The centre's registration had a condition attached in relation to the reconfiguration of the physical environment to be completed by the end of 2018. This was based on a commitment given by the provider to the Chief Inspector. However, the person in charge confirmed that works in this regard had not commenced. At the time of inspection some refurbishment was being undertaken in a small communal sitting room and the person in charge explained that this was to create a quiet room for residents and visitors. This inspection also identified areas for improvement in relation to documentation and the notification of information, as well as gaps in required training for staff, these issues are further detailed in the relevant outcomes of the report. An action plan in response to the issues identified is set out at the end of the report.
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.
1. Each staff nurse has been allocated the responsibility of an individual residents’ care plan. Refresher Training on Nursing Documentation is being given in September and October 2018 to all nursing staff to support this. Each residents’ care plan will be reviewed on a four monthly basis and also when a residents’ condition changes. The CNM2 now takes an active role in ensuring that all assessments, monthly weights, bloods etc are undertaken and that all new admissions care records are completed within 72 hours of admission.
The existing control measures included a review of the building and associated plan of remedial works. Additional control measures included a suite of proposals such as reduction of numbers of beds, widening of exit doors and the commission of a fire safety risk assessment of the building, as one had not been carried out since 2011. The additional control measures had not been implemented in spite of the due date being 'as soon as possible'. It had also been identified in the aforementioned risk assessment form that there was insufficient staff at night time and it was only when the issue was highlighted by HIQA that the provider arranged for staff levels at night to increase from four to five from 13th August 2018.
The inspector saw that there was a management structure in place. Each unit was managed by a CNM2 who was supported by a CNM1 or senior staff nurse. The centre was managed by a full time person in charge who was supported in her role by two ADON's during the day and two CNM3's at night. However the inspectors were not satisfied that there was a clearly defined management structure that identified the lines of authority and accountability that specified roles, and detailed responsibilities for all areas of service provision as required by the regulations. This was evidenced by a lack of knowledge of senior staff of the actions to be taken in response to some allegations of abuse. The role of the ADON’s and CNM3’s did not appear to be clearly defined in relation to specified roles and responsibilities. There was a lack of a senior nurse rota identifying who was in charge of the centre on a daily basis. The CNM's on the units did not have control of their own staffing arrangements as discussed further in Outcome 18. Although the senior management team were in the centre Monday to Friday they were based in an office away from the resident areas and time spent out in the resident area was limited.
Most residents in the centre were found to be well supported and presented as very content and happy over the course of inspection. There were good activation levels for many residents and multiple activities available in the centre. Inspectors spoke with many residents and some reviewed their personal plans with inspectors citing that they loved their home and were happy with the staff who supported them. Residents participated in baking, weaving, farming, cooking and various rural work around the community. Some residents with an interest in fitness went to the gym and one recently purchased a treadmill and others were observed preparing for the Christmas festivities and Christmas show.
Having reviewed a sample of care plans and other documentation, the inspectors were not satisfied that residents and relatives had been given the opportunity to outline their wishes regarding end of life care. It was unclear if residents were to be transferred to hospital if they became unwell and the circumstances around resuscitation. In addition, there were very limited single rooms available in the centre to provide additional privacy during end of life care, therefore residents' preferences for a single room at end of life care could not always be facilitated particularly for those in the open plan nightingale units.
integrate within their wider community, develop skills to be independent in day to day life and maintain links with their family. Specific activities had been identified to support residents to achieve these goals. For example, it was identified that a resident could attend a local music session in a pub and attend mass to assist in developing links with their community. The progress towards achieving these goals was monitored on a weekly basis.
Inspectors viewed a sample of five residents plans from a social care perspective the following were present: meaningful daily assessment, my life my way, my personal plan and silver birch nursing care plan. All of these documents focused on the social care needs of residents, however, none of them where linked to each other. Inspectors found the information included in these documents required significant improvements. For example, the section titled ''my community inclusion'' listed a number of items, one included going to bed. Inspectors asked staff members what this had to do with community inclusion, however, this information was not available. Overall inspectors found documents were present within resident's files, however, these were not impacting on residents lives. As various activities were identified with no evidence of progress or steps in relation to how residents would be assisted to achieve this aspect of their dreams or wishes.
There were fire policies and procedures in place that were centre-specific. There were fire safety notices for residents, visitors and staff appropriately placed throughout the building. Fire training records evidenced minor gaps. Outstanding staff have been booked in to attend the next session on the 9th January2018. Each staff member spoken to during the inspection was familiar with evacuation requirements of residents and confirmed that they had attended fire evacuation drills. The centre had carried out drills that simulated staffing levels at day time and night time. Quarterly servicing was carried out and fire safety equipment was serviced on an annual basis. There were records of weekly fire safety checks.
A plan is in place since the HIQA inspection whereby, a member of staff will assist any resident who uses a wheelchair to access all areas of the designated centre. This process will remain in place until these residents are accommodated as a priority in the first phase of the new community care unit. In the interim, an application has been made to HSE Estates for funding in order to implement the recommended actions enabling wheelchair users to independently access all areas of the designated centre. Funding has been prioritised to develop a new Community care Unit in Athy in
The centre had policies and procedures relating to health and safety within the centre dated November 2015. There was a health and safety statement dated January2018. The centre risk management policies include the requirements set out in Regulation 26(1). The centre had a current risk registrar that is kept under constant review by the management team dated January2018. The register identified areas of risk within the centre and the control measures in place to minimise any negative impact on residents. Arrangements, consistent with the national guidelines and standards for the prevention and control of healthcare associated infections, were in place. The policies were last reviewed in March 2017. Staff had access to personal protective equipment such as aprons and gloves, hand washing facilities and hand sanitisers on corridors. Staff were seen using these facilities between resident contact. Signs were on display to encourage visitors to use the hand sanitisers. Household staff spoken to were knowledgeable on the system in place to ensure that the cleaning regime minimises the risk of cross infection. The cleaning schedule included the routine daily chores but also contained detail of a deep cleaning schedule. The cleaning schedules inspected were all signed off daily. Residents spoken too confirmed that their bedrooms are cleaned on a daily basis. The inspector observed that the standard of cleanliness throughout the building was of a high standard.
St. Clare’s Ward: This ward has 11 residents and is located on the grounds of Or Lady's Hospital in Cashel. Bedroom accommodation comprises nine single and one twin room. The bedrooms were all spacious, with a large en-suite and wheelchair accessible shower, a toilet with contrasting grab rails and a wash-hand basin. Residents’ accommodation comprises an open plan living area close to the entrance hall. There were two assisted toilets and a quiet room to meet with visitors in private. There was a spacious dining room which had large windows with views of the summerhouse and the garden. This unit met the needs of residents as outlined in the statement of purpose and function.
The Centre is proposed to be a community Centre offering residential support to people with an intellectual disability. The provider had produced a document called the statement of purpose, as required by regulation, which described the service they intended to provide. The Centre was a spacious detached house in very close proximity to a small town. The provider proposed to offer residential support to four residents.
Management re commenced engagement with SIPTU in February 2018 in relation to new rosters which will facilitate specific roles for all grades, Nursing, Health Care Assistance, Housekeeping, Catering. This will eliminate crossover of duties i.e. Direct care and housekeeping by the same staff member which is recognized as non acceptable for infection control management. However, SIPTU disengaged at this point and would not negotiate with management any further. Following representation, SIPTU agreed to meet with senior management in September 2018, to scope out return to negotiations on the new roster. SIPTU insisted on a number of preconditions. Negotiations are due to recommence in November 2018, on completion of these conditions.
completed by December 2021. The management team expressed the view that they are confident that a new build will be completed prior to this time line. Plans are in place for a new development which will replace the Sheil CommunityHospital and the Rock Community Nursing Unit (both units are currently located in Ballyshannon). The inspector met with the project manager from the provider estates department with regard to the proposed new build. National approval has been authorised, planning permission has been granted and final plans have been agreed. The project manager stated that it is hoped that the project will soon go to tender with commencement of building works by end of year and completion two years thereafter. Once this centre has been completed it is envisaged that the centre will be in compliance with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older Persons)
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.