Following the inspection the registered provider, the person in charge and assistant director of nursing met with the pharmacist to discuss the medication management system and how to improve it. The Director of Nursing will continuously review the medicines management policies and procedures in place in the service to ensure that they are in line with evidence based practice and legislation, and that they continue to meet resident’s needs and expectations. The Director of Nursing and pharmacist will audit and review adherence by staff to the medicines management policies and procedures. The director of nursing will take appropriate action when these documented policies and procedures are not being adhered to. This ensures that medicines management is continuously improved in the service.
This inspection of KilcaraNursingHome 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.
number of residents. Eye care consultations and chiropody treatment were documented in the sample of care plans seen. Medication management practices were reviewed and monitored by regular audit. Pharmacists were facilitated to meet their obligations to residents and there was a choice of pharmacist available where possible. End of life care plans were in place for residents and a number of these were seen to be signed by residents. In addition, residents' wishes were clearly documented including where a resident had requested to be taken home at the end of life.
The fire policies and procedures viewed by inspectors were centre-specific. The fire safety plan was viewed by inspectors and found to be comprehensive. There were notices for residents and staff on “what to do in the case of a fire” appropriately placed throughout the building. Fire maps indicating escape routes were clearly displayed. Fire equipment training and fire evacuation training was provided. Staff demonstrated an appropriate knowledge and understanding of what to do in the event of a fire. The inspector examined the fire safety register with details of all services carried out which showed that fire fighting, fire safety equipment and fire alarms had been serviced as required and this was next due in May 2015. Fire alarm checks and automatic fire door release checks were carried out weekly and there was a daily fire door checking system. However, inspectors noted that one fire door in the laundry room was held open with containers of cleaning equipment. There was an emergency plan for the centre and inspectors were informed that the nearby home of the provider and the local resource centre could be used to provide accommodation for residents, in the event that an evacuation was necessary. Inspectors saw that this was formalised and outlined in the emergency plan.
An audit of health and safety issues was undertaken in all areas recently and the inspectors saw records of these checks. Inspectors were aware of the benefits of promoting a home like environment for the residents, however, the lighted open fire was not adequately secured. The provider was asked to reassess the risk and has put a secure fire guard in place since this inspection. There was a lift from the ground floor to the upstairs section and inspectors were informed that one resident uses this
KilcaraHouseNursingHome is a family run designated centre set in a rural location within a few kilometres of the towns of Abbeyfeale and Listowel. It is registered to accommodate a maximum of 35 residents. It is a two-storey building with stairs and lift access to the upstairs accommodation. Downstairs it is set out in three wings: Abbeyfeale with eight beds, Duagh with nine beds, the new wing with eight beds; and upstairs has ten beds. Bedroom accommodation comprises single, twin and three-bedded rooms with wash-hand basins, and some have en suite shower and toilet facilities. Communal areas comprise two sitting rooms, a day room and dining room. There is a secure enclosed courtyard with seating and there is a mature garden with walkways and seating at the front entrance to the centre. KilcaraHousenursinghome provides 24-hour nursing care to both male and female residents whose dependency range from low to maximum care needs. Long-term,
The inspector found that there were measures in place to protect residents from suffering harm or abuse. Staff interviewed demonstrated a good understanding of safeguarding and elder abuse prevention and were clear about their responsibility to report any concerns or incidents in relation to the protection of a resident. The inspector saw that safeguarding training was on-going on a regular basis in-house and the person in charge and one of the CNM's were trainers. Training records confirmed that staff had received this mandatory training however some staff required updating and further training sessions were planned in April. The person in charge and CNM also planned to attend the national safeguarding training and would roll that out to all staff. The training was supported by a policy document on elder abuse which defined the various types of abuse and outlined the process to be adopted to investigate abuse issues should they arise. Residents indicated that they could speak to the person in charge or any member of staff if they had any concerns and confirmed that they felt safe and were well looked after in the centre.
administration of medicines to residents were available. Medications were securely stored and reviewed regularly by a GP. Inspectors viewed evidence of both in-house and external pharmacy audits of medication management being conducted. The centre maintained a register of controlled drugs and MDA drugs were checked by two nurses at each shift handover. Residents were also enabled to self administer their own
A comprehensive risk management policy was in place dated 13 November 2014 covering the required areas including unauthorised absence, assault, accidental injury, aggression, violence and self-harm. The policy also included arrangements to identify record, investigate and learn from serious incidents. An accident and incident log was seen to be maintained and there were two nominated health and safety officers who managed bi-monthly meetings with responsibility for progressing actions in relation to issues identified by either clinical, kitchen or house-keeping staff. Monitoring systems were in place including daily health and safety audits and an audit of hygiene monitoring charts had been completed on 6 December 2014.
The purpose of this inspection of Ashborough Lodge NursingHome by the Health Information and Quality Authority was to inform a registration renewal decision. As part of the inspection process the inspector met with residents, relatives, the person in charge, the clinical nurse manager (CNM), nursing staff, care staff, catering staff, household staff, and administration staff. The inspector observed practices and reviewed documentation such as care plans, medical records, staff files, complaints file and financial records. A sample of relevant policies was reviewed. The findings of the inspection are set out under 18 outcome statements. These outcomes are based on the requirements of the Health Act 2007 (Care and Welfare of Residents in
Inspectors reviewed staffing rotas, staffing levels and skill mix. The person in charge informed inspectors that that she was satisfied that there were sufficient staff on duty to meet the needs of residents. Inspectors found that appropriate training was provided to staff and they were supported to deliver care that reflected contemporary evidence based practice. Staff had completed mandatory fire safety and fire evacuation training, elder abuse training and training in manual handling. The person in charge explained that a number of staff nurses provided in house training. Registration details for nursing staff were seen by inspectors.
professionals from a nutritional company, who were also contactable by telephone for advice as required. All supplements were appropriately prescribed by a doctor. Optical assessments were undertaken on residents in-house by an optician from an optical company. Residents and relatives expressed satisfaction with the medical care provided. There was evidence of regular nursing assessments using validated tools for issues such as falls risk assessment, dependency level, moving and handling, nutritional assessment and risk of pressure ulcer formation. These assessments were generally repeated on a four-monthly basis or sooner if the residents’ condition had required it. Care plans were generally developed based on the assessments. The person in charge, ADON and staff demonstrated an in-depth knowledge of the residents and their physical, social and psychological needs. However and this was not fully reflected in the care plans available for each resident. Overall the inspector found inconsistencies in the care planning
Killarney nursinghome is two storey premises comprising 56 beds, of which 52 are single bedrooms and two are twin-bedded. The centre had suffered some damage caused by the dislodged roof of an adjacent building during a storm resulting in the temporary evacuation of the residents, however, all repair work had been completed prior to this inspection and all residents had returned to the centre.
The person in charge had recently been appointed in the centre. She was interviewed by inspectors. She was found to fulfil the regulatory criteria required for the post. The person in charge had been working as a nurse in the centre for the previous six years, included a period of time as assistant director of nursing. She was employed full time in the centre. The person in charge demonstrated clinical knowledge in ensuring suitable and safe care. She demonstrated knowledge of the legislation and of her statutory responsibilities. She was engaged in the governance, operational management and administration of this centre on a regular and consistent basis. She met regularly with the provider and staff. Minutes were maintained of these meetings. She organised audit in the centre. She explained to inspectors that she was engaged in continuous
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
The inspector spoke with the chef who said that she regularly met with the person in charge and the provider to discuss the residents' dietary needs. The chef showed the inspector her files, which contained relevant information, including advice from the speech and language therapist, the dietician and a record of residents’ food preferences. Food preferences and special requirements were written up daily on a whiteboard in the kitchen and the inspector saw that this also included information on drug interactions with certain foods. The chef and the kitchen staff indicated that they received relevant training in food safety and HACCP (food hygiene). The inspector saw these records in the training file. The chef also showed the inspector a list of residents on diabetic diets and on gluten free diets. The chef explained to the inspector how she ensures that the diet is nutritious by having a variety of meat, vegetables and fruit sourced from a reputable supplier, as well as providing home cooked bread and cakes. The inspector saw the supply of both fresh and frozen foods as well as the dry stores and saw that there was a variety of food available including fresh fruit and dairy produce.
Inspectors spoke with the chef who said that he regularly met with the person in charge to discuss residents' dietary needs. The chef showed inspectors his files which contained relevant information including a copy of the most recent assessments carried out by the speech and language therapist, the dietician and a record of residents’ food preferences. The chef indicated that he received relevant training in nutrition. For example, HACCP (Hazard Analysis Critical Control Points) training had been updated. The chef explained to inspectors how he ensured that the diet was nutritious by having a variety of meat, vegetables and fruit sourced from a reputable local suppliers, as well as providing home baked bread and cakes. He was familiar with the special dietary requirements and the needs of residents who required modified or fortified diets. The kitchen was seen to be very clean and modern. Snacks and drinks were readily available throughout the day. A sample of medication administration charts and care plans were reviewed by
The second action plan received by the Authority did not provide adequate reassurance that the Regulations regarding three day notifications were being complied with in the nursinghome as per the requirements of paragraph 7 (i) to (j) of Schedule 4 of the Regulations. For example, a sudden death of a resident and an allegation of peer abuse had not been notified to the Authority within three days of their occurrence or were not submitted retrospectively, as requested on two occasions, by the Authority in the action plans set out for the provider.