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.
relation to the moving and handling of residents and this staff member did not have fire training or elder abuse training done. There was evidence in the roster that a staff nurse was on duty at all times in the centre except for one Wednesday afternoon. The nurse manager said that this was an omission from the roster and the night nurse informed inspectors that she had been asked to do that shift. Inspectors viewed up-to-date registration details with the relevant professional body for nursing staff. The person in charge lives adjacent to the centre and the nurse manager stated that she would attend the nursinghome when required.
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
Systems were in place to safeguard residents' money. The provider and deputy director of nursing outlined practices used to record financial transactions. The provider stated that fees were handled separately to personal money/belongings. He stated that invoices were sent out regularly, which reflected payments made. He informed the inspector that he would review the practice of not providing receipts for some services and any extra purchases. Personal money transactions were recorded in a lodgement book and signed by two staff members. A sample of these were checked and seen to be correct.
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.
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,
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 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.
A planned and actual staff rota was in place and both the staffing levels, and mix of skills, were appropriate to meet the needs of the resident profile, having consideration for the size and layout of the centre. The delivery of care was directed through the person in charge. Appropriate deputising arrangements were in place. There was effective supervision with a qualified nurse on duty at all times. A senior healthcare assistant was nominated on each day to ensure effective coordination of care and communication with nursing staff. Systems of oversight included a regime of audits that monitored key areas on a weekly basis, such as transfers to hospital, pressures sores, use of antibiotics and incidents or accidents. Nursing staff undertook peer competency assessments and a record of these was available. The last, on 7 April 2017, was positive on all criteria assessed. An annual appraisal system was also in place for all staff.
consultation. There were other indications that care may not have been person centred for all residents such as the timing of meals and bedtime which were addressed under other outcomes in this report. Staff said that only three residents in the centre were capable of mobilising. A podiatry service was available also and residents had access to the opticians, the dentist and the occupational therapist (OT) if required. These services were availed of in house and on an external basis. The person in charge informed inspectors that it was difficult to get an appointment with an OT due to the long waiting list for the service. Dietary advice and speech and language therapy (SALT) were
This report set out the findings of a follow inspection of St Joseph’s Unit, in Listowel Community Hospital by the Health Information and Quality Authority (HIQA or the Authority). The hospital was a single storey premises, consisting of two units, St Joseph’s and the District. St Joseph's Unit was the designated section of the premises which was due for re registration. It was situated approximately one kilometre from the centre of Listowel town with car parking facilities at the front of the building. Long term residential, respite and palliative care was provided in St Joseph’s unit for 24 residents. Care was provided primarily for older adults. The centre also provided care for two younger residents with disabilities.
In the sample of residents’ nursing records that were reviewed by the inspector it was clear that residents were frequently assessed and specific clinical care needs were identified. Residents' nursing assessments were up to date, written nursing care plans were in place for each resident and they outlined the required care and they were adjusted to reflect the care that was needed if a resident’s condition or circumstances changed. The care plans and daily nursing notes demonstrated that evidence-based nursing care was planned as well as provided and residents’ progress was closely monitored. The nursing records indicated that if a resident deteriorated it was quickly identified and managed appropriately.
Residents spoke with inspectors about various outings with relatives and staff. Since the previous inspection an activities coordinator had been employed and residents had opportunities to participate in meaningful activities informed by their interests. These activities included card playing, art work, singing, reading and chair based activities. In addition, residents had been facilitated to attend Listowel races and to a nearby farm centre where hens were kept. The activities coordinator informed inspectors that these visits formed part of a reminiscence session as residents reflected on their past lives and experiences when they returned to the centre. Local school students and Fetac Level 5 students were present in the centre on the day of inspection. Residents informed inspectors that they benefitted from the company and conversation with the students, who discussed local events with them. Students were seen to facilitate some activities and were supervised by the CNM2 and the activities co-ordinator.
There was evidence of a programme of induction for new staff and a staff appraisal system for existing staff. However, the staff appraisal system had lapsed and records indicated that when appraisal was done it was not always reflective of actual staff performance. Additionally there was not always a process of performance development implemented where staff records indicated that it was warranted. Evidence of current registration was available nursing staff. A review of personnel records indicated that most of the requirements of Schedule 2 were met, however, a full employment history was not available for all staff and not all recently recruited staff had been vetted by An Garda Síochána, however, records of vetting from their jurisdiction of origin was
Resident’s needs were comprehensively assessed; the care and support required to meet these needs so as to promote and maintain resident health and well-being was in place. Three residents living together in one house had known each other since early childhood; their close bond was evident to the inspector. There was an ethos of supporting residents to age in place and the provider had responded to increasing needs to facilitate this for as long as was possible, for example through the provision of nursing input and equipment necessary for the residents comfort. While the
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.
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.