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A designated centre for people with disabilities operated by Stewarts Care Limited

A designated centre for people with disabilities operated by Stewarts Care Limited

There was a policy in place for the prevention, detection and response to abuse which was in line with Children First: National Guidance for the Protection and Welfare of Children, 2011 (Children First, 2011). There had been one allegation of abuse in the preceding 12 month period which the inspector found had been investigated and responded to in line with the centres policy, national guidance and legislation. The senior staff nurses on duty in both houses told the inspector that there had been no other concerns, suspicions or allegations of abuse in the preceding 12 month period. Staff who spoke with inspectors were knowledgeable about what constituted abuse and how they would respond to any suspicions of abuse. The designated person in the service for care and protection was detailed in the centres policy and staff spoken with were aware of their contact details.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

Where appropriate to the residents’ capacity and needs there was evidence of life skill development and attendance at training, day care or workshops. A small number of residents in the centre attended day care services and those who could communicate with the inspector stated that they enjoyed their time there and looked forward to attending them. Decisions in regard to this were made following assessment and took account of resident’s dependency level, age range and life stage. Activity staff were allocated to two of the units of five days per week to provide support for residents which included outings and staff also tried to undertake unit based activities including baking, hand massage or sensory work with the residents. The staff could be seen to make efforts to ensure there was social participation for residents, for example going to shopping centres, the cinema, concerts, meals out or horse riding. Staff were also in some instances helping residents to develop basic life skills for example helping residents make tea for themselves under supervision and shop for clothing and other personal items.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

Residents are consulted with and participate in decisions about their care and about the organisation of the centre. Residents have access to advocacy services and information about their rights. Each resident's privacy and dignity is respected. Each resident is enabled to exercise choice and control over his/her life in accordance with his/her preferences and to maximise his/her independence. The complaints of each resident, his/her family, advocate or representative, and visitors are listened to and acted upon and there is an effective appeals procedure.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

There was evidence of overview of practices and accountable reporting systems. The nominee of the provider who is the CEO had established formal reporting structures from all departments which included directors of clinical care programmes and facilities. The person nominated to act on behalf of the provider undertook unannounced visits to the centre to review specific issues including complaints procedures and to meet with residents and staff. The provider met fortnightly on a formal basis with each of the programme managers for the various services. Weekly meetings of all the persons in charge were held. These were primarily used to support implementation plans for achieving compliance with the standards and regulations across the campus. An action plan for achieving compliance with the regulations for the centre had been developed. The person in charge of the centre had been appointed and worked under the direction of the adult services manager. The person appointed to this centre was a qualified intellectual disability nurse with extensive nursing and management experience. She had also undertaken post graduate training at degree level in healthcare management and was a trainer in the protection of vulnerable adults. The appointee was also the person in charge of another similar designated centre within the organisation. There was an appropriate day and night time on-call system in place.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

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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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

There was evidence of the annual health check for all residents and regular paediatric review for the young person where this was required. Inspectors found that the daily nursing records were detailed and demonstrated monitoring and a prompt response to residents changing health status. Where necessary appropriate assessment tools including skin integrity were utilised and plans demonstrated adherence to treatments strategies. There were protocols in place for specific procedures such as eternal feeding systems, catheter care and the use of oxygen. Families were kept informed of any external medical appointments and they confirmed this to the inspectors. There was evidence that where residents were admitted to acute care services staff maintained regular contact with residents and with the services to monitor the resident’s progress. However, given the dependency levels of the residents and the significant health care needs evident, inspectors were not satisfied that in all cases health care needs were supported by adequate nursing plans in relation to the specific issues identified. These included the management of epilepsy, asthma, or weight monitoring. In some instances the plans which were available had not been reviewed for considerable time periods and in others no such plans had been developed.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

In another house the activities staff member was on scheduled leave since November 2014 and had not been replaced. It was evident that staff were diligent and worked hard to ensure that residents had an opportunity to go out socially with staff support and participate in some in-house activities such as house parties and watching national football games on TV. The person in charge explained that they have a support staff member one evening per week to provide complimentary therapies for three residents. However, inspectors observed that the dependency needs of residents was high and this was confirmed by staff on duty. There was only one nurse on duty to administer medications to residents on two floors, complete paperwork, direct care and supervise staff and residents. Inspectors also questioned what assurance the provider had that the staffing levels at night were adequate to meet the needs of residents in this unit. Please see outcome 7 for evidence on the fire safety arrangements.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

Measures to protect residents being harmed or suffering abuse are in place and appropriate action is taken in response to allegations, disclosures or suspected abuse. Residents are assisted and supported to develop the knowledge, self-awareness, understanding and skills needed for self-care and protection. Residents are provided with emotional, behavioural and therapeutic support that promotes a positive approach to behaviour that challenges. A restraint-free environment is promoted.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

From a review of seven medical records and personal plans the inspector was satisfied that the health care needs of the residents were being appropriately assessed and attended to in a timely manner. A local general practitioner (GP) service was responsible for the health care of residents and was available on the campus five mornings per week. Overall the records reviewed demonstrated that there was regular access to this service and out-of-hours service as required. There was evidence from documents, interviews and observation that a range of allied health services were available internally to the residents. These included occupational therapy, dietician services, physiotherapy, psychiatric and psychological services. Records demonstrated that routine monitoring of bloods, weights and vital signs were undertaken. Where additional screening of bloods or weights was required by virtue of the resident’s condition or medication this was carried out and recorded.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Kildare

A designated centre for people with disabilities operated by Stewarts Care Limited, Kildare

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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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

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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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

The inspector found that the person in charge was suitably qualified and experienced. She was knowledgeable about the regulations and standards, and her role in meeting them. She was engaged full time in post and was also involved in the development of the service. She was well known to the residents. She was also the nominated person in charge of three other designated centres but there was no evidence that this impacted negatively on the services. A clinical nurse manager from the centre was assigned to deputise in her absence. The inspector found that the person in charge and the assistant were actively involved in the running of the centre and in monitoring the delivery of care.

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A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

A designated centre for people with disabilities operated by Stewarts Care Limited, Dublin 20

Implementation of these pans was recorded and there were current reviews in place. Staff demonstrated knowledge of these plans and their role in their implementation. Residents had access to appropriate health care professionals in accordance with both their needs and their choices, including out of hours General Practitioner cover. There was evidence of the recommendations of such professionals being implemented. Residents were given choice in relation to meals, for example in some of the houses meals were planned at a weekly residents’ meeting, and in other houses choice was facilitated by the use of pictures, including pictorial representation of takeaway meals for a weekly treat. Records of nutritional intake were recorded.

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Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis

Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis

communication training, if applied in the wrong popu- lation (eg, with an interest in decreasing prescribing behaviour), may have adverse effects. Similarly, when antibiotic prescribing rates are low from the outset, POC CRP may not be able to decrease rates further without becoming unsafe. Other safety issues associated with the use of POC CRP might still arise, especially in children. We found that mortality was generally under-reported and the impact on hospital admission rates has yet to be confirmed. Future studies should focus on the potential harms and assess the safety of implementing POC CRP in ambulatory care.

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Feelings, Self-Care, and Infant Care Reported by Korean Women at Risk for Postpartum Depression

Feelings, Self-Care, and Infant Care Reported by Korean Women at Risk for Postpartum Depression

In general, the study participants, though they all screened at risk for PPD, reported having similar feelings and using similar infant care and information gathering strategies to those used by most new mothers. Although the study participants reported having had pleasurable experiences while receiving care at postpartum care centers, the limited self-care and infant care instruction they reported receiving in Sanhujori facilities means a timely opportunity to learn about self-care and care of their infants was missed. Healthcare professionals should insure that comprehensive education about self-care and infant care is offered to postpartum women in every setting in which they receive care. Additionally, healthcare agencies, as part of a government-supported infrastructure, should make accurate self-care and infant care information readily available on their websites and social media platforms.

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The Effects of Multiple Gratitude Interventions Among Informal Caregivers of Persons with Dementia and Alzheimer's Disease

The Effects of Multiple Gratitude Interventions Among Informal Caregivers of Persons with Dementia and Alzheimer's Disease

Despite obvious benefits, underutilization of interpreters is common, and the cost of providing interpreter services is an area of concern. Although oncology providers identified benefits from utilizing interpreters, the majority reported they rarely or never used them due to accessibility and reimbursement issues (Karliner, Hwang, Nickleach, & Kaplan, 2011). But while healthcare providers seldom reported having any first-hand knowledge of the actual costs of interpretation services (Gadon, Balch, & Jacobs, 2007), the benefits outweighed the costs when juxtaposed with the increased rate of preventive service visits (Jacobs, Leos, Rathouz, & Fu Jr., 2011; Jacobs, Shepard, Suaya, & Stone, 2004) and decreased return visits to the emergency room (Bernstein et al., 2002). Context also impacts cost and utilization. For example, physicians in solo practice and single- specialty groups were found to be less likely to use trained interpreters (D. Z. Kuo et al., 2007; Rose et al., 2010). A study of medical residents indicated they normalized the underuse of interpreters, relying again on “getting by” (p. 256) with more convenient family members or even doing without an interpreter if they felt the time constraint posed by calling a professional interpreter outweighed the importance of communication on diagnostic decision making, even as they recognized their patients with limited English proficiency were receiving inferior service (Diamond, Schenker, Curry, Bradley, & Fernandez, 2008).

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Exploring Aboriginal aged care residents’ cultural and spiritual needs in South Australia

Exploring Aboriginal aged care residents’ cultural and spiritual needs in South Australia

The exploratory research design included an interpretive descriptive approach developed by Sally Thorne [24]. This approach is a non-categorical description, drawing on prin- ciples based in nursing epistemological stance, used as a methodology to illustrate the practical and contextualised realities of human health and healthcare needs and prac- tices [24]. Thorne, Kirkham and MacDonald-Emes (1997) considered formal research and interpretation as a founda- tional fore-structure to a new qualitative inquiry. They stated that a qualitative framework needs to be constructed based on intensive interviews with articulated research par- ticipants and critical analysis of the findings in terms of existing knowledge [25]. Given the practice focus of this study, interpretive descriptive approach was found ideal because it would investigate the relationships between the healthcare practices of carers and the capacity of aged care centres [26]. This interpretive description allowed the re- searcher to frame research questions and prompts and better maintains disciplinary logic and methodological in- tegrity. Following this interpretive descriptive approach, therefore, semi-structured interviews were conducted and data were analysed thematically for this study. An add- itional file provides a complete description of the inter- view questions used as a guide for the study [see Additional file 1].

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Developing Health Care Clinic Partnerships in Resource-Limited Regions

Developing Health Care Clinic Partnerships in Resource-Limited Regions

The key to sustainability is education. Encourage health care providers to present themselves as instructors offering technical expertise for a long-term integrated plan rather than simply as short-term visiting physi- cians. Continue to monitor and evalu- ate the program ’ s ef fi cacy, collecting data and reassessing resources on an ongoing basis to maximize the oper- ation ’ s effectiveness. Create a sense of local ownership by teaching employees how to apply for grants, solicit addi- tional partners, present and publish results, and share their stories through social media. Promote investment in local nursing, allied health, and medi- cal schools to expand the pool of po- tential health care workers for future generations, and consider using di- aspora communities to bridge gaps between foreign institutions and local personnel. Finally, structure wages and bene fi ts to attract and retain talented workers without supplanting existing caregivers. The ultimate goal of any overseas clinic should be its complete indigenization, and a time frame should be set in which this is expected to occur.

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An Evaluation of A Pronatal Subsidy Program in Korea: A Quasi Experimental Approach

An Evaluation of A Pronatal Subsidy Program in Korea: A Quasi Experimental Approach

To examine whether the BSP achieve the policy goals, I take advantage of a quasi- experiment environment where the BSP is introduced only to the families with infants cared for by private daycare centers and nursery homes. To take this approach, the pre- and post-program data sets are needed. For the pre-program data, I use the National Survey of Child Care and Education for providers’ data and National Household Survey on Child Care for households’ data conducted in the year 2004. The providers’ data col- lect information on child care facilities. The nationally representative sample of providers report detailed information on their facilities. They include information on teachers and principals such as their education, certificate, wages, and benefits, curriculum and physi- cal environment. The household survey collects the nationally representative sample from the families with children below the age of 13. It includes demographic and social charac- teristics, and detailed information on child care and education. In particular, this data set includes whether children use any non-mother care, if so what type of child care facilities are used, and how much parents are satisfied with the care quality.

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Presentation and care of a family with Huntington disease in a resource-limited community

Presentation and care of a family with Huntington disease in a resource-limited community

A hallmark of HD is onset of mood changes, psych- osis, and suicidal thoughts prior to the presentation of the movement disorder. Due to local social conventions, it is possible that these patients and their families would not recognize, or would minimize, reports of mood changes, depression, or suicidal thoughts. Although dir- ectly asked about suicidal thoughts and depression, an- swers might not be forthcoming unless the question is framed within a precise social context, or possibly even by the correct person, and not by a clinician. It is also known that people with HD have limited insight into the extent and nature of both their movement disorder and their psychological impairment [34, 35]. An additional possibility is that both affected and unaffected family members perceived the illness within the context of the family lore, and ignored features which were inconsistent with this. The possibility exists that they may not have wanted to admit to depression for fear that the local stigma attached to mood disorders would render them ineligible for further help. Consistent with this were

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