Action required from the previous inspection relating to end of life care had been addressed. A new system was being introduced to ensure that residents were afforded the opportunity to outline their wishes regarding end of life. The person in charge and director of nursing had undertaken training to implement this in the centre and the inspector read some completed documents which aimed to allow residents to plan for their future and make sure their wishes known.
There were suitable arrangements in place to meet the health and nursing needs of residents with dementia. Each resident’s needs were determined by comprehensive assessment with care plans developed based on identified needs. Care plans were updated in line with residents changing needs. Residents and their families, where appropriate were involved in the care planning process, including end of life care plans which reflected the wishes of residents with dementia. The nutritional and hydration needs of residents with dementia were met. Staff cared for residents receiving percutaneous endoscopic gastrostomy (PEG) tube replacement. The acting person in charge told inspectors that the nursing team supported by residents’ GPs were developing their practice to include care procedures that would prevent unnecessary hospital admissions. For example, provision of subcutaneous fluid replacement. Residents had a choice of General Practitioner (GP) and some residents continued to have their medical care needs met by their GP prior to their admission to the centre. Residents also had access to allied healthcare professionals including physiotherapy, occupational therapy, dietetic, speech and language therapy, dental, podiatry and ophthalmology services. Residents in the centre also had access to the specialist mental health of later life services. A member of this team assessed residents referred to them and reviewed other residents on a regular basis as follow-up to consultations they completed.
On the last inspection, a lack of meaningful activities or purposeful stimulation for residents was found. Actions required to address this non compliance were found to have been fully implemented on this inspection visit. A new activities coordinator had been appointed and she worked full time Monday to Friday. Healthcare staff were allocated protected time dedicated to activities over the weekend. The inspector saw that this was reflected on the roster. There was a revised activities programme in place and this was also available in each resident’s room on a weekly basis.
The inspector saw that the existing end-of-life room had been relocated to another room which was furnished and decorated to a good standard. The vacant room had been furnished as a twin ensuite room to accommodate two residents. The inspector viewed rosters which included an increase in staffing hours once the additional beds were occupied. The inspector was satisfied with the additional increase in health care assistant hours. Nursing hours had already been increased prior to the previous inspection. An additional eight hours nursing per week would also be implemented once the extra two beds were occupied.
This report set out the findings of an announced registration renewal inspection, which took place following an application to the Health Information and Quality Authority (HIQA), to renew registration of the designated centre. Oakfield NursingHome is a modern purpose built residential care facility that can accommodate 73 residents who need long-term general care. It is situated in a countryside location a short drive from the town of Courtown Harbour in Co. Wexford.
There were a number of centre-specific policies in relation to the care and welfare of residents including assessment and care planning, falls, wound management and challenging behaviour. Overall the welfare and well-being of residents was maintained through both evidence based nursing care and appropriate medical and allied health care such as dentistry, chiropody, occupational therapy and community mental health. Whilst the inspector saw detailed care planning in many areas, there was evidence that where a care plan was in place for a specific problem, it was not implemented in
There was a policy on restraint and the inspectors saw that restraints used in the form of bed rails and lap-belts were subject to regular checks and ongoing review. However there were not comprehensive assessments available for the need for restraint. the care manager said she was looking to implement a new assessment tool. The inspectors noted that there were a large number of residents using bed rails, some were used to enable residents to move in bed, whilst others were used to promote safety. The integrated full length bed rails in use were restrictive devices because residents were unable to release them in order to get out of bed. Although the nursing care manager said they are aiming to reduce bed rails in use and the inspectors saw some evidence of alternatives such as low low beds and alarm mats and sensors in use in the centre. The inspectors held the view that less restrictive devices could be used to achieve the goals of care, whilst supporting the resident to be independent. The practice around restraint use in the centre required review to be compliant with national best practice guidelines. Judgment:
independence, taking each residents preferences and choices into account. Reasonable measures were in place to prevent accidents in the centre and on the grounds. Root cause analysis and risk assessments following incidents or hazard identification were maintained and recorded outlining control measures. Staff were trained in moving and handling of residents and fire safety. Further training dates for mandatory training and refresher training were scheduled for all staff involved in moving and handling practices. A fire safety register and associated records were maintained and precautions against the risk of fire were in place. Service records confirmed that the fire alarm system and fire safety equipment including emergency lighting and extinguishers were serviced as required on a regular basis. Means of escape and fire exits were unobstructed and emergency exits clearly identified. Each resident had a personal emergency evacuation plan, and staff were reasonably knowledgeable regarding emergency procedures to be adopted in the event of a fire alarm being activated. Fire safety was included in the induction programme for all new staff. Although the person in charge had plans in place for six monthly simulated evacuation drills from various locations in the centre. The majority of staff had not participated in an evacuation drill in the previous two years. According to the records the 12 staff who participated in the evacuation drill in April 2016, were the only staff to have participated in an evacuation drill since 2014. Fire drills to simulate night time conditions and staffing levels were also required. Inspectors noted that the seal on the fire door in the second sitting room was not fit for purpose and recommended that a review of all fire doors be undertaken.
decorated. Moyne NursingHome is a single-storey, purpose built centre with ten single and eight twin rooms. Three bedrooms had en-suite facilities. There are additional wheelchair accessible toilets located around the building. The centre has two main day rooms, a dining room and a conservatory. A kitchen, pantry, cleaning room, laundry room, sluice room and equipment storage room, the office of the person in charge and nurse’s office complete the accommodation.
There was evidence to support that residents’ healthcare requirements were adequately and regularly assessed by competent nursing staff and that arrangements were in place to meet assessed needs. On admission residents were facilitated to retain access to their general practitioner (GP) of preference. There was documentary evidence that residents, as appropriate to their needs, had access to other healthcare professionals and services including dietetics, speech and language therapy, occupational therapy, psychiatry, chiropody and physiotherapy. Further arrangements were in place to facilitate optical and dental review. The inspector saw that each resident had a nursing plan of care and noted that they were prepared within 48 hours of admission into the center, as required by regulation. Staff to whom inspectors spoke with were knowledgeable of residents' health and social care needs.
There was a daily nursing record of each resident’s condition and the medical notes showed that residents had regular access to their GP. Residents also had good access to allied health professionals when needed such as speech and language therapist (SALT), dietician, chiropodist, physiotherapy, occupational therapy, dentist and the psychiatry of old age team. Records of these referrals were written up in the residents’ records.
Accommodation was provided in 45 single en-suite bedrooms and two double en-suite bedrooms. On this inspection building works were underway to further enhance quality of life for residents. The bed capacity of 49 will remain the same and the person in charge was aware that once the footprint of the building had changed the statement of purpose would be amended. The two double rooms were now being converted to spacious single en-suite rooms which were almost complete and the palliative care suites now had a sitting room adjacent to their bedroom. There was a new sitting area to accommodate parties added onto the dining room which was decorated to a high standard. Residents told the inspector that they liked to sit there.
Inspectors were satisfied with the systems in place to ensure the service was safe, appropriate and effectively monitored. The providers had introduced a quality assurance framework for 2014 which consisted of a monthly management meeting with a standing agenda of reviewing policies that required renewal, review of all audit results and a review of all incidents. In addition data was being collected and monitored on a three monthly basis on issues like the use of restraint, wound care, pain and the use of psychotropic medications. The person in charge had introduced a system of quality assurance reviews which included audit of nursing documentation, infection control and resident care plans. Following each audit an action plan to remedy the deficit was introduced.
The inspector was satisfied that each resident’s wellbeing and welfare was maintained by a high standard of nursing care and appropriate medical and allied health care. The inspector saw that the arrangements to meet each resident’s assessed needs were set out in individual computerised care plans. It was noted at the previous inspection that some care plans did not always contain sufficient detail to guide staff. In the sample of care plans reviewed the inspector saw that this had been addressed. There was evidence of resident or relative involvement at development and review. The inspector noted ongoing development work in this area with regular audits and additional training for staff.
CherryGroveNursingHome is a purpose-built two-storey centre and all resident areas are located on the ground floor. The building is well maintained both internally and externally. It was found to be clean, comfortable and welcoming. In total, there are 41 single, eight twin and one three-bedded bedroom. All bedrooms have full en- suite facilities. Each bedroom was appropriately decorated and contained personal items such as family photographs, posters and pictures. Bedroom windows allowed residents good views of the garden. Clocks were also available in each room. There are additional wheelchair accessible toilets located around the building. The centre has two main day rooms, a visitor's room, a dining room, an oratory, treatment room, smoking room, kitchen, hairdressing room, storage rooms and two sluice rooms. The upstairs area, which was accessible by stairs and lift, provided office space, staff facilities and the laundry in addition to storage. In their statement of purpose, the centre's philosophy is documented as, with respect to the dignity of all, they will strive to create an environment that is safe and happy, inclusive and
As was highlighted during the inspection this training is no longer being provided locally and as instructed by Nursing Homes Ireland we are advised to return to “Elder Abuse training” for staff that require same. This is in the process of being organised. We have booked online safeguarding training which obviously an incurred cost, the HSE training was free and obviously we would have utilised this option if it was not under review and available to us.