The person in charge (PIC) was on duty during the inspection. She commenced in her role on 03 May 2016 and had yet to be deemed fit to hold the post of PIC by HIQA. She was asked to submit a detailed report of her nursing experience to assure HIQA that this included 3/6 years of working with older people. She was contracted to work fulltime, is a registered disabilities nurse and has completed a module in management as part of her Masters in Palliative Care. Residents’ spoken with were aware of the change in person in charge.
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The person in charge (PIC) was on duty during the inspection. She commenced in her role on 11July 2016 and was deemed fit to hold the post of PIC by HIQA. She submitted a detailed report of her nursing experience to assure which assured HIQA she had 3/6 years experience of working with older people. She was contracted to work fulltime, is a registered nurse and has completed a her Masters in Healthcare Management and a Higher Diploma in Employment Law and another in Human Resources Management. Residents’ spoken with were aware of the change in person in charge.
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Clinical documentation was reviewed. Assessments and care plans were in place for all residents’. Residents were assessed on admission and reviewed three-monthly with a validated assessment tool for food and nutrition and skin integrity. A baseline weight and height was recorded on admission and monthly thereafter or more frequently if a resident was identified as being at risk. Assessments were detailed and reflected the resident's individual needs. Each need had a corresponding care plan which detailed the nursing care, medications/food supplements prescribed; specific care recommendations from visiting inter disciplinary team members and the GP instructions. Residents spoken with who informed the inspector that they were on a fluid restriction had this maintained and totalled by staff at the end of each 24hr day.
Beneavin Lodge is supported by a Training Coordinator who works closely with the PIC and ADON. Training needs that have been identified are prioritized with an agreed timeframe for rollout. This occurs on a continuous basis and most recently included fire training and evacuation, safeguarding, infection control, MAPA, and food safety. There is ongoing MAPA training with seven staff recently completed and next training scheduled for 3/10/18. All new staff recruited attend a very comprehensive induction program to ensure they have the knowledge, skills and competency, to be rostered as part of our care team.
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The Five residents were admitted to Beneavin Lodge in one week. Four of these were residents from another FirstCare Nursing Home with complete oversight by both Home Managers and absolute concern for the greater good of all residents involved.The admission of these four residents was not viewed as a breach of the commitment given to HIQA to admit a maximum of three residents per week as they were already residing within a FirstCare Home, were well known to staff and careplans were already in place. The moves were conducted in such a manner to ensure consistency of care, familiar faces and surroundings for all residents involved. Both moves were pre-planned which also involved regular staff moving with the residents to ensure consistency. The moves were communicated to all families in advance with appropriate viewing times of the new more suitable environment. All moves were agreed by families involved and supported by the GP.
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Residents reported they were sufficiently busy and had options to attend some group activities and outings (as detailed further in the residents views section earlier in the report). Their social activity care plan included detail of their likes and dislike and day to day records were being maintained by either nursing staff of the activity or care team. The activity team consists of three different members of staff, and the programme runs across the full seven days a week. Some on ward activity was observed in some unit while the inspector went through care plans with nursing staff. These activities consisted of ball games, and table top crafts. Large format group activities (for example music sessions) took place in a large activity room on the ground floor. Residents with challenging behaviours often remained on their units.
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There were safe secure outdoor garden spaces for residents to use and these were well cultivated and provided with appropriate seating. Systems were in place to ensure the environment was safe for residents, staff and visitors. There were policies, procedures, systems and practices in place to assess, monitor and analyze potential risks and control measures were in place to ensure risk was minimised. The centre was clean and well organised. The fire safety arrangements were satisfactory and staff were familiar with the fire safety routines, the location of fire fighting equipment and the actions they were required to take should the fire alarm be activated. There was an ongoing programme of decoration and maintenance undertaken by a team of maintenance staff and a health and safety officer. Care, nursing staff and ancillary staff were well informed and conveyed a
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The inspector found that there was an adequate complement of consistent nursing and care staff on duty each day and night. There were two nurses on duty with the person in charge daily. Care staff numbers were varied throughout the day to meet the needs of residents and there were usually 3 or 4 carers on duty. The care team was supported by the provider representative who had responsibility for general business matters, maintenance and fire safety and who worked daily in the centre. Cleaning, laundry and catering staff were also on duty each day. At night there was one nurse and two carers until 23.30 when the staff complement reduced to one nurse and one carer. Staff were noted to be deployed effectively and were available in adequate numbers during the early morning and evening when residents were getting up and going to bed.
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Recent changes had occurred to the organisational structure. A new person in charge had taken up post. The clinical nurse manager (CNM) was promoted to assistant director of nursing (ADON) and a new group manager was also in post. The group manager also had responsibilities for two other centres. The organisational structure was defined in the statement of purpose.
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The inspector observed the activity co-ordinator preparing to facilitate a scheduled activity while background music was playing. While twenty six of the fifty one residents residing in the centre were in the sitting room at this time, not all participated. Residents spoken with by the inspector said they preferred to listen rather than participate in some activities. One resident told the inspector that while she attended the activity and didn't participate, she planned to participate in the scheduled afternoon activity as it was her favourite. The weekly activity programme was displayed. Another resident with reduced mobility function told the inspector that she wasn't able to engage in the activities she used to do to relax at home due to her medical condition. Staff were knowledgeable regarding her past interests and hobbies. However, the inspector found that inadequate records were available evaluating whether participation in scheduled activities resulted in positive outcomes for individual residents. Although the inspector was told that the activity co-ordinator attended residents who remained in bed or in their bedrooms, an activity/recreation care plan was not present in one resident's documentation reviewed. Judgment:
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On the day of inspection, the inspectors reviewed the staffing rota. Annual leave and other planned/unplanned staff absences were covered from within the existing staffing complement and with the support of an identified 'relief' team which provided continuity for residents. The inspectors found that pre-nursing students on work experience were not recorded on the staffing rota given to inspectors. In addition two care staff recorded as working on the duty rota were not documented on staff training records. Full names of catering staff were not referenced in the duty rota. The hours of duty of all staff with the exception of nursing staff, the person in charge and the provider were not entered on the staff rota using a 24hour clock format. This finding is discussed in outcome 5.
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Nursing staff were observed as they administered medicines. Residents were unhurried. Prescription and administration records were maintained in accordance with the centre’s policy and professional standards. Of the prescriptions reviewed the maximum dose of any medicine to be administered within a 24 hour period was recorded on all as required medicines. Residents are supported to self administer medicines. The system in place minimises any risk. The documentation reviewed evidenced a risk assessment process and a detailed care plan that guides practice. The inspector spoke with a resident that currently self administers their own night time medication and the resident voiced that the staff are very supportive of this choice.
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Staff confirmed that residents and families were given a choice as to place of death including a single room and families were encouraged and supported to remain with their loved ones as long as they wished. There were designated facilities available for family members and these facilities were being enhanced by the addition of another room with sleeping accommodation. Staff including care staff had received training in end of life care and further training was planned. There was a good working relationship established with the local palliative care team and residents’ doctors and nursing staff could make referrals for advice and consultation.
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Residents told the inspectors that the food provided was “tasty and well presented”, “difficult to fault” and also said “there is a choice available at each meal and if I don’t want to have a big meal staff will give me something lighter”. There was a planned menu that was served on a four week rotation however the chef said that food was cooked on the premises and there were variations so that produce in season could be included. The inspector reviewed the menu and discussed the options available to residents. There were two choices of cooked meal at midday and in the evening. Nutritious snack options were available between meals to ensure sufficient and adequate calorie intake particularly where residents were on fortified diets. These included home baked cakes and scones which the chef said were very popular with residents at afternoon tea and supper times. Fresh fruit was served daily in a variety of ways. The fortification of food was noted to include yoghurt's, milk puddings and extra butter. Staff had access to the kitchen areas to prepare snacks for residents during the night. Liquids, including water, juices and soft drinks were readily available in communal areas and by residents’ beds. Staff were noted to prompt residents who needed
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mealtimes. The inspector reviewed the diet sheet for a newly admitted resident and food preferences along with food consistency were clearly documented. There were arrangements in place for communication of residents' dietary needs between nursing and catering staff to support residents with special dietary requirements. Residents on specialised diets such as diabetic, fortified and modified consistency diets and thickened fluids received their correct diets and fluid consistencies. For the most part residents received discreet assistance from staff with eating where necessary. However, one resident with behaviour that challenges was seen sitting in isolation facing a wall. This did not demonstrate social inclusion and appropriate support at this time. This is dealt with under Outcome 2 of the action plan.
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The provider and person in charge were aware of their responsibility to notify the Chief Inspector of the proposed absence of the person in charge from the designated centre and the arrangements in place for the management of the designated centre during her absence. The fitness of the deputising person in charge - Sarah Murphy was determined by interview during this inspection. She was found competent. She had qualified as a registered nurse in 2009 and was appointed to the post of Clinical Nurse Manager 2013. She worked full-time in the centre and had maintained her professional development. She recently completed a course on CHEWS, medication management, foot screening and associated education of patients with diabetes, hip replacement and total knee replacement, dementia care, Alzheimer’s care, special purpose award in care of the older person and had a certificate in respiratory nursing. Her mandatory training in adult protection, manual handling and fire safety and her registration was up-to-date with an An Bord Altranais.
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Under Regulation 06(1) you are required to: Having regard to the care plan prepared under Regulation 5, provide appropriate medical and health care for a resident, including a high standard of evidence based nursing care in accordance with professional guidelines issued by An Bord Altranais agus Cnáimhseachais. Please state the actions you have taken or are planning to take:
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information on their food preferences care plans for nutrition and hydration were drawn up. Care, nursing and catering staff worked together to ensure that information on residents' specialist needs were up to date and that appropriate food was available and prepared according to residents' requirements. Staff said that there were formal and informal arrangements in place such as regular team meetings to communicate changes in residents’ diets to catering staff who kept records of all individual requirements in the kitchen.
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The inspector noted that there were staff meetings arranged and that a range of topics were discussed. All staff were present at handover each morning and would discuss any issues arising also at that time. The inspector found that the education and training made available to staff was supporting them in their roles. There was good access to mandatory training, which was refreshed routinely. Documentary evidence of training attended was in place and staff verified that training was delivered and refreshed often. Training had been provided on a range of topics that included elder abuse and the protection of vulnerable people, fire safety, infection control, food safety, restraint management and dementia. Good supervision practices were in place with the nurses visible on each floor providing guidance to staff and monitoring the care delivered to residents. Staff told inspectors that the director of nursing was involved on a daily basis and clear directional leadership and support was noted to be provided by the
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The inspector was told that a recruitment drive had been on-going and that a number of staff including nursing staff had been employed recently. At the time of this inspection there were new members of nursing staff recently recruited on duty that confirmed this. The inspector found from an examination of the staff roster, communication with staff on duty and residents that the levels and skill mix of staff at the time of inspection were sufficient to meet the needs of residents. However, the inspector was not assured that the supervision of staff, staffing levels and skill mix at all times, including night time, was suitable and sufficient to meet the needs of all residents. While there was the minimum of one registered nurse on duty at all times, all staff working in the centre had not completed appropriate training and or certification relevant to their role and
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