The centre was located in a rural area just outside Killarney and set back from the road on its own grounds. The original building had been extensively developed as a modern, two storey premises with balcony space extending along the length of the first floor. Ample parking facilities were available to the front of the premises. The centre provided accommodation for up to 74 residents comprising 42 single rooms, 39 of which were ensuite. There were 13 twin rooms, 11 of which were ensuite and two three bedded rooms with wash-hand basins. Bathroom and toilet facilities were appropriately located throughout the centre with separate facilities available for staff that included an area for changing and storage. The premises were very well maintained with a good standard of cleanliness in evidence throughout.
A relevant policy and procedure was in place on the management of responsive behaviours. Management demonstrated a commitment to ensuring that staff received ongoing training in this area. The restraint policy promoted a restraint free environment with the stated aim that restraint be used only as a last resort. Appropriate assessments were in place that took account of both the assessed need of the resident and any risk that might arise as a result of using a restraint. Where restraints such as bedrails were in place, there was a record of audit around their use that included verification of regular monitoring and release in keeping with standard requirements. Care plans reviewed by the inspector contained recorded assessments that reflected consultation with residents, their relatives and a medical practitioner as appropriate.
The provider acknowledges on the day of inspection a training matrix was provided to the inspector which clearly identified the current status of all employees attendance at mandatory training. The provider wishes to express the absolute commitment to the safety and welfare of the residents and staff at the facility. The continual training and awareness in moving and handling has always been a priority with the continuous supply of training. The provider is currently rescheduling mandatory training in this area ensuring 100% compliance for all employees with exception to those on protective leave.
In the current era of universal health coverage implemen- tation, Indonesia has put efforts into implementing a large- scale village midwives program and provides free maternal- and-child health services that are closely located to clients at the village level [2, 8]. These efforts include provision of the standard four postnatal care sessions, i.e. on the first day, the 6th day, the 14th day, and the 6th weeks after childbirth. The standard postnatal care covers physical examinations (of vital signs, breast, the fundus of the uterus, lochia and other vaginal discharges), communication/information/edu- cation on exclusive breastfeeding and family planning. A home visit for postnatal care by the midwives should be conducted when mothers do not visit the village clinic .
schedule 2 records for all persons working in the designated centre and for volunteers. The person in charge told inspectors she had recruited two new nurses who were waiting to have their adaptation (aptitude test) in September 2016 in order to join the team of nurses by October 2016. Inspectors were also told by the person in charge that her attempts to recruit nurses locally and nationally had not been successful to-date. As a result, existing part-time nursing staff were working additional hours or on a full time basis to ensure 24 hour nursing care was provided to the residents. A contingency plan was required in the event that the adaptation of two recruited nurses was unsuccessful and or in the event of unplanned absences by existing nurses.
assessed on admission and regularly thereafter. Nutritional care plans were in place that detailed residents' individual food preferences, and outlined the recommendations of dieticians and speech and language therapists where appropriate. Some residents were on supplements which were prescribed and administered appropriately. Nutritional and fluid intake records were not in use. Information about dietary intake was reported in the daily nursing notes and verbally at shift handover meetings. Inspectors noted that the person in charge and nurse on duty enquired about the dietary intake of residents reported to have a poor appetite after each meal. They also assisted these residents to take supplements and drinks during the day. Records showed that residents who experienced weight loss gained weight. However the documentation of food intake required improvement and the menu had not been assessed by a dietician.
After the training, Monitoring and Evaluation (M&E) tools in the form of daily health facility form, monthly health facility summary forms, and Local Government (LGA) summary forms were distributed to all selected health facilities and LGAs respectively.As of November 2010, all the LGAs andselected health facility has been visited by researchers who are malaria experts to check for the proper use ofM&E forms, proper storage of forms, proper submission of forms,reporting and replenishing of stocks usingobservation and checklist. The daily entry of all malaria cases seen , diagnosed and treated using an Artemisini- based combination therapy, appropriate summary of all cases seen in a months,date of sending out forms, time for reporting stock-outs and time it took LGA to replenish stock out were checked at the health facility level. At the LGA level, the time health facility monthly forms were received, appropriate entering of all collated forms from the health facilities, time LGA summary forms are sent to the state RBM programme and time for reporting stock-out of malaria commodities received from the facilities and replenishing them were cross examined using the observation checklist as well. The researchers also collected information on health workers/officer knowledge, attitude and perception on monitoring and evaluation of malaria control activities as well as their general practice on malaria activities using a pre-tested interviewer administered questionnaire.
In Indian context, in order to address the health concerns of the under-served rural areas, Government of India (GOI) has launched National Rural Health Mission (NRHM) in April, 2005, under National Health Mission (NHM). The aim of the mission is to establish a fully functional, community owned, decentralized health care delivery system with intersectional convergence at all level, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality. Primary health care facilities (HCFs) are delivered through health sub centres, primary health centres (PHCs) and community health centres (CHCs), district hospitals (DH), and dispensaries situated at the village, block and district level respectively.
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.
Since the previous inspection staff had not participated in training in the protection of residents from abuse. An examination of the training records identified in April and August 2014 sixteen staff attended training in the protection of residents from abuse. Twenty five staff work in the designated centre. The provider informed the inspectors that training in this area has not yet been sourced. There was no Garda Clearance on file for two of the three recently recruited staff or the maintenance staff member. The policy on behavioural management had not been updated to reference the current Health Act (Care and Welfare of Residents in Designated Centres for Older People) and associated regulations. There was no validated assessment tool to assess residents who had behaviours that challenged. This was not in accordance with the designated centre’s policy/procedure on behavioural management.
4. Further attention was required to ensure the physical environment was designed in a way that was consistent with some of the design principles of dementia-specific care. We have been aiming where possible to achieve an environment that is consistent with design principles of dementia-specific care and we introduce changes gradually in line with our resources. Residents and their families are encouraged to bring items from home such as pieces of furniture and other items that are familiar to them. We have an established central garden area with pathways suitable for residents to expend their energy in a safe environment and ensure shoes and walking aids are in good repair. There is an extensive list of social activities to keep residents engaged and we try where possible to keep a sense of safety and familiarity for them.
Australian Catholic women religious have played a significant role in the spread of the Gospel and in the provision of services, especially in education and health care, from the middle of the nineteenth century. One such group is the Congregation of the Daughters of OurLady of the Sacred Heart (OLSH). From their base in Sydney in 1885, missionaries were sent to remote communities in Australia, Papua New Guinea and beyond. In 2011, as part of the celebration of the centenary of the promulgation of the Australian Province, the Provincial Council invited sisters to tell their stories in a series of interviews. These interviews have been used to provide personal perspectives on the challenges and rewards of missionary life. 1
chapels. Up to the intermediate ring level, the plane zones bounded by the ribs are given by sub-horizontal r.c. slabs with variable thickness (Figure 4). At the highest part of each rib, their assembly forms a truncated cone that supports a bronze statue of OurLady on the top. In the following, elevation 0.00 m is as- sumed at the extrados of the Crypt’s covering. The base ring of the whole dome is supported on 22 r.c. columns: they have trapezoidal shape and are placed with 10.00 m spacing along the circle with a height of 3.74 m from the elevation 0.00 m of the Crypt’s extrados (Figure 5). A steel-teflon sliding pot bearing with capac- ity 9810 kN was installed between each column and the base ring above. The bearings allowed the displacements in the radial direction due to tensional and thermal variations, as well as the base ring’s rotations, while the displacements in the tangential direction were restrained.
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
The inspectors visited every unit in the centre at 18.00 hours on the first evening of the inspection and found that the majority of residents in the centre were either in bed or sat beside their bed with the exception of one unit where approximately six of the residents were sitting in the day room watching TV. These practices did not fit in with person-centred care nor did it promote the privacy and dignity of the residents on the units which were open to visitors for the evening. On the first day of the inspection, at lunchtime on Heather and Hawthorn units, there were only four tables set and occupied for dinner. This catered for approximately 12 residents out of a total of 72 residents in the units. The remaining residents either had their dinner in their bed or on a bed table beside their bed. Although in the dining room the tables were attractively set and were by the window, the rest of the room was sparse with tables against the wall. The large day room next to it also required attention to make it an inviting place to spend the day. On the second day there was a much higher percentage of residents in the day and dining rooms and residents appeared to enjoy the change of position. The practice of the majority of residents spending their day in multi-occupancy rooms where they eat, slept, used commodes, received visitors was institutionalised and not in keeping with person-centred practices.
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.
accordance with relevant professional guidelines. There were written nursing care plans in place for individual residents and there was evidence that in the majority of cases they were reviewed at least every three months. There were assessments in place in regard to residents own personal activities of daily living such as personal hygiene, eating and drinking and sleeping. However, in some cases they were not consistently completed on a three-monthly basis or more frequently if a resident’s condition changed.
Fire training takes place annually and continues to roll out throughout the year. Many of our staff who have been employed for several years have undergone regular annual training. We already had three fire training sessions and drills this year and two more are planned for October. The schedule is designed to work in line with our staff rosters and catch all staff so that they have attended at least one training session. A catch up class will be held at year end if there are any staff members yet to attend.