The centre was a single story building which has been extended on both sides around an enclosed central courtyard. There were 15 single bedrooms and eight double bedrooms some with en-suite facilities. The centre was not purpose built as a nursinghome, being converted from a domestic bungalow. The centre was well adapted for use as a nursinghome with bedrooms, communal areas and bathrooms easily accessible for residents including those with reduced mobility or using wheelchairs.
There were not effective arrangements in place to manage risk and protect residents from harm. Inspectors identified numerous risks throughout the service and the premises that required immediate review. There were not adequate precautions in place against the risk of fire. Fire fighting equipment such as extinguishers and fire blankets were in place and serviced annually, however there was not evidence of regular checks of these and other fire safety areas in between servicing. Fire alarms and emergency lighting was not regularly checked and serviced. A fire drill had taken place in October 2017 but there was no detail of who attended, what was undertaken and what the outcomes and learning was. Many staff had not received recent fire training. During the last inspection inspectors saw numerous fire doors wedged open. Following the previous inspection a large number of fire doors were fitted with electronic controls that automatically release in the case of fire. However, on this inspection the inspectors saw a small number of fire doors wedged open with chairs and waste paper bins. The smoking room upstairs was closed for safety
The capacity of the centre had increased by an additional 26 bed places since the last registration inspection. As part of the application to the regulator to increase the size of the centre, the provider submitted a plan to increase the number of direct care staff to deliver the expansion in the service. The provider had committed to increasing the clinical management team by one additional clinical nurse manager(CNM). A further four full-time care assistants on the day shift with additional care assistant staffing hours on evening shifts up to 11pm on each floor were also proposed to facilitate the expansion. On review of the rosters since the service increased in July 2017, inspectors found that the full-time increase of one CNM and four care assistants were put in place. However, the additional evening hours were not rostered. The findings of this inspection did not identify any serious negative impacts to residents associated with an overall lack of staff, but some findings, suggest the need to keep staffing under on-going review. This was discussed with the provider representative and person in charge at the conclusion of the inspection. Subsequent to the inspection the provider forwarded evidence of recent staffing reviews and gave assurances that staffing is monitored as part of a continuous process by the management team.
We use a template document for our weekly meeting which we feel meets our needs, this document covers 11 points to be discussed which includes, unresolved issues from previous meeting, corrective actions, Accidents/incidents/near misses, medication errors, complaints or concerns, feedback from residents meetings, welfare/health and safety including maintenance and infection control, clinical governance and end of life care, external reports, staff – recruitment and training and any other matters. Anything that is highlighted under any of these topics there is a timeframe set and person
Measures to protect residents being harmed or suffering abuse were in place. Residents were safe in the centre. The premises was safe and secure. There was a receptionist at the main door and the entry door to the nursinghome was accessed by entering a keycode or by being opened by staff. Both areas had a visitors sign in book in place. There was a policy and procedures in place for the prevention, detection and response to abuse. Staff demonstrated a good knowledge of what constituted abuse and they all had up-to-date refresher training in place. The provider told the inspector that all staff had a vetting disclosure in place in accordance with the National Vetting Bureau (Children and Vulnerable Persons) Act 2012. The provider had reapplied for a renewed vetting disclosure for all staff as a high number of staff were employed in the centre for greater than five years. The inspectors reviewed a random sample of three staff files which confirmed this process had commenced.
Where residents had healthcare needs, appropriate referrals were seen to have been made to allied professionals such as the dietician and occupational therapist. Where recommendations for treatment had been made, they were seen to be put in to place. For example where residents required a modified diet the kitchen staff were informed and the care staff ensured the resident received a meal of the correct consistency. A range of nursing assessment tools were used to assess residents needs, and where the outcomes identified action was needed, evidence was seen that it was taken. Records showed that the nursing staff responded to the results of the assessments and took appropriate action. For example if residents were losing weight, records showed that the general practitioner was informed, referrals were made to the dietician, and more frequent checks were carried out for example monitoring the residents weight weekly rather than monthly.
This was a well-organised and managed centre. The provider representative has a dual role as person in charge. Both roles were carried out effectively with support from the board of directors and the assistant director of nursing. There were well established systems and processes in place to ensure appropriate oversight of the quality of care and services provided to residents. Improvements were required in relation to information provided to residents in the contract of care and their involvement in the annual review of the service.
This designated centre is a 24 hour nurse led service which can accommodate maximum twenty two men and women over the age of 18 years who have an intellectual disability. The centre consists of six separate residential properties. Five of these properties are detached houses which are located beside each other in an urban location close to a large town in Co. Kildare. Each of the five houses have two reception rooms, a kitchen and four bedrooms. Each house has a bathroom, shower room and three toilets. All houses have a separate utility area out the back of the house. Each house has a small support building for different purposes such as staff room, archiving, snoozelen, CNM office and relaxation room. Currently one of the five houses has no residents living in it and is being used as office space for staff and a resident's relaxation therapy room upstairs. The sixth premises is a detached
Part of the centre consisted of a row of five detached houses whereby 15 residents lived across four houses and one house was used as an office space by the provider and administration support. These houses while built a number of years ago were decorated and comfortable for the residents living there. Each resident had their own bedroom that were found to be personalised and had sufficient space and storage for personal
Mandatory training was in place and staff had received up to date training in fire safety, safe moving and handling, management of responsive behaviours and safeguarding vulnerable persons. Other training provided included restraint procedures, dementia specific training, infection control, and end of life, continence promotion, food and nutrition hydration and the management of dysphagia. Nursing staff confirmed they had also attended clinical training including blood- letting, infection control and medication management. The inspector saw that other training courses had been booked and were scheduled for the coming months. The person in charge and the ADON had completed train the trainer and were providing a lot of the mandatory training in-house.
The centre aimed to promote a restraint free environment in line with the national policy. An approved policy reflecting the national guidance document was available to guide restraint usage and review. A register of bedrail restraints use by residents was maintained. Risk assessments had been completed and records of decisions regarding the use of bedrails were available to show the decision was made in consultation with the resident or representative, nursing staff and general practitioner (GP). Decisions were also reflected in the resident's care plan and subject to review. Alternative equipment such as, low low beds, sensory alarms and floor mats were available and tried prior to the use of bedrails. This formed part of the assessment and review process.
The provider had completed a dementia care self-assessment form in advance of the inspection. The self-assessment form compared the service with the requirements of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulation 2013 and the National Quality Standards for Residential Care Settings for Older People. The provider’s self assessment and the assessment of findings on inspection are set out in the table below for ease of reference. In relation to residents' healthcare and nursing needs the inspection findings were positive with a high standard of care in evidence where assessed. Effective and appropriate communication and interaction between staff and residents with dementia or a cognitive impairment was noted during the inspection. All staff demonstrated an understanding of the particular needs of residents with impaired cognition and also a commitment to the delivery of person-centred care to all residents. The provider had been responsive in taking action to address areas for improvement that had been identified on previous inspections. The layout of a six-bedded room had been
Elmgrove NursingHome provides accommodation for a maximum of 24 male and female residents, over 18 years of age. Residents are admitted on a long-term residential, respite and convalescence care basis. The centre is located on a mature site at the end of a short avenue in from the road and within walking distance from Birr town centre. The premises is a listed period building. Residents' accommodation consists of 24 single bedrooms, located over three split floor levels. Shared toilets and washing facilities are available on each floor. The upper floors are accessible by stairs and stair lifts. A variety of communal rooms are provided for residents' use, including sitting, dining and recreational facilities. Each resident's dependency needs are regularly assessed to ensure their care needs are met. The provider employs a staff team consisting of registered nurses, care assistants, maintenance,
capabilities, interests and preferences. One full-time activity co-ordinator was employed in the centre. An activity schedule was displayed prominently within the centre. It detailed the activities to take place on the ground and first floor from Monday to Friday. One-to-one sessions, which are more suitable for residents with dementia who are unable to meaningfully participate in group activities, were scheduled for each Tuesday and Thursday. The activity schedule did not detail planned activities for the weekends, but inspectors were told that care assistants were responsible for facilitating activities on these days. Additional activities such as live music performances (which took place monthly) or dancing were also regularly organised for Fridays or at the weekends. A history and genealogy information service was visiting the centre on the week of the inspection. Photographs of previous activities, such as doll-house making, were displayed on corridors. An initiative was underway at the time of the inspection to develop person-centred life stories and memory boxes for residents with dementia. Coffee/tea making facilities were made available each evening to residents and visitors on both floors. Outings to the beach or to local hotels had taken place since the last inspection, and the activities coordinator informed inspectors that more outings would be planned for the coming months.
The centre is based in Bray and has good access to local amenities including bus routes. The premises is purpose built and four floors are in use with bedroom accommodation located on the ground, first and second floor. Three lifts provide access between the floors. The centre offers 93 places for men and women over the age of 18. The centre caters for residents of all dependencies, low, medium, high and maximum, and can offer convalescence care, palliative care, respite and long term care. Twenty-four-hour nursing care is provided. A comprehensive pre-
validated assessment tool. All residents were weighed monthly or more often if staff had concerns. Nursing staff told the inspector that that if there was a change in a resident’s weight, nursing staff would reassess the resident, liaise with the GP and send referrals to the dietician. Files reviewed by the inspector confirmed this to be the case. Some residents were prescribed nutritional supplements which were administered as prescribed. Staff were aware of residents who required specialised diets or modified diets and were knowledgeable regarding the recommendations of the dietician and speech and language therapist.
completed to a high standard. Comprehensive up-to-date nursing assessments were completed. A range of up-to-date risk assessments had been completed including nutrition, falls, dependency, manual handling, bedrail use, oral care and skin integrity. Care plans were found to be person-centred, individualised and clearly described the care to be delivered. Care plans were in place for all identified issues. Care plans had been reviewed and updated on a regular basis. While nursing staff spoken with told inspectors that they regularly involved residents and discussed care plans with relatives, systems were not in place to record evidence of residents' and relatives' involvement in the development and review of their care plans.
appropriate communication between the nursing and catering staff to ensure that those with special dietary requirements, received the prescribed diet. The inspector saw that residents who required modified consistency diets and thickened fluids received the correct diet and modified meals were attractively served. Residents identified as having weight loss were assessed by a dietician and the advice had been recorded in the care plan and appropriately communicated to catering staff. In discussion with the head chef, the inspector heard that suggestions from residents were incorporated into the menu and in addition to traditional favourites she tried to incorporate Indian and Italian dishes favoured by some younger residents.
manager. The role of assistant director of nursing was no longer in existence. While the management arrangements put in place at the last inspection had sustained certain improvements in the centre, inspectors were concerned about the ongoing sustainability of these improvements due to current issues with staffing. The person in charge was currently rostered to work most shifts as a staff nurse in the centre in order to deal with the nursing vacancies. The management structure was currently not in full effect due to the post of person in charge not being a full time role, to ensure the effective