There was a training matrix available which conveyed that staff had access to ongoing education and a range of training was provided. The inspector found that in addition to mandatory training required by the regulations staff had attended training on infection control, nutritional care, cardio pulmonary resuscitation techniques and end of life care. All nursing staff were facilitated to engage in continuous professional development and had completed training on medication management.
23 Read more
The provider employs a whole-time equivalent of 11·5 registered nurses and 34 care assistants. In addition, there is catering, cleaning and an activity coordinator employed. The inspector viewed the staff duty rota for a four week period. The rota showed the staff complement on duty over each 24-hour period. The person in charge at all times was denoted on the rota. The staff roster detailed their position and full name. The inspector noted that the planned staff rota matched the staffing levels on duty. There was an adequate number and skill mix of nursing, care assistants, catering and cleaning staff rostered on the day of inspection to meet the assessed care needs of residents. Call bells were answered promptly and there was a visible presence of staff in the day rooms and around the building during the inspection.
19 Read more
The designated centre provides care and support to meet the needs of both male and female older persons. It provides twenty-four hour nursing care to 70 residents both long-term (continuing and dementia care) and short-term (convalescence and respite care). The philosophy of care is to provide excellence in the delivery of compassionate care to residents. The centre is a three storey building located in an urban area.
11 Read more
In line with national policy a restraint free environment was promoted. There were three residents wearing security monitoring cotags. A risk assessments and a plan of care is developed to outline the need with consent obtained. There was evidence of multi disciplinary involvement in the restraint decision making process, including the nursing team, GP and the physiotherapist. A risk balance tool was completed in each case where a resident had their bedrails raised. The rationale why alternatives trialled were
20 Read more
The provider met with the inspector and discussed the governance and operational overview required by her role. However, the organisational structures in place to support the person in charge require review. Due to difficulty in recruitment the deputy to the person in charge was rostered for clinical duty. She had reduced hours to oversee her role and responsibilities in clinical governance. The provider indicated nursing staffing resources have been recruited and are due to commence in post in early September 2015.
22 Read more
Esker Ri Nursing Home is a purpose-built, single-storey premises. The centre is situated on an elevated site off the Tullamore road on the way out of the village of Clara. The centre currently provides accommodation for a maximum of 80 male and female residents aged over 18 years of age. The provider proposes to increase accommodation capacity to 130 residents with completion of a new two storey 50 bed extension to one side of the centre. Residents are accommodated in single and twin bedrooms with en suite facilities. The centre provides mainly residential care to older adults and also provides respite, convalescence and care for people with an intellectual disability, physical disability, acquired brain injury, dementia and palliative care needs. The provider employs a staff team consisting of registered nurses, care assistants, activity coordination staff, administration, maintenance, housekeeping and catering staff. The provider states that their aim is to provide a residential setting wherein residents are cared for, supported and valued within a care environment that promotes their health and wellbeing.
19 Read more
There were suitable arrangements in place to meet the health and nursing needs of residents with dementia. Comprehensive assessments were carried out and care plans developed based on the assessments. Care plans were reviewed at a minimum on a four monthly basis but the care plan reviews were not comprehensive and did not always reflect the changing health status of a resident. In the case of a resident who was tracked; their care plan referred to a period when they were mobile even though the resident was confined to a chair and no longer mobile. Residents and their families, where appropriate were involved in developing care plans but not in the care plan review. This was also a finding on the previous inspection. None of the care plans examined held end of life care plans which reflected the wishes of residents with
24 Read more
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.
26 Read more
Nursing staff had not completed the wound assessment records consistently or completely. Records were not maintained sufficiently to give a clinical picture of the condition or of previous treatment of residents by nursing and medical staff. There were gaps of up to 6 weeks where the only entry with regard to the provision of care was by way of cross referencing care plans with letters and no supporting narrative note with regard to the medical/nursing care provided to residents.
12 Read more
Residents confirmed that they had been offered the opportunity to vote at election time. In-house polling was available or some residents returned home for this. Mass took place on a weekly basis. Many residents undertook the various tasks for this such as the readings and prayers. A resident-led rosary was also recited each evening and residents told the inspector how important this was to them. The person in charge said that residents from all religious denominations were supported to practice their religious beliefs.
19 Read more
Esker Ri Nursing Home is a purpose-built, single-storey premises. The centre is situated on an elevated site off the Tullamore road on the way out of the village of Clara. The centre currently provides accommodation for a maximum of 80 male and female residents aged over 18 years of age. The provider proposes to increase accommodation capacity to 130 residents with completion of a new two-storey 50- bed extension to one side of the centre. Residents are accommodated in single and twin bedrooms with en suite facilities. The centre provides mainly residential care to older adults and also provides respite, convalescence and care for people with an intellectual disability, physical disability, acquired brain injury, dementia and palliative care needs. The provider employs a staff team consisting of registered nurses, care assistants, activity coordination staff, administration, maintenance, housekeeping and catering staff. The provider states that their aim is to provide a residential setting wherein residents are cared for, supported and valued within a care environment that promotes their health and wellbeing.
The inspector found that arrangements were in place to avoid unnecessary transfer to hospital, including nursing staff trained in the administration of medication via a syringe driver and subcutaneous injection. In this way, residents who were no longer able to take oral medication for pain relief could have their pain managed via other routes. Where a resident refused care, this was respected and clearly documented.
11 Read more
Care plans maintained provided a good overview of residents’ care and provided good direction on how care was to be delivered. On admission, there was a comprehensive nursing assessment and additional risk assessments were complied for all residents. Care plans were updated at the required intervals and in a timely manner in response to a change in a resident’s health condition or following recommendations from allied health professionals. Residents had access to medical services and the inspector saw that many residents had been reviewed multiple times due to rapid fluctuations in health needs. Access to allied health professionals such as speech and language therapists, dieticians, occupational therapists and community mental health nurses was available. There was evidence that residents and where required relatives were involved in the completion of care plans and contributed to information that enabled staff to deliver person centred care. For example past occupations were described and residents were supported to carry out tasks or chores in the centre that would have been part of their previous life style.
29 Read more
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.
13 Read more
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:
29 Read more
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.
10 Read more
The inspector reviewed the care files of the two residents accommodated for short term care. A comprehensive suite of risk assessments to identify all their care needs was not completed. A moving and handling risk assessment was not completed for one resident. Another did not have a care plan to outline the post surgery guidance issued by the hospital. There was evidence in the nursing notes of one resident of contact with the public health nurse to plan for a home discharge, However, each resident did not have a discharge care plan completed to guide staff in their rehabilitive goals and ensure a safe discharge.
22 Read more
The inspector found that there was an appropriate nursing and care staff ratio on duty at inspection time and the inspector reviewed the roster and found that the designated centre was suitably staffed. The inspector found that all staff had been provided with relevant and up to date mandatory training and all staff spoken to were satisfactorily knowledgeable of same. The inspector reviewed a number of staff files and found that all staff had Garda vetting and appropriate references in place. The inspector was satisfied that staff were supervised in accordance with their needs and discussed same with staff. The inspector reviewed staff meeting minutes and discussed these with the person in charge who highlighted the importance of ongoing supervision and
16 Read more
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.
15 Read more
The inspector reviewed medication policies which were robust and gave clear guidance to nursing staff on areas including medication administration, refusal and withholding of medications, medications requiring strict controls, disposal of medications, medication errors, crushing medications and medication self administration. Individual medication safes were present in each residents' room so as each residents medication was stored beside residents beds. The inspector discussed medication protocols with nursing staff who presented as having competent knowledge and understanding of same. The inspector found two locked fridges had been purchased for medication and one for blood specimens and these were located in a fully equipped secure treatment room. The person in charge showed the inspector the secure storage for medications that required strict control measures (MDA's). The person in charge explained all prescription and administration protocols and had established arrangements and agreements in place with a pharmacist. The inspector reviewed proposed documentation and record templates and found that they were in order.
21 Read more