A draft End of Life Care Plan has been adopted for use in KanturkCommunityHospital; this will be piloted for residents at the end stage of their life. This Care Plan will be developed in consultation with the resident and/or their family and will ensure only appropriate interventions are carried out. It will also act as a guide for nursing staff to treatment and documenting progress and promoting comprehensive communication for the multidisciplinary Team.
KanturkCommunityHospital was a single storey, 40 bedded facility situated on the outskirts of the town. The inspection was carried out over the course of two days by one inspector on the first day and two inspectors on the second day. During this inspection, which was a renewal of registration inspection, the inspectors met with a number of residents, relatives and staff members. The inspectors observed practices and reviewed records such as nursing care plans, medical records, accident and incident logs, policies and procedures and a sample of personnel files.
KanturkCommunityHospital is a designated centre operated by the Health Service Executive (HSE). It is located on the outskirts of the town of Kanturk, Co. Cork. The centre is a single-storey building and the layout comprises a long corridor with multi- occupancy wards on either side of the corridor. Bedroom accommodation comprises six single rooms with wash-hand basins and five multi-occupancy rooms with four to six residents. Toilet, shower and bath facilities are available throughout. Communal areas comprise a day room which is also the dining area, a conservatory, church, and a small quiet room and a secure garden area with seating. The service provides 24- hour nursing care to both male and female residents whose dependency range from low to maximum care needs. Long-term care, respite and palliative care is provided, mainly to older adults.
An evidence based system will be put in place to ensure that the service provided is safe, appropriate consistent and effective .Audits will be carried out in order to capture appropriate data on areas such as: Nursing Care Plans, Pressure Ulcers, Environment, Resident Experience, Falls, Restraint, Health and Safety. Current weekly data collection will be discontinued. The hospital is involved in a Falls Project since Jan 2016, part of this project is to establish a baseline, identify trends, establish ways of preventing and reducing falls .Issues raised at residents’ meetings will be addressed adequately,
Current and site-specific policies and procedures were in place in relation to the care and welfare of residents. The inspector reviewed a number of care plans that were well laid out and easy to follow with entries clearly recorded. The inspector reviewed care planning practice with members of nursing staff who demonstrated a comprehensive understanding of assessment, review and care planning processes. Following admission all residents were routinely assessed using standardised assessment tools. Care plans were developed in line with these admission assessments and included relevant information about the residents’ health, medication and communication needs. Care plans were maintained in hard copy format and contained documented records of consent and consultation as appropriate. Relatives who met the inspector during the course of the inspection confirmed that they were kept informed of their relative’s care. Care plans also included a record of vital signs, daily nursing notes and the property record. Documentation and correspondence around discharges and transfers, including records of medication, were complete and accessible. Arrangements were in place to provide residents with regular access to eye care and dental checks. The service was well supported by community health services including psychiatry and palliative care. The services of a consultant geriatrician were accessible on referral as necessary. Care plans reviewed had relevant information and guidance on care in relation to activities of daily living such as mobility, cognition, communication and nutrition, for example. Where particular needs were identified the circumstances were recorded and a plan of care was clearly set out. Specific and relevant information was in place around particular needs on catheter care, wound management and the use of a percutaneous endoscopic gastrostomy (PEG), for example. Mobility plans were in place that identified the needs of the resident and described the necessary supports to provide appropriate and safe care. There was evidence that these plans of care were regularly reviewed in keeping with statutory requirements, or as assessed needs indicated. Care plans were individualised and staff spoken with had a well developed knowledge and understanding of the needs and personal circumstances around individual residents.
Officer is due to meet with Cork County Council Fire Authority on site to discuss the planned works and to ascertain if any additional works may be required by the Fire Authority. These works will involve the widening of doors in a number of wards and will entail the reduction of beds in the hospital from 40 to 33, for which the Chief Officer has approved. The removal of these 7 beds has already taken place to allow for evacuation drills to happen and also to prepare for the
provide long-term care services for older adults. Inspectors noted that the premises were clean and were regularly maintained with a good standard of décor. Efforts had been made to create an atmosphere of comfort through the use of suitable fittings and furniture and there was evidence that renovations had been carried out to improve the ambience. Toilet doors in each area had been painted different colours to aid residents in identifying their function. There was a spacious multi-purpose sitting room which had large conservatory type windows providing plenty of natural light. This room was used for a number of functions including activities, music, TV and dining. There was also an impressive oratory which was used for religious services and for residents who wished to meet relatives in private. Staff informed inspectors that this extension had been funded by the local community. However, the following actions from previous inspections were still outstanding:
Since the previous inspection, inspectors viewed a number of improvements particularly in the laundry and sluice facilities as well as the development of a suitable, safe outdoor garden area for all residents. Residents who spoke with inspectors stated that they were happy. They informed inspectors that staff were kind and that they enjoyed the food. One resident stated that he "couldn't fault the centre". There was evidence of residents' needs being assessed and staff were seen to support residents with their needs in a discreet manner, where necessary. Staff informed inspectors that community and family involvement were encouraged in the centre. There was a varied activities programme set out weekly. This was displayed on the notice board. Residents with dementia were seen to engage in the activity programme and to avail of the outdoor secure garden area.
compliance. Hand sanitisers and sinks were present at the entrance to the building, on the corridors and in the staff and resident areas. Inspectors saw that gloves were stored safely. Hoists, wheelchairs, weighing scales, electric beds and mattresses were serviced on a regular basis and these records were seen by inspectors. The centre had an outside smoking area. There were risk assessments noted in the files of residents who smoked and staff were also obliged to use the outside smoking area as the centre was a non- smoking area. Clinical risk assessments were undertaken for the residents, including falls risk assessment, dependency levels, nutrition, skin integrity, continence, moving and handling and challenging behaviour. Inspectors viewed these in the residents' care plans. However, inspectors observed that not all the risks in the centre had been identified and risk assessed. There were open external side and back doors for the general public to gain access to the centre, to the physiotherapy and to the hospital chapel. There was a risk assessment seen and controls in place to mitigate the risks associated with this. However, inspectors formed the opinion that there were too many open entrance doors to the centre to enable suitable supervision of access. This issue required further review/risk assessment. This was addressed under outcome 12: Premises. In addition, unrestricted window openings, the use of the lift, the unlocked doorways at the entrance to stairways and hot radiators in one section of the building were among the risks which had not been assessed. Inspectors also noted that the sluice rooms, an unused room where there was an open door to the external area, the room containing the photocopier and the electronic operations control box and the kitchenette, were unsecured and open access to these rooms had not been risk
External advocacy services were available to residents and information on this service was displayed, on notice boards. There was evidence that residents were consulted about how the centre was run. Residents' meetings were facilitated by an external group. Suggestions, emanating from these meetings, were acted upon, by the person in charge. Residents' and relatives' satisfaction surveys were undertaken. The centre was located near a busy town and was centrally placed, in the community. For example, local school students, from transition year, visited the centre weekly, to chat, play music and facilitate bingo, with residents. Residents were facilitated to partake in meaningful activities and local events. For example, the person in charge informed inspectors that a large group of residents were supported to go to the local Christmas fair with staff, and enjoyed a shopping and dining experience. Residents, with whom inspectors spoke, were aware of recent world events and conversed about their life and experiences, in the centre. Residents spoken with, said that they felt content and safe. Inspectors observed that visitors were plentiful and those with whom inspectors spoke, were pleased with all aspects of care, in the centre. The person in charge met with residents and relatives on a daily basis. Inspectors observed that staff appeared approachable and kind to residents. Residents had access to telephones and mobile phones, in the centre. Televisions were located in the bedrooms and in the communal rooms.
the requirements for premises in Regulation 17 (1) and Regulation 17 (2). For example, inspectors noted that visitors, residents and staff had to pass by residents, sitting by or lying on their beds, to access the small communal sitting areas. This had a major impact on the privacy and dignity of residents lying in bed or eating meals beside their beds. The 'back' hospital was accessed by crossing an external courtyard. This older section was a three-storey building with accommodation provided on the lower two floors. The first floor of this back hospital had a lift installed as well as stairways. St. Mary’s ward was on the ground floor and this provided accommodation for seven female residents. It had a separate living/dining room and a small sitting room between the bedroom areas. Also a small kitchenette, two toilets and an assisted shower room were available for residents’ use. Upstairs St. Anne’s and St. Ita’s wards accommodated eight and five female residents respectively and St. Joseph’s and St. Patrick’s wards accommodated eight and five male residents respectively. St. Anne’s and St. Ita’s had four toilets between them and an assisted shower room. St. Joseph’s and St. Patrick’s had four toilets and one assisted bathroom for residents' use. A visitors’ room was available on the second floor located in the hallway outside the ward area, near the lift. A
This report sets out the findings of an announced follow-up inspection of kinsale communityhospital following an application by the provider to vary their conditions of registration. The centre was registered with restrictive conditions due to ongoing issues in relation to the premises and fire safety. As part of the inspection inspectors met with the person in charge, the Clinical Nurse Manager 2 (CNM2), residents, relatives and numerous staff members. Inspectors observed practices and reviewed the premises and operational documentation to inform the application to vary process. The fire and estates inspector reviewed the current fire safety procedures. The person in charge and staff team displayed good knowledge of the regulatory requirements and they were found to be committed to providing good care for the residents. The inspection was focused on the actions from the previous inspection undertaken on the 29th September 2015. The actions in relation to policies and procedures had been rectified. Although there had been a very high quality
Medical notes were examined and residents had regular access to their chosen GP. Referrals to specialist services were evidenced. Residents were reviewed in-house by the dietician and speech and language specialist services; occupational therapy was not available. Diagnostic services, dental and diabetic services were available off-site upon request. Residents had access to palliative care services based in Bantry Hospital. Notes reviewed demonstrated that residents were reviewed in-house, had timely access, interventions and follow-ups from this service.
There was evidence of timely access to health care services facilitated for all residents. Four different General Practitioner (GP)practices acted as medical officers provided medical services to the centre and an on call medical service was available in the evenings and out of hours and this was confirmed by residents. A sample of medical records reviewed demonstrated that resident’s were reviewed on a regular basis. Specialist medical services were also available when required. Reviews and on-going medical interventions as well as laboratory results, were evidenced. There were policies in place to ensure that relevant information was shared between providers and services for when the resident was admitted to, transferred or discharged from the centre. On the previous inspection inspectors found that pre admission assessments completed on a potential resident were not comprehensive and did not reflect the full health, personal and social care needs of a person intending to become a resident. This was identified as an issue as a resident could be admitted and inappropriately placed in a ward which was not equipped to facilitate their needs pre-admission assessments were not conducted by hospital staff but other HSE staff external to the centre. On this inspection the ADON and CNMs confirmed that this had much improved and they were using a new system to ensure they had far greater and more comprehensive information on all residents prior to admission to ensure appropriate placement in the centre and CNMs would be able to prepare for the needs of the resident being admitted.