation 29: Medicines and pharmaceutical services
Staff were knowledgeable about the medicines in use, and administration, storage and disposal practices were safe. There were clear arrangements for the receipt, storage and administration of medicines in the centre. Nurses had completed medicines management training. The inspector reviewed a sample of medicines prescription sheets and observed administration practices.
The use of psychotropic medicines and antibiotics was closely reviewed by the person in charge. Doctors reviewed medicines regularly and many residents interviewed were well informed about the medicines they took to manage their health conditions.
Judgment: Compliant
Regulation 5: Individual assessment and care plan
Residents care records showed that pre-admission assessments were completed, care plans put in place and reviews occurred every four months or more frequently if required. There were records of reviews and decisions taken were clearly
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Judgment: Compliant
Regulation 6: Health care
Appropriate medical and allied health-care advice was available and the services were accessible to residents, in line with their identified health and social care needs. The person in charge provided leadership and guidance that ensured that evidence-based nursing care practice was in place.
Judgment: Compliant
Regulation 7: Managing behaviour that is challenging
The indication for use of prescribed as required psychotropic medications was clearly outlined in each resident's care plan where responsive behaviour was evident. A review of the records of behaviour changes described individual triggers, the behaviours that presented possible triggers for the behaviour.
Judgment: Compliant
Regulation 8: Protection
Measures were in place to protect residents from abuse and adverse
events. Training was provided to staff to guide them in recognising and responding to actual, alleged or suspected incidents of abuse. Staff spoken with knew their responsibilities in relation to ensuring residents were safe and protected. All had completed training or refresher training during the past two years
Residents confirmed to inspectors they felt safe in the centre.
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Regulation 9: Residents' rights
Residents rights were protected and promoted. There were arrangements for residents to access advocacy services and the inspector saw that advocacy interventions had had good outcomes for residents.
Residents were registered to vote and were aware of the pending general election. many residents said they voted in the centre and described the arrangements in place for them to do this.
Residents the inspector talked to said they had good control over their daily lives and were free to alter their routines from day to day.
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Appendix 1 - Full list of regulations considered under each dimension
Regulation Title
Judgment
Capacity and capability
Registration Regulation 4: Application for registration or
renewal of registration Compliant
Regulation 14: Persons in charge Compliant
Regulation 15: Staffing Substantially
compliant Regulation 16: Training and staff development Compliant Regulation 19: Directory of residents Compliant
Regulation 21: Records Substantially
compliant Regulation 23: Governance and management Compliant Regulation 24: Contract for the provision of services Substantially
compliant Regulation 3: Statement of purpose Compliant Regulation 31: Notification of incidents Compliant Regulation 34: Complaints procedure Compliant Regulation 4: Written policies and procedures Compliant
Quality and safety
Regulation 10: Communication difficulties Compliant
Regulation 11: Visits Compliant
Regulation 12: Personal possessions Compliant
Regulation 13: End of life Compliant
Regulation 17: Premises Substantially
compliant Regulation 18: Food and nutrition Compliant Regulation 20: Information for residents Substantially
compliant Regulation 26: Risk management Substantially
compliant Regulation 27: Infection control Compliant Regulation 28: Fire precautions Substantially
compliant Regulation 29: Medicines and pharmaceutical services Compliant Regulation 5: Individual assessment and care plan Compliant
Regulation 6: Health care Compliant
Regulation 7: Managing behaviour that is challenging Compliant
Regulation 8: Protection Compliant
Regulation 9: Residents' rights Compliant
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Compliance Plan for Drumderrig House
OSV-0004457
Inspection ID: MON-0023300
Date of inspection: 02 & 03/10/2018
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.
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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 15: Staffing Substantially Compliant
Outline how you are going to come into compliance with Regulation 15: Staffing: Residents who have medium to high risk needs are accommodated in the sitting room near the main office. This area is monitor by a member of staff throughout the day. All other areas are allocated to residents who are low risk needs.
Staff allocated to the low risk areas are monitoring their areas more frequently during busy times of the day to be available to attend to the resident’s needs.
We are continually assessing the needs of the residents and adjusting staffing levels to meet these needs.
Regulation 21: Records Substantially Compliant
Outline how you are going to come into compliance with Regulation 21: Records: All staff are requested to complete a new up to date CV to include full employment history.
Regulation 24: Contract for the
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Outline how you are going to come into compliance with Regulation 24: Contract for the provision of services:
We have put in place an audit on all residents contracts to highlight which ones that don’t have the room number allocated.
All contracts will have the resident’s room number clearly written in schedule 1 of their contract.
Regulation 17: Premises Substantially Compliant
Outline how you are going to come into compliance with Regulation 17: Premises: The first sitting is allocated to residents who requires assistance with dining. Residents who are mobile and do not require assistance are to attend the 2nd seating, some of these residents likes to come in themselves to this sitting, this can make the room look crowed.
Residents who do not require assistance with dining are to attend the second sitting, this will free up space.
Regulation 20: Information for
residents Substantially Compliant
Outline how you are going to come into compliance with Regulation 20: Information for residents:
A resident’s guide was developed with larger font and is available for residents.
Regulation 26: Risk management Substantially Compliant
Outline how you are going to come into compliance with Regulation 26: Risk management:
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Regulation 28: Fire precautions Substantially Compliant
Outline how you are going to come into compliance with Regulation 28: Fire precautions: We have completed fire training and evacuations on the 16th and 17th of October 2018. We did them at 2 different times one in the afternoon and another in the evening.
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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 15(1) The registered provider shall ensure that the number and skill mix of staff is appropriate having regard to the needs of the
residents, assessed in accordance with Regulation 5, and the size and layout of the designated centre concerned.
Substantially
Compliant Yellow 01/11/2018
Regulation 17(1) The registered provider shall ensure that the premises of a designated centre are appropriate to the number and needs of the residents of that centre and in accordance with the statement of purpose prepared under Regulation 3.
Substantially
Compliant Yellow 01/11/2018
Regulation 20(1) The registered
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prepare and make available to
residents a guide in respect of a designated centre. 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 07/12/2018
Regulation 24(1) The registered provider shall agree in writing with each resident, on the admission of that resident to the designated centre concerned, the terms,
including terms relating to the bedroom to be provided to the resident and the number of other occupants (if any) of that bedroom, on which that resident shall reside in that centre.
Substantially
Compliant Yellow 07/12/2018
Regulation
26(1)(c)(i) The registered provider shall ensure that the risk management policy set out in Schedule 5 includes the measures and actions in place to control abuse.
Substantially
Compliant Yellow 07/11/2018
Regulation
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ensure, by means of fire safety management and fire drills at suitable intervals, that the persons working at the designated centre and, in so far as is reasonably
