There were 40 residents on 28/07/2007. The Nursing Home is currently fully registered for 50 residents.

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1 Nursing Home Inspectorate, HSE Dublin North East Area, Kells Business Park, Cavan Rd., Kells, Co. Meath. Tel No: / Fax No: Tuesday, 9 th October 2007 Mowlam Healthcare Ltd., Registered Proprietor Kilmainhamwood Nursing Home, Kilmainhamwood, Co. Meath Inspection Report Re: Inspection of Kilmainhamwood Nursing Home Kilmainhamwood Kells Co Meath under the Health (Nursing Homes) Act, 1990 and the Nursing Homes (Care and Welfare) Regulations, Dear Registered Proprietor, The Health Service Executive Nursing Home Inspection Team from a nursing and environmental health perspective inspected Kilmainhamwood Nursing Home on 28/07/2007. The inspection commenced at 9.30am and was completed by 3.45pm. This inspection was routine unannounced. There were 40 residents on 28/07/2007. The Nursing Home is currently fully registered for 50 residents. Issues identified in the previous Inspections of; December 5 th & 13 th (a), (b) and (g), s 7.2 and 7.3, 14 (a), & 11.2 (d) & (f) 29(a) 11.2 (k) 12 (a) have been addressed. December 5 th & 13 th 2006, 11.2(h) (lighting and ventilation) remains outstanding. December 5 th & 13 th (b&d) is partially addressed. April 19 th & 1 st May 2007, 19.1 (h), 14 (a), (b) & (c) have been addressed. April 19 th & 1 st May (d) 11.2 (h) and 27.3 remain outstanding as detailed below:

2 Current Inspection; The following issues require your attention and action A written confirmation provided in accordance with 27.2(i) shall suffice on any subsequent registration of the nursing home, save where structural alterations to the home have been carried out, in which case, a new written confirmation in accordance with 27.2(i) shall be produced to the Health Board. Written confirmation from a competent person (such competent person to have the qualifications of a Chartered Engineer or an Architect who is a properly and suitably qualified Architect with experience in fire safety design and management) regarding article 27.1(a) (b) (c) (d) of the statutory fire authority not available to the designated officers. The provision of this certificate remains outstanding since January 07. However the Inspectors were advised by ** on 28 th July 07 that she was awaiting a date for inspection of the premises by a fire safety engineer from Mullingar. ** was given a further seven days to comply with this regulation. Correspondence received on August 1 st 2007, being a copy of letter indicating that ORS Fire Safety Consultants are engaged in this regard does not meet the requirements of Please forward to the Inspectorate a written confirmation of compliance in accordance with 27.3 Within 2 weeks of receipt of this report. 11.2(f) In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows: suitable and sufficient equipment and facilities having regard to the nature and extent of the dependency of the persons maintained in the nursing home. Issue Lack of annual service records for all lifting and handling equipment to ensure adequacy and safety of all equipment used by residents and staff. Equipment service records to be made available. To be forwarded to Inspectorate within 7 days of receipt of this report.

3 12 (a) The registered proprietor and the person in charge of the nursing home shall take precautions against the risk of accidents to any dependent person in the nursing home and in the grounds of the nursing home. Non-compliance Door of outside sluice/cleaners room in walkway to garden left open leaving unrestricted access to hazardous chemicals. 1. Person in charge to ensure doors remain locked at all times and to raise staff awareness in this regard. 2. Provide for the safe storage and disposal of hazardous chemicals in a secure area. The Safety Health & Welfare at Work Act 2005 requires that, as far as is reasonably practicable employers must prevent risk to health from any article or substance (including plant, tools, chemical substances and equipment). Storage of chemicals must comply with the Chemical Agents Regulations S.I. No. 619 of 2001 under the Safety Health & Welfare at Work Act Plan and implement a training programme for all staff on all aspects of Health & safety requirements which should include education on the safe storage and use of chemicals used in the course of their daily work. 1. & 2.Within 48 hours of receipt of this report 3. Within 3 months of receipt of this report. 12 (a) The registered proprietor and the person in charge of the nursing home shall: take precautions against the risk of accidents to any dependant person in the nursing home and in the grounds of the nursing home. Non-compliance An oxygen bottle (size G), two chairs and seated weighing scales were stored in the corridor of Rooms * -** and **-** and a trolley with pads, wipes gloves etc. and hairdressing items were noted in the assisted bathroom. These presented a trip hazard to patients. Inspectors were advised that a separate portacabin is being purchased as a storage facility. Ensure a separate store, big enough in size, is provided for the safe storage of all equipment used in the home. Within 4 weeks of receipt of this report.

4 14 (b) The registered proprietor and the person in charge of the nursing home shall make adequate arrangements for the prevention of infection, infestation, toxic conditions, or spread of infection and infestation at the nursing home. Non-compliance 1. Patient s plastic wash hand basins are being stored on ensuite bathroom floors. 2. In Room ** urinals were noted lying on the floor in both the bedroom and en-suite bathroom. 3. Used latex gloves found in Room ** on top of chest of drawers. 4. Both the assisted bath and the commode in the bathroom were found to be in a dirty condition. 1. Cease practice of storing plastic wash basins and urinals on the floors of bedrooms or bathroom en-suites to prevent infection. 2. Look at feasibility of storing resident s personal hygiene requirements/toiletries in a designated area or provide shelving appropriate to the needs of patients in en-suite bathrooms. 3. Immediately review practices in relation to disposal of latex gloves and other clinical waste in the Nursing Home. The Person in Charge should ensure that all staff involved with personal care are instructed and reminded of the policy on clinical waste in the Nursing Home. 4. Ensure thorough cleaning of all assistive equipment, furniture and fittings, particularly after use. Review cleaning schedule to ensure inclusion of the thorough cleaning of all assistive equipment, furniture and fittings, particularly after use and provide supervision where required. 1. Within 24 hours of receipt of this report 2. Within 4 weeks of receipt of this report 3. Within 24 hours of receipt of this report 4. Within 72 hours of receipt of this report 18.1 (f) In every nursing home there shall be kept in a safe place a bound register of all dependent persons resident in the home, which shall include the following particulars in respect of each person where the person is admitted to hospital, the date of and reasons for the admission and the name of the hospital. Non-compliance Dependent person **. was not in residence on the day of the inspection having been admitted to hospital approx. 72 hrs earlier. However this was not updated or reflected on the register. The register is kept up to date at all times Within 48hrs of receipt of this report

5 11.2 (g) In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows bed and bedding appropriate to the dependency of each person and suitable and sufficient furniture and other necessary fittings and equipment. Issue In Room **, a Divan style mattress was noted to be badly stained despite the plastic covering. The mattress should be either deep cleaned or replaced. Within 7 days of receipt of this report In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows:- (b) adequate day space for each person in an area separate from the circulation and sleeping areas and adequate dining and sitting space for mobile persons At time of inspection the EHO was informed that 42 residents were present in the home yet only 31 spaces were available in the dining area Ensure that adequate dining spaces are made available for all residents dining in the home. Within 7 days of receipt of this report 11.2 (h) In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows; (h) suitable and sufficient lighting and ventilation, with natural lighting and ventilation in rooms which are regularly occupied by dependent persons. The dimmer switch in room ** was not working. Room ** had a flickering light and also the string on the light over the mirror in the bathroom was difficult to work. In room ** the overbed light was not working. The mechanical ventilation in the assisted bathroom was working ineffectively. There was again, a smell of smoke in the corridor at the time of inspection. No remedial work has been done to solve ventilation problems in the smoking room or to adequately seal the double doors despite it being continually mentioned in the three previous inspection reports. Repair dimmer switch and lights mentioned above.

6 Investigate and repair mechanical ventilation in assisted bathroom. Submit proposals for the provision of adequate negative ventilation in the smoking room and measures to be taken to prevent the migration of smoke from this room. Within 7 days of receipt of this report (j) In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows: (j) emergency call facilities are provided at each bed. The emergency call light outside room ** was not working. The bedside call facilities in room * were not working. Repair the above emergency call facilities. Immediately on receipt of this report 12 (a) The registered proprietor and the person in charge of the nursing home shall:(a) take precautions against the risk of accidents to any dependent person in the nursing home and in the grounds of the nursing home. In room ** two TV s were balanced precariously on a shelving unit. In the assisted shower room portable screens were used when washing patients. These were incorrectly mounted and extremely unstable, easily able to fall on either patient or carer during washing. Ensure adequate space is provided for secure storage of TV s. Mount TV s onto wall brackets if necessary. Remove portable screens and replace their use with correctly mounted and stable screens. Within 1 week of receipt of this report

7 14 (a) The registered proprietor and the person in charge of the nursing home shall:- ensure that the Nursing Home and its curtilage is maintained in a proper state of repair and in clean and hygienic condition. On the day of inspection cleaning in the home was found to be unsatisfactory. Incontinence pads were stored incorrectly in unsealed bins in certain bathrooms throughout the home. Basins to aid the washing of patients were found to be in a dirty condition, stored on the floors in bathrooms. Dirt was observed on skirting boards, on shelving, on the walls and floors underneath and behind beds. All assisted bathrooms and commodes, along with the hairdressing area and private visitors area were found to be in a grimy and dirty condition. Damp and mould growth was observed on the wooden frame by the sink in the hairdressing area. The bath in the assisted bathroom was broken and taped up at time of inspection. Water was leaking from the bottom of the toilet in room *. The radiator knob in room * was broken. The wash hand basin in room ** was cracked. Organise an intensive, thorough cleaning of all surfaces, fixtures and fittings throughout the home. Ensure existing cleaning schedules are revised and updated to include; (i) All surfaces to be cleaned including structures, fittings, furnishings and equipment, (ii) Frequency of cleaning, (iii) Materials to be used for cleaning and dilution rates of detergents/disinfectants (iv) Personnel responsible for carrying out the cleaning. Adequate training and supervision shall be provided to cleaning staff. Management shall check that cleaning schedules are being adhered to. Separate equipment, brushes and cloths shall be used to clean toilet areas. In shared bathrooms adequate space and arrangements shall be made for the hygienic storage of individual resident s toiletries. Treat dampness by sink in hairdressing area. Repair the bath in assisted bathroom or replace if necessary. Investigate and repair the leaking toilet in room *. Repair the radiator in room *. Repair cracked wash hand basin in room *. Within 7 days of receipt of this report

8 14 (a) The registered proprietor and the person in charge of the nursing home shall: ensure that a separate well ventilated room is provided for sluicing and for the storage of dirty linen. At the time of inspection we were informed that the assisted bathroom was still doubling up as the sluice room. Stop this practice of using the bathroom as a sluice room and ensure the existing sluice room on site is utilised for its intended purpose. Should this prove unsuitable to management submit proposals to convert separate area on site into new sluice room. Within 7 days of receipt of this report. Recommendations It was noted during the course of the Inspection that some activities are provided for residents i.e. Bingo, Mass, Art and Hairdresser. The Re-Registration Application of January 07 indicates that an activity therapist provides 5 sessions per week and further to clarification received it is noted that two staff members currently co-ordinate an activity schedule, however, it is recommended that given the mix of clients currently in residence, that a review of activities be undertaken to reflect both the gender balance and the interest of the residents. It is recommended that some chairs be removed from the Oratory / Quiet room to facilitate wheelchair accessibility. It is recommended that the brochure be updated to include an identifiable, specific Admissions policy It was noted that clients care plans were regularly reviewed and updated and it is recommended that dependency levels should also be reviewed on a regular basis. Training records indicate that some training is being delivered to staff however it is recommended that the Person in Charge devise an appropriate on-going training schedule for all staff that is evidence based and reflects best practice. Training for staff and the development of policies are required on the following; Assessment, treatment and management of Continence, Wound & Pressure Area Care, Falls Risk Assessment, Restraint, HACCP, Food Hygiene. The Nursing Home Inspection Team is to be notified in writing on or before the above dates indicating the steps taken by the Nursing Home to carry out the actions as required under the Regulations.

9 Signed: Chairperson/ Designated Officer. Environmental Health Designated Officer. Officer/Designated Officer. cc. Ms Marie Helene Finnegan, Person-in-Charge of Nursing Home