Up-to-date registration numbers were in place for nursing staff. An actual and planned roster was maintained in the centre with any changes clearly indicated. The inspectors reviewed the roster which reflected the staff on duty and noted that there were at least two nurses on duty in a 24 hour period. An audit of staffing based on the dependencies of residents had recently been carried out and actions were being progressed to recruit two senior carers to supervise and support care staff in the delivery of care to residents. There were no volunteers in the centre at the time of inspection. The provider was aware of the requirements of the regulations in this regard.
It was found that, overall, general records as required under Schedule 4 of the regulations were maintained including key records such as appropriate staff rosters, accident and incidents, nursing and medical records and operational policies and procedures as required by Schedule 5 of the Regulations. Polices were reviewed on a regular basis and within the three year timeframe required by the regulations. However, it was found that some policies in place were not fully implemented in practice. These included the policies on end-of-life care and restraint assessment. These are further referenced under outcomes 7 and 14.
A programme of works is in place to address the secondary means of escape from the rear of the centre for residents of mixed mobility and is scheduled for completion by 31st January, 2018. Prior to works taking place a formal plan will be drafted detailing any resources and systems that will need to be implemented to ensure there is as little impact as possible to the residents. This will be done in conjunction with the Provider Nominee, Person in Charge, General Manager and Contractors. Until these works are complete only residents who are mobile or require minimal assistance will be
Communication with residents with dementia was enhanced by careful signage around the building, that would help them find their way, However there was no signage in use to mark individual bedroom doors. Posters displaying the activity programme were small and not easily identified by residents with dementia and while there were clocks around the building and signs informing the residents what nursing staff were on duty, there was no large orientation board or boards in key locations that could prompt residents to know the day of the week, the date or the weather conditions outside.
Ros Aoibhinn is located on the outskirts of Bunclody. The centre can accommodate 30 residents in four single and 13 twin rooms. There are two floors and most of the residents are accommodated on the ground floor, where communal accommodation includes two sitting rooms, a dining room and a conservatory. Accommodation on the first floor comprises one single and three twin bedrooms and is accessible by a stair lift. Ros Aoibhinn provides 24-hour nursing care to both male and female residents over 18 years of age. Long-term care, convalescent and respite care is provided to those who meet the criteria for admission.
Castleturvin NursingHome is registered to provide care for 42 residents. It is purpose built and located in a rural setting a short drive from the town of Athenry. The building was laid out over two storeys with lift access provided to the first floor. Accommodation is provided in 22 single and 10 double rooms all of which have ensuite facilities. There are communal areas on both floors. Externally there are extensive grounds with a large garden area that is accessible to residents. Many rooms have doors that lead directly onto the garden.Residents that have high, medium or low care needs are accommodated and care is provided on a long or short term basis.
Bedrooms were personalised with residents' possessions. Each suite area had an assisted bath for residents' use. Relatives and residents stated that having a kettle, a fridge, an en-suite and a washing machine in the individual bedrooms enhanced the quality and enjoyment of their later years. A number of residents were seen to sit near the nurses' desk as it was adjacent to the entrance and there was a lot of activity in that area. Passing staff, visitors and other residents were available to chat with them. The kitchen hatch opened out into the central hallway of the home also which encouraged residents to ask for snacks between mealtimes. An oratory was available for mass or reflection.
of governance and management had improved. However despite these conditions the provider failed to take the required action and the Chief Inspector issued a notice of proposal to refuse to renew the registration of the centre in June 2018. On receipt of this notice the provider made representation to the Chief Inspector citing improvements which had been implemented. This inspection was undertaken to assess the effectiveness of these improvements in to determine if the it was appropriate to renew the registration of Rochestown NursingHome. In the interim of this decision the current registration with a prohibition on admissions remains in place.
arrangements to ensure safe and suitable care for residents. For example, as part of a structured care quality initiative; the assistant director of nursing was working alongside individual healthcare assistants for defined periods to support them in their clinical competency development and practice in order to improve the delivery of care to residents. There had also been a review of the admissions policy to ensure all potential residents needs including residents with a dementia, could be suitably met, taking into consideration the residents already living within the centre. There were processes in place to ensure that when residents were admitted, transferred or discharged to and from the centre, relevant and appropriate information about their care and treatment was available and maintained, and shared between providers and services. In relation to admissions to any shared bedroom, the person in charge outlined how each prospective resident was assessed prior to any such admission to inform the suitability/compatibility of such admission. In addition, a care plan audits had most recently been completed in January 2018 and the findings from this review informed discussions with staff and governance management team meetings. The inspector noted that following these meetings corrective actions were taken including further care practice audits and on- going changes to the care planning documentation. The person in charge also outlined additional enhanced clinical governance and oversight in the centre. For example, all residents with dementia and/or their representatives had completed questionnaires that informed staff as to their choices and preferences for end of life care. There had been an audit of meals and meal times which resulted in improvements and changes to the menu and an improved dining experience for residents, including residents with dementia.
There was a person in charge of the centre. The person in charge was supported by an assistant director of nursing and staff team to meet the needs of residents. The provider supported the person in charge and was actively engaged in the day to day running of the centre. The management team were committed to provide a good quality service. Residents, their relatives and staff who spoke with inspectors said that the person in charge and the providers were always available and put the residents at the centre of everything and were very supportive of families and of staff. Residents and families spoken with said they were kept up to date on all aspects concerning their care. The person in charge and the providers reviewed the service regarding management/operational issues however this was not done on a formal basis and there were no minutes available of governance/management meetings, action plans or progress made.
Inspectors were not assured that there were sufficient staff to meet the needs of residents including nursing staff. The provider representative stated that there was a recruitment drive in progress to fill vacancies and to create a pool of regular relief staff to replace staff on planned and unplanned leave. In the interim, efforts were being made to reduce the use of agency staff and use part-time staff to cover shifts when required. This provided continuity of care to residents by staff who knew the residents well. There was usually one nurse on duty four days per week. There were inherent risks, as one nurse could not safely administer medications, provide nursing care and supervise care delivered to residents. For example inspectors observed that the nurse was interrupted on several occasions while doing the morning medication round, to meet visiting health professionals and support health care staff when requested. The medication round took over 2.5 hours. Inspectors also found instances where the care delivered was not in line with residents' plans. Inspectors observed a warm, friendly relationship between the staff and residents and residents were well groomed. However, staff reported that staffing levels were not adequate and they were rushed when providing care. This impacted on
There was a clear complaints procedure in place and information in relation to the complaints procedure was available in the resident's guide and was displayed in the centre's reception area. The person in charge maintained a log of formal complaints that were received in the centre however there was no log of informal complaints received by staff on the units and no record of how these had been managed. Residents and families who spoke with the inspectors were aware that there was a complaints process in place but a number of those spoken with were not aware of who was responsible for managing complaints in the centre. Residents and families told the inspectors that when they raised issues with staff on the units the issues had been dealt with at the time but that the same problems would recur again and they had to report the issue a second or third time. Records showed that one resident council meeting had been held in the centre in January 2018, however these meetings should have been held every quarter in line with the centre’s
The nursinghome had a low turnover of staff and operates a recruitment policy and selection process for prospective employees and work experience students, which is aimed at ensuring that staff are suitable to care and support residents. This includes the completion of Garda Vetting which was seen completed in a sample of the staff files examined. The provider representative and person in charge told inspectors that all staff had a disclosure of Garda Vetting. Staff recruitment and
There were adequate resources allocated to the delivery of the service in terms of equipment, catering, household and maintenance. Care and nursing staff vacancies were filled with temporary agency staff to implement the planned roster. Staff allocations and provision to meet the needs of residents required review, as the centre is currently recruiting to the staff team. Inspectors saw some examples of staff engaging with residents in a person centred and respectful manner.
The person in charge was an experienced nurse manager and had worked full-time in the centre since 2006. She had been working in the centre as a manager since 2009 and as the person in charge since 2015. During the two days of the inspection, the person in charge demonstrated good knowledge of the legislation and of her statutory responsibilities. She was clear in her role and responsibilities as person in charge and displayed a strong commitment towards providing a person-centred, high-quality service. She had committed to continued professional development and she had regularly attended relevant education and training sessions, including a post-graduate management training course. The inspector found that she was well known to all residents and staff. Residents and relatives all identified her as the person who had responsibility and accountability for the service and said she was very approachable. The person in charge was also described by a number of staff as a hands on and very approachable manager, who was always supportive of staff. There were arrangements for the assistant director of nursing or the staff nurse on duty to replace the person in charge for short periods including the evenings, weekends and during annual leave periods.
Maryfield NursingHome aims to provide full time nursing care in a supportive and stimulating environment for residents over the age of 18. General nursing care, dementia care, palliative and end of life care are all available in the nursinghome. It is situated in Chapelizod with many amenities nearby. These include restaurants, public houses, shops and public parks. It is a purpose built nursinghome with 69 single ensuite bedrooms. There are facilities for recreation onsite; including activity rooms, a library and pleasant grounds which include secure internal courtyards. There are activities taking place in the centre that link with the community, for example a choir and a knitting group. There is also daily roman catholic mass.