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
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
The provider's self-assessment and overall self assessment of compliance identified compliance with Outcome 14 and Standard 16 of the National Quality Standards for Residential Care Settings for Older People in Ireland. The inspector reviewed the centre's policy on end-of-life care and noted that the policy was up to date, robust and comprehensive. It provided good guidance on the management of the period prior to death and the care of the body. It outlined procedures for end of life care and provided guidance for staff on care planning for end of life, consent, assessment of capacity, symptom control and how to provide support to relatives. Staff who spoke with the inspector were familiar with the policy. Training records indicated that the policy was also presented to all staff by a member of the nursing staff.
The inspector was satisfied that there were suitable arrangements in place to meet the health and nursing needs of residents with dementia. Residents were satisfied with the service provided. Residents had access to general practitioner (GP) services and out-of- hours medical cover was provided. A full range of other services was available on referral including speech and language therapy (SALT) and occupational therapy (OT) services. Physiotherapy services were available on site. Chiropody, dental and optical services were also provided. The inspector reviewed residents’ records and found that some residents had been referred to these services and results of appointments were written up in the residents’ notes.
Each resident’s wellbeing and welfare is maintained by a high standard of evidence-based nursing care and appropriate medical and allied health care. The arrangements to meet each resident’s 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 circumstances.
The inspector confirmed that up to date registration numbers were in place for nursing staff. The inspector reviewed the roster which reflected the staff on duty. Resident dependency was assessed using a recognised dependency scale and the staffing rotas were adjusted accordingly. The inspector was satisfied that there was sufficient staff on duty to adequately provide care to the residents. Residents spoken with confirmed this. The person in charge promoted professional development for staff. Training was tailored to meet residents’ needs. Staff told the inspector they had received a broad range of training which included caring for the person with dementia, end-of-life care, responsive behaviour and hand hygiene. Detailed records were maintained of attendance and course content.
The inspector followed up on the findings from the last inspection. The design and layout of the centre is in line with the statement of purpose. The premises meets the needs of all residents and the design promotes residents' dignity, independence and wellbeing. Laurel Lodge is a purpose built nursinghome that can currently accommodate 107 residents. Internal renovation work and upgrading has occurred in all three units that will increase the capacity to 114 residents. The capacity within Glencar unit will increase by two residents. The Hazelwood unit will increase from 36 to 40 residents and Lissadell unit will increase from 33 to 34 residents. The furnishings and fixtures in all new rooms are finished to a high standard. Within the Lissadell unit the double room is awaiting the installation of a roof window to increase the level of natural light. The person in charge has confirmed that this work will be completed prior to the admission of any resident.
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
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.
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
The inspector found that the governance and management system in the centre was not in compliance with the regulations for the sector, specified in the introduction to this report. Similar to findings on the previous inspection, an annual review of the quality and safety of care had not been completed for 2015 and 2016. This was required under Regulation 23(d). The person in charge stated that she was aware of this requirement, as this had been identified as an action to be completed following the last inspection of 11 and 12 May 2016. At that time, the timescale for completion of the annual review had been identified by the provider as 31 October 2016. In addition, management meetings were not held. Minutes were not available and senior management staff confirmed with the inspector that there were no management meetings held to coordinate nursing and administration management in the centre, for example, staff supervision requirements such as, staff appraisals. Staff supervision arrangements were a requirement under Regulation 16 (b).
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.
The person in charge had recently been appointed in the centre. She was interviewed by inspectors. She was found to fulfil the regulatory criteria required for the post. The person in charge had been working as a nurse in the centre for the previous six years, included a period of time as assistant director of nursing. She was employed full time in the centre. The person in charge demonstrated clinical knowledge in ensuring suitable and safe care. She demonstrated knowledge of the legislation and of her statutory responsibilities. She was engaged in the governance, operational management and administration of this centre on a regular and consistent basis. She met regularly with the provider and staff. Minutes were maintained of these meetings. She organised audit in the centre. She explained to inspectors that she was engaged in continuous
On the day of inspection, the inspector reviewed the staffing rota and found that a senior carer grade was rostered to work on each day shift with the exception of one Sunday. This finding provided additional support for the carer team. The provider and person in charge both registered nurses worked Monday to Friday. The inspector noted that one staff nurse was on duty from 16:00hrs to 08:00hrs each 24hr period which may not be adequate to meet the high support nursing care needs of residents in the high dependency unit. 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. While the inspector confirmed that there was a staff handover, there was no lap-over of the shift start and finish times to include this activity into the structure of the staff schedule. This finding is discussed in outcome 4 of this report.
The inspector spoke with the chef who said that she regularly met with the person in charge and the provider to discuss the residents' dietary needs. The chef showed the inspector her files, which contained relevant information, including advice from the speech and language therapist, the dietician and a record of residents’ food preferences. Food preferences and special requirements were written up daily on a whiteboard in the kitchen and the inspector saw that this also included information on drug interactions with certain foods. The chef and the kitchen staff indicated that they received relevant training in food safety and HACCP (food hygiene). The inspector saw these records in the training file. The chef also showed the inspector a list of residents on diabetic diets and on gluten free diets. The chef explained to the inspector how she ensures that the diet is nutritious by having a variety of meat, vegetables and fruit sourced from a reputable supplier, as well as providing home cooked bread and cakes. The inspector saw the supply of both fresh and frozen foods as well as the dry stores and saw that there was a variety of food available including fresh fruit and dairy produce.
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.
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: