The inspector reviewed a sample of residents’ care plans and found that relevant risk assessments, such as skin integrity, continence, falls and nutrition were routinely carried out. Residents had care plans in place for their identified needs however there was inconsistent evidence of resident or next of kin involvement in the care planning process.
documented with a clear schedule of completed and due training. Recruitment and vetting procedures were robust and verified the qualifications, training and security backgrounds of all staff. Effective appraisal systems were in place which underlined learning from reviews and audits and further ensured staff were competent to deliver care in keeping with current evidence based practice. Staff were also enabled in relation to further training and development with access to continuous professional development facilitated by the provider and person in charge. Copies of the regulations and standards were readily available to staff who were aware of their statutory duties in relation to the general welfare and protection of residents.
Inspectors observed the quality of interactions between staff and residents using a validated observational tool to rate and record these interactions at five minute intervals in both dining-rooms and an activity area. Scores for the quality of interactions are +2 (positive connective care), +1 (task orientated care, 0 (neutral care), -1 (protective and controlling), -2 (institutional, controlling care). The scores reflect the quality of the interactions with the majority of residents. Inspectors’ observations concluded that while there was some evidence of positive connective care with individual residents, this finding was not evident for many residents with dementia. Not all opportunities were taken when completing tasks of care to positively engage with residents. There were numerous occasions where staff interrupted their care of a resident to provide care to another, and occasions where individual residents were requested to wait for attention until staff completed care activities or supervision of other residents. This finding did not reflect a high standard of person-centred care that respected residents' dignity.
inspection and the second person to assist with activities was also on extended leave. There did not appear to be an adequate system in place to ensure residents engaged in activities while activity co-ordinators were not working. The inspector was unable to confirm if the activities were more meaningful when the activity coordinator was on duty although several residents said they would like something else to do during the day. This was discussed at the feedback meeting and the inspector saw that this aspect of care was under review by the management group.
There was a policy on challenging behaviour. Inspectors reviewed a care plan of a resident who presented with challenging behaviour. Inspectors saw that no assessment had been completed for this resident in relation to challenging behaviour. Inspectors did not observe any evidence of any support plans to sufficiently outline the antecedents and communication functions of the behaviours displayed which, when identified promptly, would guide staff to support residents in preventing incidents of behaviour that challenged. Only 11 staff out of 62 had received training in behaviours that challenge. There was a policy in place regarding residents' personal property and possessions. Where residents had access to their own personal monies secure storage systems were in place and records of all transactions were maintained.
The inspector found that there was inadequate screening in shared rooms to facilitate residents to undertake personal activities in private. Screening was available but it did not sufficiently enclose both beds. This was discussed with the person in charge. There was limited evidence that feedback was sought from residents with dementia or that they were consulted regarding the organisation of the centre. Residents' meetings were held on a regular basis and minutes were maintained. However there was no evidence to suggest that residents with dementia were included in this or that additional measures were undertaken to ensure that these residents had a say in the organisation of the centre. The inspector did note that the person in charge had carried out a
The inspector found however that food diaries were not accurately maintained. In some cases where the care plan stipulated that accurate records of what residents ate were to be maintained, the inspector found gaps in the records and also it was unclear in others what had been eaten. For example in one case, the lunch time record merely stated 'half'. The inspector could not find out if this was half of the dinner itself or soup and dessert as well. Staff spoken with seemed unclear what it meant.
description of their likes and dislikes and their routines, interests, feelings and various things they wished the staff to know about them. This document functioned as a child- friendly version of a personal plan. However, only those children whose needs were complex and who availed of respite very frequently had formal personal plans that set out their goals. While the lack of formal personal plans did not impact on the care of other children who availed of respite infrequently, the absence of clearly established goals meant that it was difficult to assess the effectiveness of the plans for the children's care while in respite.
Inspectors were informed by staff that there were a number of options available for all residents in relation to social activities. Many of the residents enjoyed bowling, cinema outings, concerts, line dancing, shows, picnics, meals out, shopping trips, swimming, library visits, attending mass and any festivals or events locally. Apart from the activities provided in the centre the rest are community based, are age appropriate and reflect the goals chosen as part of their person-centred plan. Residents to whom inspectors spoke described the many and varied activities they enjoyed and spoke of the day trips out and attending social night on Monday nights. Staff told inspectors that residents are encouraged and supported to participate in family events and gatherings as they arise. A resident told an inspector that she would go abroad with her parent to visit her sibling.
The inspector was informed by staff that there were a number of options available for all residents in relation to social activities. Many of the residents enjoyed bowling, cinema outings, concerts, meals out, shopping trips, swimming, library visits, attending mass and any festivals or events locally. Apart from the activities provided in the centre the rest are community based, are age appropriate and reflect the goals chosen as part of their person-centred plan. Residents to whom the inspector spoke with described the many and varied activities they enjoyed and spoke of the day trips out and attending the social night on Monday nights. The person in charge said that residents are
To conclude, I would like to return to the 1879 commemoration. One of the speakers, Erasmus Brooks, described the burning of the Haudenosaunee fields of corn, beans, and squash, the crops known among the Haudenosaunee as the Three Sisters. Brooks dramatically referred to “the destruction of all [Haudenosaunee] homes, all their crops, all their possessions. It changed cultivated fields, ripe for the harvest, into the desolations of the three furies— ferocity, fire and famine” (Cook 1887: 417). Quite literally, the Three Furies of Sullivan’s army destroyed the Three Sisters. Since the year 1779, the narrative of the Battle of Newtown has been negotiated and renegotiated; this process continues today. The issues and perspectives commemorated in the landscape of the Battle of Newtown will, in all probability, reflect the dominant spirit of the United States and its people at the time. Because of the ever- changing political climate in the United States, the question remains whether that tone will backpedal to mimic earlier eras. Will the memorialization of Newtown revert to the original 1879 agenda and serve as a memorial to the Three Furies of General Sullivan’s army, glorifying the opening of central and western New York to white settlement? Or will the memorializations continue their multivocal trend of slowly acknowledging and memorial- izing the Native Americans and their Loyalist allies who fought at Newtown in defense of the Three Sisters and the different ways of life of both the Loyalists and the Haudenosaunee? Conclusion
Residents are consulted with and participate in decisions about their care and about the organisation of the centre. Residents have access to advocacy services and information about their rights. Each resident's privacy and dignity is respected. Each resident is enabled to exercise choice and control over his/her life in accordance with his/her preferences and to maximise his/her independence. The complaints of each resident, his/her family, advocate or representative, and visitors are listened to and acted upon and there is an effective appeals procedure.
were seen to be very involved in the day-to-day running of the centre and staff and residents reported them to be easily accessible to them. There was evidence of individual residents’ needs being met and the staff supported and encouraged residents to maintain their independence where possible. Community and family involvement was evident and greatly encouraged as observed by inspectors. The person in charge informed inspectors that she endeavoured to provide a person- centred service to effectively meet the needs of residents at all stages of their lives and illness. One resident with palliative care needs had been facilitated to receive full end-of-life care in the centre.
Measures to protect residents being harmed or suffering abuse are in place and appropriate action is taken in response to allegations, disclosures or suspected abuse. Residents are assisted and supported to develop the knowledge, self-awareness, understanding and skills needed for self-care and protection. Residents are provided with emotional, behavioural and therapeutic support that promotes a positive approach to behaviour that challenges. A restraint-free environment is promoted.
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.
The centre is located in a rural costal area accessed from the road via a driveway. There are a number of ancillary buildings located in amongst these premises including a workshop building, a store, farm building and animal shelters. A meeting/community hall and weaving centre is onsite. The residential accommodation for which the application is made is comprised of eight houses with one stand alone apartment attached to one of the houses. Administration offices are located in the largest of the houses.
possessions. Inspectors‟ reviewed the local arrangements‟ to ensure residents‟ financial arrangements were safeguarded through appropriate practices and record keeping. Inspectors met with the finance manager who confirmed that the centre acted as social welfare agents for most of the residents and the inspector saw that they had all the correct documentation in place. The centre receive payment on a fortnightly basis and process the money through a payroll system where they deduct the cost of residential charges and any other items they charge for such as meals in the canteen, gym membership and pocket money given to the resident. The resident receives a payslip every fortnight with charges and deductions clearly identified. The remainder of the residents‟ money is paid into their bank or credit union account.
residents were provided with support in relation to areas of daily living including eating and drinking, personal cleansing and dressing, toileting and oral care. There was evidence of some assessments being used including physical wellbeing assessments, epilepsy, people related hazard assessments, eating and drinking assessment. The acting person in charge outlined that a number of residents had passed away in recent years and that co-workers and staff endeavoured to facilitate end of life care in the centre whenever possible. Inspectors noted that there were a number of elderly residents and there was an end of life policy available. However, from a review of residents‟ personal plans there were no records available in relation to residents‟ preferences for support at times of illness or at the end of their lives to meet their physical, emotional, social or spiritual needs.
There were measures in place to safeguard the children and protect them from abuse. There was a centre-specific policy and procedures on child protection which had been updated on 20 May 2014. The policy was comprehensive and the guidance for staff was clear in relation to their responsibility to report abuse of children. It made clear that staff were free to consult with or report to senior management, the Child and Family Agency or An Garda Síochána if, having raised concerns about a child's situation, they remain concerned. The document also contained a copy of the standard report form and the contact details for the local social work department.
Centre-specific policies on managing challenging behaviour and restraint and physical intervention were in place dated 1 April 2014. Staff had received appropriate training in the use of restraint and managing challenging behaviour and also the use of positive behaviour support plans. Through discussion with both staff members and residents, and observation of interactions between staff and residents, the inspector was satisfied that residents were assisted and supported in developing a self-awareness around their behaviour generally and that positive behavioural supports were implemented. Several residents spoken with demonstrated insight around their behaviour and understood when it might be problematic and potentially a source of distress for themselves or other residents; they could also talk about things they did, or avoided, to try and make sure they did not have to get upset and also how staff helped them with this. There were no instances of restraint in use during the course of the inspection.