KilcaraHouseNursingHome is a family run designated centre set in a rural location within a few kilometres of the towns of Abbeyfeale and Listowel. It is registered to accommodate a maximum of 35 residents. It is a two-storey building with stairs and lift access to the upstairs accommodation. Downstairs it is set out in three wings: Abbeyfeale with eight beds, Duagh with nine beds, the new wing with eight beds; and upstairs has ten beds. Bedroom accommodation comprises single, twin and three-bedded rooms with wash-hand basins, and some have en suite shower and toilet facilities. Communal areas comprise two sitting rooms, a day room and dining room. There is a secure enclosed courtyard with seating and there is a mature garden with walkways and seating at the front entrance to the centre. KilcaraHousenursinghome provides 24-hour nursing care to both male and female residents whose dependency range from low to maximum care needs. Long-term,
Systems were in place to safeguard residents' money. The provider and deputy director of nursing outlined practices used to record financial transactions. The provider stated that fees were handled separately to personal money/belongings. He stated that invoices were sent out regularly, which reflected payments made. He informed the inspector that he would review the practice of not providing receipts for some services and any extra purchases. Personal money transactions were recorded in a lodgement book and signed by two staff members. A sample of these were checked and seen to be correct.
This inspection of KilcaraNursingHome by the Health Information and Quality Authority (HIQA) was an unannounced inspection. As a result of finding of non- compliance with regulations on the previous registration renewal inspection, a follow- up inspection was carried out. This was done to ascertain if the required actions had been addressed to the satisfaction of the Chief Inspector, prior to a decision being made on whether or not conditions would be attached to the registration renewal. On the day of inspection there were 29 residents in the centre and six vacant beds. During the inspection, inspectors met with residents, the provider, the person in charge, staff from various roles, kitchen and household staff. Inspectors reviewed documentation such as, the complaints log, the risk register, care plans, training records and the annual review of the quality and safety of care. A new person in charge had been appointed since the previous inspection. She was supported in the management of the centre by the deputy person in charge.
number of residents. Eye care consultations and chiropody treatment were documented in the sample of care plans seen. Medication management practices were reviewed and monitored by regular audit. Pharmacists were facilitated to meet their obligations to residents and there was a choice of pharmacist available where possible. End of life care plans were in place for residents and a number of these were seen to be signed by residents. In addition, residents' wishes were clearly documented including where a resident had requested to be taken home at the end of life.
The fire policies and procedures viewed by inspectors were centre-specific. The fire safety plan was viewed by inspectors and found to be comprehensive. There were notices for residents and staff on “what to do in the case of a fire” appropriately placed throughout the building. Fire maps indicating escape routes were clearly displayed. Fire equipment training and fire evacuation training was provided. Staff demonstrated an appropriate knowledge and understanding of what to do in the event of a fire. The inspector examined the fire safety register with details of all services carried out which showed that fire fighting, fire safety equipment and fire alarms had been serviced as required and this was next due in May 2015. Fire alarm checks and automatic fire door release checks were carried out weekly and there was a daily fire door checking system. However, inspectors noted that one fire door in the laundry room was held open with containers of cleaning equipment. There was an emergency plan for the centre and inspectors were informed that the nearby home of the provider and the local resource centre could be used to provide accommodation for residents, in the event that an evacuation was necessary. Inspectors saw that this was formalised and outlined in the emergency plan.
An audit of health and safety issues was undertaken in all areas recently and the inspectors saw records of these checks. Inspectors were aware of the benefits of promoting a home like environment for the residents, however, the lighted open fire was not adequately secured. The provider was asked to reassess the risk and has put a secure fire guard in place since this inspection. There was a lift from the ground floor to the upstairs section and inspectors were informed that one resident uses this
The inspector found there was an appropriate number and skill mix of staff on duty to meet the assessed needs of the residents. Staff were supervised to their role and appraisals were also conducted. On the days of inspection there were 38 residents including six residents assessed as low dependency, 12 as medium dependency, 11 as high dependency and nine as maximum dependency. There were two care staff on duty in the dementia specific unit throughout the day and evening time up to 22.00 hours and three care staff on duty in the main nursinghome during the day and evening time up to 18.00 hours. An additional care assistant was allocated to one resident on a one to one basis. There were normally two nurses on duty for the entire nursinghome during the day time. At night time, there was one nurse and three care assistants on duty up until 22.00 hours and one nurse and two care assistants on duty from 22.00 hours to 8.00 hours. The person in charge and assistant director of nursing were normally on duty during the week days. The clinical nurse manager or a senior nurse supervised the delivery of care at weekends. The person in charge advised the inspector that she will continue to review staffing levels taking into consideration the assessed needs and dependency of residents.
Information in the daily nursing records was limited. It cannot be demonstrated therefore that the care required including evidenced based nursing care following assessment was actually delivered. The outcome of the care plans could not be accurately reviewed. The care plans were-pro-forma templates and staff were not amending them to ensure they were person-centred and accurate to the individual residents. Inspectors were also concerned that in some instances staff were not familiar with the resident health, for example, if a resident with pressure areas had been
The inspectors noted that the recruitment of additional senior management staff was well advanced and the provider was actively trying to recruit an additional clinical nurse manager (CNM) and other nursing staff, improvements were noted to medication management, restraint management and nursing documentation. As part of the inspection the inspectors met with residents and staff members. The inspectors observed practices and reviewed documentation such as care plans, medication records, complaints and incident logs, policies and procedures.
medications and this was discussed with the management team who gave the inspectors a copy of a comprehensive audit tool they were planning to use. Medication reviews were completed at three monthly intervals and this was evidenced on residents’ prescriptions. The pharmacist attended the centre on a regular basis to do a complete review of residents’ medication management as well as education sessions with staff. The pharmacist was also in discussion with the staff around giving advice and support to residents about their individual medication regime but this had not commenced to date. Medications were delivered in monitored dose units and these were checked by nursing staff to verify that what was delivered corresponded with prescription records.
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 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.
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.
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
Audits completed by the person in charge included: medication, falls, restraint and infection control. Some learning were evident, particularly following the falls audit where the times and cause of falls had been analysed and a reduction in falls had been noted compared to the previous quarter. However, other learning had not instigated an improvement in practices, for example, medication management. Significant deviations from NMBI (Nursing and Midwifery Board of Ireland) guidelines were found in the medication audit for quarter 1 of 2016. The person in charge stated that she was in the process of completing the audit for quarter 2, but had noted that issues were still arising and inspectors witnessed poor medication management practices over the course of the inspection.
There were two nurses rostered each day from 8.00am until 8.00pm and one nurse each night supported by three care assistants until midnight. There are six care assistant rostered throughout the day until 3.00pm and four care assistant in the evening time. The day rooms are well supervised at all times with two additional staff assigned to each sitting room from 10.00am until 5.00pm on the ground floor and 6.00pm on the first floor. These staff facilitated an activity program for residents throughout the day. In addition to the person in charge there is a clinical nurse manager rostered most days of the week to support the nursing team.