manager. The role of assistant director of nursing was no longer in existence. While the management arrangements put in place at the last inspection had sustained certain improvements in the centre, inspectors were concerned about the ongoing sustainability of these improvements due to current issues with staffing. The person in charge was currently rostered to work most shifts as a staff nurse in the centre in order to deal with the nursing vacancies. The management structure was currently not in full effect due to the post of person in charge not being a full time role, to ensure the effective
systems. Each resident had their own wardrobe, chest of drawers and lockable storage space. Several bedrooms had been personalized with photographs, artifacts and in some rooms small items of furniture from the resident's own home. Residents took pride in their bedrooms and were keen to show the inspectors around their rooms. The communal areas were light and spacious and were well used by the residents during the inspection which gave the centre a real sense of community. There was a large sitting room to the rear of the building with double patio doors which looked out onto the courtyard area and provided access to this outside space. In addition there was a smaller quiet lounge area to the front of the building which provided quiet comfortable seating for those residents who preferred a calm space. Residents in this area told the inspectors that they enjoyed chatting amongst themselves and playing card games or watching sport on TV.
During the last inspection inspectors were not satisfied that the skill mix of staff at certain times of the day was sufficient to ensure that residents' needs were being met, as one nurse was on duty to support 28 residents. The inspector was not assured during this inspection that the rostered nursing hours were sufficient. The nursing hours as indicated on the rosters did not reflect the number of whole time equivalent nurses as detailed in the statement of purpose. The inspector was provided with an analysis of the staffing levels in the centre based on the dependency levels of the current residents. However this analysis indicated that there were two nurses on duty every day from 8am to 12pm, but a review of the staff roster indicated that over a 4 week period this 8am- 12pm shift was only filled or rostered to be filled four times.
comprehensive and informative daily life care plan was in place for all residents which outlined clear guidance for staff in areas such as washing and dressing, elimination, eating and drinking, mobilisation and safe environment, communication, controlling temperature, social, mental and emotional state, expressing sexuality, maintaining respect and dignity, sleeping and end of life care. Care plans guided care and were regularly reviewed. Care plans were person centered and individualised. There was evidence of relative/resident involvement in the review of care plans. There was also large print signage in the entrance areas informing residents/relatives what a care plan was and that they were available for review and could be discussed at any time. There was evidence to show that care plans were reviewed regularly on a three monthly basis and more frequently if required. Nursing staff and health care assistants spoken with were familiar with and knowledgeable regarding residents up to date needs. Care staff were also included in the review and updating of residents care plans, they told the inspector that systems were in place to ensure that any changes or information relating to residents needs was used to update care plans.
evidence based assessment tools. The assessments were reviewed frequently to reflect any changes noted in residents health care. Inspectors also found that residents had regular access to general practitioner (GP) services and to allied services including speech and language, physiotherapy, which was provided in house,occupational therapy dental and opthalmatic services. However, access to psychiatry of old age was not evident despite the number of residents who had cognitive impairment or dementia. The recommendations made by allied specialists were available. Staff were found to support residents with the interventions outlined by the speech and language therapist as part of a rehabilitation programme. Resident’s weights, food and fluids were
The inspectors had some concerns that the numbers of nursing staff on duty at night time had been reduced since the last inspection. The number of nursing staff had been reduced from three to two at night time. There were eight care assistants on duty up until 22.00 and six care assistants on duty from 22.00 to 8.00am. The provider/person in charge had identified the reduced number of nursing staff as a risk and updated the risk register accordingly. The person in charge told inspectors that the numbers of nursing staff available had reduced and that she was actively trying to recruit additional nurses. She stated that she had tried to get agency nursing staff in the interim but had been unsuccessful. The person in charge advised inspectors that she had rostered an
observed. Residents were provided with a choice of hot meal at mealtimes. There was an effective system of communication between nursing and catering staff to support residents with special dietary requirements. An inspector observed the lunchtime meal and found that all opportunities were not availed of to make mealtimes in the dining room a social occasion for residents. There was limited interaction by staff with residents whilst providing assistance to them with their meal. Staff were observed to rush residents with eating, assisting more than one resident at the same time and tended not to sit with residents whilst providing assistance to them. These observations did not reflect person-centred care practices. This finding is also discussed in outcomes 3 and 5.
The inspectors heard relatives complaining of the cold in some bedrooms. Residents complained that the ground floor smoking room was cold and inspectors noted same. Nursing staff confirmed that the heating was not working in some zones while other zones were too warm. Free standing electric heaters had been provided to some bedrooms. The inspectors had concerns that these posed a risk to residents. This is discussed further under outcome 8 Health and Safety.
Inspectors noted that the policy on behavioural management was still not fully reflected in practice. Inspectors reviewed the files of residents presenting with behaviours that challenged and noted that there were no behavioural assessments or monitoring charts on file as outlined in the policy. The provider told inspectors that she had attended one of a two day dementia and challenging behaviour training course and was due to attend day 2 following the inspection, she stated that this training was scheduled for staff in the nursinghome on 23 April 2015.
The centre provides care primarily for residents with long-term nursing care needs. Relatives confirmed that staff informed them of their relatives’ health care needs and any changes in their conditions. Residents had access to GP services and out-of-hours medical cover was provided. Psychiatry of later life services were available and provided to residents upon referral. The centre employed a physiotherapist and a full range of other services was available on referral basis including speech and language therapy (SALT) and occupational therapy (OT), dietician, chiropody, dental and optical services. Inspectors reviewed residents’ records and found that some residents had been referred to these services and results of appointments were recorded in the residents’ notes. Inspectors found that residents had a comprehensive nursing assessment and care plans developed based on these assessments. For example, there was information which detailed residents' choices with regard to food likes and dislikes, risk assessments such as moving and handling, falls, use of bed rails, nutrition, continence and the risk of pressure sores.
The inspectors were informed that there were two residents who were self administering some of their own medications. Risk assessments had been completed on the residents’ competency to self-administer and locked storage for the resident’s medication was provided. However, the inspectors had concerns that the systems in place were not sufficiently robust to protect the residents or the staff. Nurses were giving medications to the resident as requested on a daily basis which at times was in excess of the daily prescribed amounts. A record was signed by the nurse and the resident to indicate that the resident had received the quantity of medication. Nursing staff were also signing the administration chart for times they thought the resident might be taking the tablets as if they had administered them at that time. This practice was not in compliance with best practice guidelines, nor in line with their self administration policy. One of the
Each residents wellbeing and welfare is maintained by a high standard of evidence- based nursing care and appropriate medical and allied health care. Each resident has opportunities to participate in meaningful activities, appropriate to his or her interests and preferences. The arrangements to meet each residents assessed needs are set out in an individual care plan, that reflect his/her needs, interests and capacities, are drawn up with the involvement of the resident and reflect his/her changing needs and
Of the sample of files reviewed by the inspectors, the wishes of the resident with regard to end of life had been identified and documented, including place of death. All residents who had died in the centre over the past two years had been provided with the choice of a single room if they were not already in one as they reached their end of life. The person in charge reported that some residents had expressed a wish to remain in a shared bedroom; this was confirmed in relatives’ questionnaires. The centre-specific policy stated and the person in charge confirmed that, if possible, the option to go home for end of life care was facilitated.
On the previous inspections the inspectors expressed concern in relation to nurse cover and it was not demonstrated that arrangements in place in relation to the skill mix of staff were appropriate at all times to meet the needs of residents. There was only one nurse on duty from 08.00 to 20.00 to address all the nursing needs of the residents and to undertake three medication rounds throughout the day. Nursing staff reported having to stay on duty late most evenings to complete their reports and documentation. There were no contingencies for residents who became unwell or were at end of life. The provider and person in charge said they were actively recruiting nursing staff and as discussed previously had stopped taking admissions to ensure the service to residents was safe. The inspectors also expressed concern in relation to the staffing levels at night which reduced to one nurse and two care staff from 20.00hrs. The night time
Four actions were identified at the previous inspection. One action had been completed, one had been partially completed and the timeframe for two actions had not yet passed. At the time of the previous inspection, a new person in charge had recently commenced in the centre and an assistant director of nursing (ADON) had recently been selected and was due to shortly take up the ADON role. Reporting structures had been clarified. The creation of a ‘senior carer’ position was planned. At that time, it was not possible to determine the effectiveness or otherwise of the changes to the management system or reporting structure.
Part of the centre consisted of a row of five detached houses whereby 15 residents lived across four houses and one house was used as an office space by the provider and administration support. These houses while built a number of years ago were decorated and comfortable for the residents living there. Each resident had their own bedroom that were found to be personalised and had sufficient space and storage for personal
Inspectors reviewed a sample of eight files of current residents and found that the end of life preferences of only one resident was documented. Care plans are discussed further under Outcome 11: Health and Social Care Needs and the resulting actions. Inspectors reviewed the files of two residents who had passed away and found evidence of good practice. The residents' wishes about how they chose to spend their final days were clearly documented and had been fulfilled; relatives were supported to be with their loved ones; nursing staff had identified when a resident's condition was