A policy informing the use of restraint was available to staff in the centre and was demonstrated in practice. A restraint register recorded any type of restraint used and the duration of restraint used. Commitment from recent efforts by the person in charge and staff team was demonstrated to maintaining a restraint-free environment. Bedrails were in use for 14 residents. Since the last inspection, documentation to ensure use of bedrails was informed by comprehensive risk assessment was improved to ensure that residents' safety was not compromised by use of a bedrail. Three residents used lap belts which were attached as part of their assistive chairs to promote their safety. Care plans for residents who had bedrails and lap belts were implemented. Low-level beds, foam floor mats and sensor alert equipment were used as alternatives to bedrails for a number of residents. However, there was inconsistent documentary evidence that less restrictive measures were trialled before bedrails were used.
guidance to staff and was complete with a quick glance easy to read guide for staff. The inspectors saw in resident's files, who had been identified as a falls risk, assessments and care plans in place. The inspectors saw in the rooms of those residents at risk of falls control measures such as call bells, appropriate lighting, clutter free floor, low low beds, sensor mats and bed rails where required. Where bed rails were in use the resident’s general practitioner had been involved and consent from the resident, where permissible, had been received. Documentation regarding their usage was also present in the restraint register. Where residents required assistance of two care staff, due to their mobility, the inspectors found there was sufficient space in their bedrooms for this assistance. The bathrooms they availed of were equipped with appropriate facilities and space for two staff. The inspectors were assured that falls management was appropriate to the individual needs of residents.
Where necessary the inspector saw that referrals had been made to the dietician and plans of care put in place such as an increase in protein to promote tissue granulation. Tissue Viability Nurses were also sourced when required which for the most part were sourced through the general practitioner. The general practitioner also reviewed
person in charge was a qualified nurse with postgraduate qualification in healthcare management and gerontology. Her post at the centre was full-time and she was assisted by an assistant director of nursing in addition to a team of nurses, healthcare assistants and ancillary staff members. She facilitated the inspection well and demonstrated her knowledge of the Regulations and the Standards in addition to her responsibilities in implementing these throughout the day for example good care planning and record management.
Staff provided end-of-life care to residents with the support of their medical practitioner and community palliative care services as necessary. No resident was in receipt of palliative care services at the time of inspection. A pain assessment tool for residents, including residents who were non-verbal was available to support pain management. Inspectors reviewed a number of 'End of life' care plans and found that they outlined the physical, psychological and spiritual needs of residents. Residents' individual wishes regarding place for receipt of 'end of life' care were also recorded. Advanced directives were in place for some residents regarding resuscitation procedures. This documentation recorded family input on behalf of the resident in most cases in the documentation reviewed. However, there was some room for improvement to ensure residents were involved in these decisions where appropriate. Residents had access to an oratory in the centre. Single rooms were available for 'end of life' care and relatives were facilitated to stay overnight with residents at the ‘end of life’ stage of their lives. Staff outlined how residents' religious and cultural practices were facilitated. Members of the local clergy from the various religious faiths provided pastoral and spiritual support to residents. There were care procedures in place to prevent residents developing pressure related skin injuries. Each resident had their risk of developing pressure sores assessed. Pressure relieving mattresses, cushions and repositioning schedules were in use to mitigate risk of ulcers developing. Since the inspection the Health Information and Quality Authority (HIQA) were notified of one incident of pressure sore that occurred since 01 January 2016. Inspectors were told that no residents in the centre had a pressure related skin injury on the day of this inspection. Staff discussed care
The purpose of regulation in relation to designated centres is to safeguard vulnerable people of any age who are receiving residential care services. Regulation provides assurance to the public that people living in a designated centre are receiving a service that meets the requirements of quality standards which are underpinned by regulations. This process also seeks to ensure that the health, wellbeing and quality of life of people in residential care is promoted and protected. Regulation also has an important role in driving continuous improvement so that residents have better, safer lives.
This inspection report sets out the findings of a thematic inspection which focused on two specific outcomes, End of Life Care and Food and Nutrition. In preparation for this thematic inspection providers were invited to attend an information seminar, received evidence-based guidance and undertook a self-assessment in relation to both outcomes. The inspector reviewed policies and analysed surveys which relatives submitted to the Health Information and Quality Authority prior to the inspection. During the inspections residents and staff were met with in addition to the inspector observing practices and the serving of two meals breakfast and lunch. Documents were also reviewed on the day, including but not limited to, training records, internal audits and care plans.
Inspectors reviewed the management of clinical issues such as wound care and falls management and found they were well managed and guided by robust policies. Extensive work had been undertaken on falls prevention and management including audits to ensure compliance with the policy. In addition each fall was analysed to identify any possible patterns or trends. The location of falls was also plotted on a floor map to review the exact location of the falls and identify any potential environmental hazards. Inspectors saw that an area outside the nurses' station had been identified as a risk area. Additional handrails were put in and inspectors saw that no falls had occured in this area since.
A comprehensive system was in place to monitor the quality and safety of care and the service provided. This process was supported by an electronic data management system which was readily accessible to the provider and all members of the senior management team. The inspector found that key aspects of the service and key clinical parameters were audited including resident falls, complaints, person-centred care standards and risks. Data collated was analyzed and action plans were developed to inform areas requiring improvement. There was evidence that action plans were followed through to completion and improvements made were sustained. A schedule was in place to inform the frequency of audits. A monthly and quarterly governance and management meeting schedule was resumed where all aspects of the service were reviewed by the provider, person in charge and senior management team.
members and reviewed documentation including resident assessments and care plans, policies, risk management, audits and staff training records. Progress with completion of the action plan developed from findings of the last inspection of the centre by the the Health Information and Quality Authority (HIQA) in March 2015 was also reviewed. There were 15 actions identified in the action plan from the last inspection, all of which were addressed with the exception of two actions which are restated in the action plan for this inspection. Unsolicited information received by HIQA regarding inadequate heating in specified parts of the centre and over sedation of residents was also reviewed and was not substantiated by the inspector's findings. Residents were consulted about the operation of the centre and the were informed regarding the new extension. Arrangements were in place to facilitate them to view it and change their current room location if they wished. The collective feedback from residents and relatives spoken with was complementary in relation to care and the service provided.
Since the centre's last inspection in October 2016, systems were improved to optimise communications between residents and residents' families. There were arrangements in place for communication regarding residents between the acute hospital and the centre. The person in charge or her deputy visited prospective residents in hospital or their home in the community prior to admission. Inspectors were told that a number of residents admitted on a respite basis transitioned to continuing care in the centre. Prospective residents and their families were welcomed into the centre to view the facilities and discuss the services provided before making a decision to live in the centre. This gave residents and their families information about the centre and also ensured them that the service could adequately meet their needs.
The inspector reviewed the questionnaires that were returned and completed by family members. Their feedback on their experience of the nursing home, during end of life, was highly commended. Family members stated the dignity of their loved one was maintained as to their wishes. The family members also spoke of the importance of their loved ones being pain free and comfortable. The centre had a guest room complete with a shower and wash hand basin for family members to avail off. There was a couch that could also be used as a pull out bed. The room was nicely decorated and the inspector saw there was also a comfort box for the guests in addition to an information pack on end of life care. Family members were supplied with beverages and food as they wished.
An activity coordinator on each floor facilitated activities for residents with the support of care staff. Group activities provided were varied and tailored to meet the interests and capabilities of residents with dementia. Residents with one-to-one needs were also provided with activities to meet their interests and capabilities. A recent one-to-one initiative implemented to meet the needs of residents who became unsettled in the evening had positive outcomes for them. While inspectors observed that residents participated in and enjoyed the group activities, there was room for improvement in order to maximise opportunities for all residents to participate in activities in accordance with their interests and capacities. Consideration should be given to the numbers who participate in group activities and the availability of staff to support the facilitator to help less- able residents to participate in an activity. One inspector observed an activity coordinator facilitate an activity for a group of 20 residents. The room was too small to comfortably accommodate the group and there was no other staff member present to deal with issues as they arose or to attend to residents who might require additional assistance. The activity was interrupted when the facilitator had to assist a person who came into the room while the activity was in progress. Inspectors found that
The centre had a falls management policy which was relevant, clear and known to staff. The practices and procedures outlined within the policy ensured resident’s safety was maintained and the inspector found these procedures were implemented in practice. For example the policy stated that post fall a resident should be reassessed. The inspector saw this reflected in resident’s care planning and assessments. The inspector found that additional control measures where necessary were also identified and implemented. The inspector observed the use of censored mats , crash mats and low low beds where applicable. Care staff spoken with by the inspector were informed of the procedure should a resident fall, all care staff spoken with stated they would not move the resident, that they would make them comfortable and use the emergency call bell to alert the nurse on duty. The inspector found that incident/accident forms were
A key worker was assigned to each resident whose role was to support residents in identifying person centred goals and to maintain their personal plans and review and update them as required. There was a of evidence that each resident had received an inclusive personal centred planning meeting and ongoing review of how to achieve goals identified. Despite residents complex needs or healthcare conditions they had a good standard of social care in relation to community participation and achievement of specific goals and targets.
There were arrangements in place to manage and monitor wounds. The inspectors, in particular, examined the care plans of 2 residents with wounds. The nursing team were aware that wound prevention and treatment was multi-factorial and the inspectors saw specific person-centred care plans and regular reviews. Wound assessment charts were in place and provided a clinical picture for comparative purposes to monitor whether the wound was progressing or regressing. A noted improvement was evident for both
Residents had access to a GP of their choice and to allied health professionals as required and referrals with follow-up consultations were evidenced for physiotherapy, occupational therapy, optical and dental care. Findings on the last inspection of the centre supported improvement requirements in access by residents with compromised swallowing reflexes to speech and language therapy assessment services. This specialist assessment service is now available to residents in the centre.
Overall, inspectors found that the person in charge ensured that residents' medical and nursing needs were met to a good standard. Residents looked well cared for, engaged readily with the inspectors and provided positive feedback on the staff, care and services provided. The inspectors found evidence of good practice in a range of areas. Staff interacted with residents in a respectful, warm and friendly manner and demonstrated a thorough knowledge of residents’ needs, likes, dislikes and
The inspectors found that arrangements were in place to ensure residents received dignified and respectful care throughout the day of inspection. Staff were observed to knock before entering residents’ bedrooms and to maintain their privacy during personal care procedures by closing doors and bed screen curtains in twin rooms. Staff engaged with residents in a respectful and patient way during encounters with them. Residents were facilitated and encouraged to exercise personal choices and autonomy supported by many examples observed by inspector during the day of the inspections including choice of food, time of dining and time of getting up and going to bed.
There were systems in place to ensure that the service provided was safe, appropriate to meet resident needs, consistent and regularly monitored. Regular and consistent reviewing of key areas of clinical care, the environment and feedback from residents and their relatives was done. Action plans to address deficits identified from audits were developed and tracked to completion. An annual report detailing a review of the quality and safety of care delivered to residents in accordance with the national standards was completed for 2015 and was in draft format for 2016. This draft document was due for completion by end of January 2016. There was evidence of completion of quality improvements identified in the 2015 report for completion in 2016. Improvements progressed and those in progress were made in consultation with residents. This finding was demonstrated by meaningful actions taken in response to resident feedback on their environment and how they wanted it to be. A programme to redecorate residents' bedrooms was underway with arrangements in place to give residents choice regarding colour and design schemes for their curtains and bed covers.