Millhouse Care Centre is a purpose-built two-storey centre, which provides residential care for 62 people. Approximately 35% of residents have dementia. The atmosphere was homely, comfortable and in keeping with the overall assessed needs of the residents who lived there. A wing has recently been designated as a dementia specific unit with a total of 9 beds. This wing is referred to as the Memory Unit. Each resident was assessed prior to admission to ensure the service could meet their needs and to determine the suitability of the placement. Residents had access to general practitioner (GP) services and to a range of other health services. Residents had a comprehensive assessment undertaken and care plans were in place to meet their assessed needs although some gaps were noted. Improvement was also required to ensure that the care plans were updated to reflect recommendations from allied health professionals.
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The purpose of regulation in relation to designated centres is to safeguard vulnerable people of any age who are receiving residential care services. Regulation provides assurance to the public that people living in a designated centre are receiving a service that meets the requirements of quality standards which are underpinned by regulations. This process also seeks to ensure that the health, wellbeing and quality of life of people in residential care is promoted and protected. Regulation also has an important role in driving continuous improvement so that residents have better, safer lives.
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The deputy person in charge told inspectors that he was supported by the healthcare manager who was always available by phone or email. The practice development facilitator was present in the centre on the day of inspection. She told inspectors that her role was mentorship, support and guidance to the deputy person in charge. It was her first meeting with the deputy on the day of inspection. Inspectors found that the support provided by the Registered Provider was insufficient considering the absence of the person in charge in addition to the type and number of non compliances identified throughout the inspection. Inspectors were not satisfied that the deputy person in charge could ensure that the service provided was safe, appropriate, consistent and effectively monitored.
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The Person-in-Charge will review all care plans to ensure that they accurately reflect the nutritional status of each resident, including nutritional intake, an indication of how frequently weight recordings are required, close monitoring of weight loss or weight gain, requirement for dietary supplements or fortification. The Person-in-Charge will ensure that the recommendations of the dietitian are incorporated into the nursing care plan. The Person-in-Charge will ensure that all care staff and catering staff are aware of the specific dietary requirements of residents as appropriate.
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A comprehensive policy for the monitoring and documentation of nutritional intake was in place dated 1 July 2013 and a review of care plans indicated this was implemented in practice. Residents were assessed on admission including weight, oral health, dietary needs and preferences. A food and nutrition folder was in place to provide staff with advice and guidance around maintaining a positive dining experience and attention to a residents' personal needs around mealtimes. A communications folder was in place to ensure that information between carers and kitchen staff could be appropriately relayed and updated. This included information around special dietary requirements. Where swallow plans were in place they were also discreetly available for reference by staff in residents' rooms.
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convalescence, dementia and palliative care. Care for persons with learning, physical and psychological needs can also be met within the centre. Care is provided for people with a range of needs: low, medium, high and maximum dependency. This centre is situated on the outskirts of a town. It is constructed over two floors. Access between floors is serviced by a lift and stairs. Bedroom accommodation consists of 54 single and four twin rooms, all with full en-suite facilities. Sufficient communal accommodation is available including day rooms and dining areas as well as a prayer room and library space. There are a number of toilets and bathrooms throughout the building. Kitchen and laundry facilities are located on the ground floor. There are nurses and care assistants on duty covering day and night shifts. Adequate supervision is provided.
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The inspector found that while some improvement had taken place, some actions required from previous inspections around the use of restraint had not been addressed. The inspector reviewed the care plans of residents who were using bedrails and lap belts and found that details of the use and type of restraint were included. The care plans reviewed now outlined how often safety checks should be completed when bedrails were in use, an action required from the previous inspection. However there was still limited documented evidence that these safety checks were being completed in line with national guidelines. A detailed policy was in place but was not implemented by staff. It is acknowledged that overall usage of restraint was low and additional equipment such as low beds had been purchased to reduce the need.
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Overall, the inspector was satisfied that residents received a quality service. There was evidence of improved levels of compliance, in a range of areas, with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 and the National Standards for Residential Care Settings for Older People in Ireland. Eight of 13 actions required from the previous inspection had been addressed including the major non-compliances. Although not within the agreed timescales, an improvement plan was underway to complete the remaining five, some of which were partially completed. Additional improvements were also identified at this inspection.
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Residents’ files seen by the inspector indicated that weights were recorded monthly and changes were reported and discussed with staff. The MUST (Malnutrition Universal Screening Tool) tool was utilised to ascertain the nutritional status of residents. Nutritional assessments were completed and dietary advice was obtained from a dietician from a nutritional company. Supplements were available for residents who required additional nutritional support. The inspector saw that these were prescribed by the GP in the centre and they were documented as given by the staff nurses. Nutritional care plans were seen in residents' notes and there was a regular review of these care plans by the multidisciplinary team (MDT). The speech and language therapist (SALT) had prepared nutritional plans for any residents who had swallowing difficulties and there were instructions in the care plan on the correct consistency for food and fluids. This was in written and visual form. These modified diets were presented attractively to residents and the chef informed the inspector that there was a choice available for residents on modified diets also.
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encouraged with relatives and relatives stated they are welcomed at any time. The centre was finished to a high standard and there was appropriate use of color and soft furnishings to create a homely environment. The dementia-specific unit had the addition of wall murals which provided good focal points throughout the unit. There were a number of improvements required which included improvements with the documentation, policy updating and care planning. These improvements and other improvements as outlined below are required to comply with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 (as amended) and the National Quality Standards for Residential Care Settings for Older People in Ireland. The provider was required to complete an action plan to address these areas.
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The records listed in Schedules 2, 3 and 4 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 were maintained accurately and were easily accessible to the inspector. The designated centre was adequately insured against accidents or injury to residents, staff and visitors. Insurance certification was viewed by the inspector. This was due for renewal in 2017. Most policies required under Schedule 5 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) were in place and were seen to be updated three yearly, as required. However, the policy on communication and the policy on the creation, access to, and retention of records, required updating. Staff were aware of the policies and the person in charge stated that these were implemented in practice. Complaints and incidents were documented. Copies of medication errors were
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While mobile screens were available there are limitations in multi occupancy bedrooms to ensure adequate privacy. The provider at the time of this inspection did not have in place a plan to reconfigure multiple occupancy bedroom accommodation. This is required in accordance with the premises and physical environment regulatory notice and the National Quality Standards for Residential Care settings for Older People in Ireland.
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The person in charge stated she sent a personalised sympathy card to the relatives from staff in the centre. The person in charge had information books and leaflets available to relatives relating to support services in the locality and information relating to the bereavement process. Those residents who died in the past year were remembered at an annual mass service held in the centre where a candle was lit in memory of each of the deceased residents. The person in charge stated that the resident’s belongings were returned at a time suitable to them and the person in charge confirmed that the
corresponding care plan which detailed the nursing care, medications/food supplements prescribed; specific care recommendations from visiting inter disciplinary team members and the general practitioners instructions. However, one resident with a swallowing difficulty did not have plan of care. While the recommendations from the speech and language therapist were available, a plan of care was not devised to manage all aspects of the problem and ensure regular review. There was access to the GP and allied health professionals for residents who were identified as being at risk of poor nutrition or
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Hepatobiliary manifestations are amongst the most important extraintestinal There is paucity of data on hepatobiliary The study was carried out to evaluate the hepatobiliary alterations in ulcerative colitis patients admitted to a tertiary care centre in Odisha. admitted to Gastroenterology Department SCB Medical College, Cuttack from 0ct 2013 to April 2015 were included in the study. Patients with history of liver diseases were excluded. All patients were subjected to clinical examination, liver hepatobiliary alterations. MRCP was performed in selected patients. Controls were recruited from healthy subjects (n=100). Results: A total of 112 patients [73(65.1 %%) male; 39(34.9%) female] with ulcerative colitis were included. The mean age respectively. Patients with mild, moderate and severe disease activity were 22(19.6%), 67(59.8%) and 23(20.5%) respectively. The median duration 48). Extra intestinal manifestations were found in 68 6(5.3%) had arthritis, 13(11.6%) had episcleritis,2(1.7%) had stomatitis, 3(2.6%) had Erythematic Nodosum, 1(0.9%) had pyoderma Gangrenosum. 60 (53.8%) patients developed hepatobiliary alterations.2(1.7%) had jaundice, pruritus and clay colored stool in whom MRCP revealed primary sclerosing cholangitis. 22(19.6%) had hepatic steatosis, 42(37.5%) had asymptomatic transaminitis, 17(15.1%) had elevated alkaline In control groups 17(17%) had hepatic steatosis, 28(28%) had transaminitis, 8(8%) had elevated alkaline phosphatase. Conclusion: The study revealed that approximately 61% of Ulcerative colitis patients had extra intestinal manifestations. Hepatobiliary alterations are the most common (53.5%) extra intestinal manifestations in Ulcerative colitis and asymptomatic transaminitis is the most common hepatobiliary alterations in the patients with
The stem cells in Cryo-bags are stored in tanks that are cooled by vapors or liquid nitrogen. Liquid nitrogen is less subject to fluctuations in temperature. The storage temperature is maintained at -196 C. the computer system constantly monitors and tracks stem cells at all times. The tanks have inbuilt trolleys, for shifting in classes of any calamities (Gorin, 1992; Aird et al., 1990 and Stiff, 1991).Basic services (FACT- JACIE, 2010 and UNDP/World Bank/WHO) infrastructure of the Centre should be planned according to the services provided. The basic infrastructure facilities include:
Though various Indian and International studies on epidemiology of dermatophytes are available, no such study has been carried out in Madurai. Since Government Rajaji Hospital, (GRH) Madurai is the largest tertiary care hospital affiliated to Madurai Medical College catering to the needs of lakhs of people from the southern districts of Tamilnadu, the present study was carried out among patients attending GRH and the data were analysed with reference to objectives.
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There were 27 residents in the centre during the inspection and one in hospital. There were ten residents with maximum care needs. Four residents were assessed as highly dependent. Seven had medium dependency care needs. Six residents were considered as low dependency. Many residents were noted to have a range of healthcare issues and the majority had more than one medical condition.
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Information Centre (HSCIC) (NHS England 2015). The data collected by the HSCIC is comprehensive; it includes anonymized patient demographic information, the type of FGM identified, the age at presentation and the age at which FGM was done, family history of FGM, and limited obstetric history (HSCIC 2017). It also includes whether or not the woman has any daughters. This data has invaluably aided our understanding of the prevalence of FGM in the UK, particularly in locating vulnerable populations and in highlighting the extent of the problem in this country. Since the current form of mandatory reporting to the police only applies in relation to girls under the age of 18, as of yet it remains to be seen how the HSCIC data of recorded cases of FGM will be used to influence policy and protect all of the vulnerable people identified.
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Temperature: according to the study in table 3 cane wash effluent temperature is less than millhouse and boiling house. The step where exchange of heat energy and occurrence of chemical reactions such as decomposition expected to take place in millhouse and boiling house .The temperature of water sample obtained from the river determined to be lower than any of the sample analyzed.