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
Killarneynursinghome 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.
outskirts of Abbeydorney, Kerry. There was access from the main road to a large car park at the side of the premises. Resident accommodation was laid out on the ground floor only. The centre provided accommodation for up to 27 residents comprising 3 single rooms, one of which was en-suite, and 12 twin rooms, all provided with wash- hand basins. All rooms were appropriately furnished, with adequate storage and equipment as necessary. All twin rooms had privacy screens in place. All rooms had a radio or television and were fitted with call-bell facilities. Bathroom and toilet facilities were accessible and appropriately located throughout the centre; these facilities were well equipped and maintained. There was a large garden area at the back of the
All the communal areas had large windows with good natural lighting. The centre was set on its own grounds away from the main road. A secure garden space at the front of the premises provided sheltered seating and residents had direct access to this area. Residents and visitors could also use a courtyard area in the centre of the premises that was laid out with plants and bench seating. Residents’ rooms were comfortable and seen to be personalised with individual possessions and memorabilia. Call-bells were visible and easy to reach where needed. There was a separate room for residents to receive visitors in private if they so wished. This room could also be made available overnight for the families of residents wishing to be with their relative if necessary. Residents also had access to a small oratory. The layout of the centre supported the needs of residents with a cognitive impairment to mobilise independently between communal areas and their individual rooms. The building and grounds were accessible by wheelchair. The centre was bright, comfortable and well maintained with attractive decoration and furnishings. The person in charge described learning that had been taken from the self-assessment process that included a review of surfaces and colours. There was now an aquarium in one of the communal areas. All floor coverings had been replaced and signage had also been improved. Consideration had been given to the needs of residents with a cognitive impairment when trying to orientate around the premises. The doors of bathrooms had been painted a distinctive colour and the person in charge confirmed that this had been of benefit in assisting some of the residents with dementia find their own way. Toilet seats were a bright colour that contrasted
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.
There was good communication between the catering staff and the nursing staff and the chef was able to clearly identify which residents required special diets or modified food. There were adequate supplies of dry goods, meat, fresh fruit and vegetables in stock. The inspector viewed the menus and saw that there was a choice at all mealtimes. The kitchen was clean, well laid out and organised. There was evidence of home baked food and the kitchen staff were informed and well trained in the area of food preparation and kitchen management.
Residents were encouraged to personalise their rooms which were spacious and very comfortable. They were decorated with personal items of soft furnishings, furniture and residents’ pictures and photographs. Storage space for clothing and belongings was adequate. Each resident had a kettle in the room. Residents and staff spoke with the inspector about the advantage of being able to make a cup of tea for each other when they felt like it. Residents appreciated this semblance of a home-like environment. An updated inventory was maintained of residents' personal items and these were signed by the resident or their representative.
include the most up to date pain medication prescribed. There was no daily note made in the care plan for one month between 29 May 2015 and 29 June 2015. This resident also had diabetes and had detailed recommendations from the dietician regarding care of their nutritional needs. However, there was no care plan in place to support this part of the residents needs. This was addressed under Outcome 15 Food and Nutrition. Another resident had recently had an eye infection. Inspectors were assured that care was been given, however a care plan was not initiated to support the management and treatment of the infection. As care plans were often in place which had been initiated in 2014 with no updated interventions recorded, it was difficult for inspectors to evaluate whether or not the care plan had been reviewed regularly by nursing staff to reflect residents' most up to date needs.
Since the previous inspection in June 2015 there have been a number of changes to the governance and management of the centre which included changes to the person in charge. The person in charge had been working in the centre as an ADON and was appointed as acting director of nursing and person in charge in September 2016. There were also two newly appointed ADONs working in the centre as persons participating in management. An interview was conducted with the new person in charge and ADON's during this inspection. The management team displayed good knowledge of the regulatory requirements and they were found to be committed to providing evidence-based care for the residents. They were proactive in response to a number of actions required from previous inspections however inspectors viewed a number of actions that remained non-compliant and further actions were required on this inspection including an immediate action in relation to fire training and lack of fire drills. The combination of incomplete staff fire training and no fire drills caused inspectors to issue an immediate action plan to address the risk to residents in the event of a fire. A comprehensive plan was returned to HIQA by the provider, within the required time-frame, detailing immediate actions taken to counteract this risk. Inspectors found that residents' healthcare and nursing needs were met to a good standard. Residents had easy access to medical, allied health and psychiatry of later life services. A number of the allied health staff were on site or in close proximity to the centre. Staff interacted with residents in a kind and respectful manner and inspectors found that residents appeared to be very well cared for. Residents and relatives were spoken with throughout the inspection. The feedback received from them was generally positive and indicated that they were satisfied with the staff and care provided. However, a number of residents did tell the inspectors that they found residing in the multi-occupancy rooms difficult. This was due to the lack of privacy and increased noise levels disturbing them during the day and the night.
The inspector reviewed the records of two residents who had recently received end of life care and it was clear that the residents had received individualised nursing and medical care that met the residents' specific needs. The records indicated that the residents' end of life care preferences had been identified, care plans were in place detailing the required end of life care and there was evidence of family involvement. Staff and residents confirmed that religious practices were facilitated and there was a spacious oratory in the centre. The inspector was informed that family and friends were facilitated to be with a resident at end of life and this was also confirmed in residents' records.
The inspector reviewed a sample of records for two residents who had recently received end of life care. The records indicated that residents had been medically reviewed by their general medical practitioner on a frequent basis and the nursing care plans and daily nursing notes indicated the residents had also received appropriate nursing care. Upon referral community palliative care services had been made available when required and a multi-disciplinary care approach was clearly evident. The records indicated good communication between all health professionals and the individual residents as well as involvement with the respective relatives.
Similar to findings on the previous inspection, inspectors found that there was adequate private and communal space in the centre. There were three sitting rooms downstairs, an oratory and an interlinked dining room/conservatory area. The smokers' room in the centre had been tidied up since the previous inspection and the door from this room was now closed when in use. The centre was clean and generally in good repair. Inspectors saw evidence of a cleaning schedule for all areas. The kitchen was located in the centre of the home and was easily accessible to staff and residents.
The request for a hairdressing sink came from the residents at a residents’ meeting. Aware that placing a hairdressing sink in the bathroom would pose an infection control risk advice was sought from the Health Protection and surveillance centre and controls were put in place to reduce the risk. These controls included closing the toilet for use on the one day per month that the hairdresser visits the home. Deep Cleaning the bathroom prior to using the room for hairdressing. Construction of a mobile shelf that rolls in over the toilet to ensure everyone is aware that the toilet is not in use that day. The senior person in charge then inspects the room prior to its use as a hairdressing room. These controls are included in a risk assessment which was placed in the risk register prior to insertion of the sink. Following the advice of the HPSC construction of a hairdressing room has begun as part of a planned extension. As the risk of infection is assessed as being low the controls will continue to be implemented until the new hairdressing room is opened.
The perennial T. speciosum sporophyte is a medium to small fern with translucent membranous fronds that are light green when young and a deep-dark green when they mature. Images of T. speciosum fronds are shown in Figure 1.1. Fronds often hang from vertical rock surfaces but are also known to occur on damp woodland floors. Frond length is reported to range from 20 - 45 cm (Page, 1997). In the study of 27 Irish populations between 2009 and 2011, frond lengths typically fell within that range, although the longest mature frond measured was 55 cm (Ní Dhúill, 2014). The fronds are ovate to ovate-lanceolate in outline with a stipe that typically occupies 1/3 of the total frond length (Page, 1997). The proportion of stipe to total frond length often fell within this range at the 27 Irish populations monitored between 2009 and 2011, but in some cases the stipes were found to occupy between 40% to 60% of the total mature frond length (Ní Dhúill, unpublished data). The fronds are finely dissected with acutely tapering pinnae and a very thin lamina which extends down the pale green rigid stipe forming a wing on either side (Page, 1997). This winged stipe is a characteristic feature of the sporophyte (Figure 1.1 (G)).
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.
Each residents wellbeing and welfare is maintained by a high standard of evidence- based nursing care and appropriate medical and allied health care. Each resident has opportunities to participate in meaningful activities, appropriate to his or her interests and preferences. The arrangements to meet each residents assessed needs are set out in an individual care plan, that reflect his/her needs, interests and capacities, are drawn up with the involvement of the resident and reflect his/her changing needs and
There were policies and procedures in place supporting the management of medications. Residents had a choice of pharmacist, even though most medications were dispensed from one pharmacy. Medication management practices were audited regularly and any identified deficits were remedied. A review of records indicated that nursing staff had been administering medications to one resident without a valid prescription. Even though there was a copy of a recent discharge record listing the resident's medications, this did not constitute a valid prescription. This was brought to the attention of the person in charge and the registered provider representative and was addressed prior to the end of the inspection.
This was a two-day announced inspection which was undertaken in response to an application to renew the registration of the centre. As part of this inspection, the inspector met with residents, relatives and staff members. The inspector observed practices and reviewed documentation such as care plans, audits, management meeting minutes and policies and procedures. The inspector also met the person in charge, the assistant director of nursing and the regional manager who were able to provide clear information to the inspector when requested.