Appropriate arrangements were in place to meet the health and nursing needs of residents with dementia. Admission procedures included an assessment, both before and on, admission by a suitably qualified person. Care plans were developed in line with admission assessments and residents' changing needs. A sample of care plans was tracked on inspection and it was found that timely assessments were carried out and reviewed in keeping with regulatory requirements. The care planning process involved the use of validated tools to assess residents’ risk of falls, nutritional status, level of cognitive impairment and skin integrity. Of the cases reviewed appropriate care plans were in place around the activities of daily living that covered 12 domains, and included areas such as nutrition, mobility and management of the behaviours and psychological symptoms of dementia. Specific care plans had been developed for all residents with dementia that addressed specific areas of risk, such as absconsion and personal
The request for a hairdressing sink came from the residents at a residents’ meeting. Aware that placing a hairdressing sink in the bathroom would pose an infection control risk advice was sought from the Health Protection and surveillance centre and controls were put in place to reduce the risk. These controls included closing the toilet for use on the one day per month that the hairdresser visits the home. Deep Cleaning the bathroom prior to using the room for hairdressing. Construction of a mobile shelf that rolls in over the toilet to ensure everyone is aware that the toilet is not in use that day. The senior person in charge then inspects the room prior to its use as a hairdressing room. These controls are included in a risk assessment which was placed in the risk register prior to insertion of the sink. Following the advice of the HPSC construction of a hairdressing room has begun as part of a planned extension. As the risk of infection is assessed as being low the controls will continue to be implemented until the new hairdressing room is opened.
The inspector reviewed a sample of residents' nursing, medical and allied health records and there was evidence of a multi-disciplinary approach to managing residents that had specific nutritional needs and/or had risk of poor nutrition. Nurses used well recognised assessment tools to assess and monitor on an ongoing basis residents' nutritional status and nursing care plans were in place to support residents with their nutritional needs. Those residents that required close monitoring had food charts in place, their total daily intakes were closely observed and they had their weights regularly recorded. Residents' nursing and medical records indicated that residents had regular review by medical practitioners and any deterioration in a resident's food or fluid intake was well communicated. There was evidence that residents had timely access to dietician
service in the adjoining church on a daily basis and relatives were seen to accompany residents. Records also showed that residents had the opportunity to shop in the local town, to attend restaurants with friends and staff and to participate in local events. Since the previous inspection an activities coordinator had been employed and residents had opportunities to participate in meaningful activities informed by their interests. These activities included card playing, art work, singing, reading and chair based activities. In addition, residents had been facilitated to attend Listowel races and to nearby farm centre where hens were kept. The activities coordinator informed
During the two day inspection inspectors met with residents, relatives, and staff members. Inspectors observed practices and reviewed documentation such as nursing records, care plans, medical records, incident and complaints logs, policies, and staff records. The provider, who had recently been appointed, was interviewed on day two by inspectors and she outlined the funding difficulties being experienced to provide for more suitable or modified premises, which would comply with the requirements of the legislation. She acknowledged to inspectors that the privacy, dignity and rights of residents were seriously compromised in the current building, due to the design and layout of the multi occupancy five bedded rooms, and the lack of private space for residents to meet their visitors and carry out activities in private. She also acknowledged that the amount and location of just two shower rooms for 24 highly dependent residents had serious consequences for residents' dignity, privacy and choice.
Residents spoke with inspectors about various outings with relatives and staff. Since the previous inspection an activities coordinator had been employed and residents had opportunities to participate in meaningful activities informed by their interests. These activities included card playing, art work, singing, reading and chair based activities. In addition, residents had been facilitated to attend Listowel races and to a nearby farm centre where hens were kept. The activities coordinator informed inspectors that these visits formed part of a reminiscence session as residents reflected on their past lives and experiences when they returned to the centre. Local school students and Fetac Level 5 students were present in the centre on the day of inspection. Residents informed inspectors that they benefitted from the company and conversation with the students, who discussed local events with them. Students were seen to facilitate some activities and were supervised by the CNM2 and the activities co-ordinator.
Generally, medication management practices were safe although the centre policy and professional guidelines on transcribing did not inform current nursing staff practice. The inspector noted that there had been a change in medication management practice since the last inspection in June 2015. Nursing staff had started to transcribe residents' prescription. However, the inspector read that they had not signed the transcribed prescription, as required by the centre policy and professional guidelines. A required action relating to this issue is included under Outcome 5. The person in charge forwarded evidence after the inspection that a new prescription sheet had been developed and approved for implementation.
Resident’s needs were comprehensively assessed; the care and support required to meet these needs so as to promote and maintain resident health and well-being was in place. Three residents living together in one house had known each other since early childhood; their close bond was evident to the inspector. There was an ethos of supporting residents to age in place and the provider had responded to increasing needs to facilitate this for as long as was possible, for example through the provision of nursing input and equipment necessary for the residents comfort. While the
The entrance was secure and required a key pad code to open the doors. Residents spoken with stated they felt safe and secure in the centre. A culture of promoting a restraint free environment with evidence of alternatives such as low-low beds, chair alarms was in place. The national policy, ’Towards of Restraint Free Environment in Nursing Homes (2011)’ was available in the centre. Seven residents had bedrails in place. In discussion with the person in charge on the use of bedrails she described how most were used as an enabling function and were in place for the purpose of positioning or enhancing physical or psychological function. Care plans were in place but they did not detail the rationale for use of the bed rails. Laps straps were in used as a safety measure when moving residents in chairs. Records indicated that restraint was only used following a risk assessment and there was evidence of discussion with the family /significant other but poor evidence of discussion with the resident.
ArasMhuire Community Nursing Unit was built in the 1960s. It was originally a novitiate for nuns and opened as a care centre for older persons in 1975. It is a two- storey building with landscaped gardens, and wheelchair access at the front and rear. All residents are accommodated on the ground floor. It is located on the outskirts of Tuam in Co. Galway, within walking distance of the town centre. The centre is registered to provide care to 20 residents. It has fifteen single rooms, two dedicated palliative care places, one twin room and one three bedded room.
outskirts of Abbeydorney, Kerry. There was access from the main road to a large car park at the side of the premises. Resident accommodation was laid out on the ground floor only. The centre provided accommodation for up to 27 residents comprising 3 single rooms, one of which was en-suite, and 12 twin rooms, all provided with wash- hand basins. All rooms were appropriately furnished, with adequate storage and equipment as necessary. All twin rooms had privacy screens in place. All rooms had a radio or television and were fitted with call-bell facilities. Bathroom and toilet facilities were accessible and appropriately located throughout the centre; these facilities were well equipped and maintained. There was a large garden area at the back of the
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
In the sample of residents’ nursing records that were reviewed by the inspector it was clear that residents were frequently assessed and specific clinical care needs were identified. Residents' nursing assessments were up to date, written nursing care plans were in place for each resident and they outlined the required care and they were adjusted to reflect the care that was needed if a resident’s condition or circumstances changed. The care plans and daily nursing notes demonstrated that evidence-based nursing care was planned as well as provided and residents’ progress was closely monitored. The nursing records indicated that if a resident deteriorated it was quickly identified and managed appropriately.
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 Kilcara NursingHome 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.
residents had a comprehensive assessment and care plans were in place to meet their assessed needs. The service was in the process of transiting to a computerised system for assessments, care planning and residents records. The health needs of residents were met to a high standard. Residents had access to medical services and a range of other health services and evidence-based nursing care was provided. The service had made significant progress towards creating a restraint free environment. There was evidence of good interdisciplinary approaches in the management of behaviours that challenge with positive outcomes for residents. The service functioned in a way that supported residents to lead purposeful lives. Positive connective care was observed during the formal observation periods. Collaboration and respect for residents was very evident and the daily routine was organised to meet the needs of individual residents.
Residents with dementia were supported to maintain their independence. There was an emphasis on promoting health and wellbeing. Residents were encouraged to participate in the social life of the centre. During the inspection a physiotherapist was providing exercise classes to residents. Residents informed inspectors that this was a weekly occurrence. Residents participated in chair-based exercises and individual walking and strengthening exercises with the physiotherapist and staff. The inspector spoke with the physiotherapist who was employed by the nursinghome to attend the centre on a weekly basis. On one day of the inspection he had been asked to see 18 residents. Some residents had a private arrangement with him when physiotherapy was required following a hospital stay or for on-going medical issue. He explained that residents with dementia also participated in games such as ball throwing and skittles. He also supplied an individual exercise sheet where appropriate. These exercise sheets were seen in residents' files. Residents informed the inspector that this regular access to
Duty rosters were maintained for all staff and during the two days of inspection the number and skill-mix of staff working was observed to be appropriate to meet the needs of the current residents. Relatives spoken to said that at times there appeared to be a shortage of staff and expressed concern over the high turnover of senior nursing staff. The provider is requested to keep his staffing levels under review to ensure he has adequate staff with the right skills to meet the needs of the residents. The person in charge and deputy person in charge were due to leave the centre in the next number of weeks and a replacement for them had not been identified which will leave the centre short of nursing staff.