Report of an inspection of a Designated Centre for Older People Name of designated centre: Name of provider: Address of centre: Sonas Nursing Home Melview Sonas Asset Holdings Limited Prior Park, Clonmel, Tipperary Type of inspection: Announced Date of inspection: 07 August 2018 Centre ID: OSV-0000250 Fieldwork ID: MON-0022218 Page 1 of 14
About the designated centre The following information has been submitted by the registered provider and describes the service they provide. Sonas Nursing Home Melview is a four-storey facility located within the urban setting of Clonmel town. The centre can accommodate 51 residents. There are two lifts on either side of the house to enable easy access to the four floors. Bedrooms comprise single, single en suite, double, double en suite and three-bedded rooms. There are day rooms on each floor, a dining room on the ground floor and a lounge area on the middle floor. There is a new extension comprising seven single bedrooms with en-suite shower and toilet facilities and a visitors' room with comfortable seating and kitchenette facilities. Residents have access to gardens and walkways around the centre. Sonas Nursing Home Melview provides 24-hour nursing care to both male and female residents. It can accommodate older people (over 65), those with a physical disability, mental health diagnoses and people who are under 65 whose care needs can be met by Sonas Nursing Home Melview. Long-term care, convalescent care, respite and palliative care is provided to those who meet the criteria for admission. Maximum, high, medium and low dependency residents can be accommodated in the home. The following information outlines some additional data on this centre. Current registration end date: Number of residents on the date of inspection: 24/01/2019 38 Page 2 of 14
How we inspect To prepare for this inspection the inspector or inspectors reviewed all information about this centre. This included any previous inspection findings, registration information, information submitted by the provider or person in charge and other unsolicited information since the last inspection. As part of our inspection, where possible, we: speak with residents and the people who visit them to find out their experience of the service, talk with staff and management to find out how they plan, deliver and monitor the care and support services that are provided to people who live in the centre, observe practice and daily life to see if it reflects what people tell us, review documents to see if appropriate records are kept and that they reflect practice and what people tell us. In order to summarise our inspection findings and to describe how well a service is doing, we group and report on the regulations under two dimensions of: 1. Capacity and capability of the service: This section describes the leadership and management of the centre and how effective it is in ensuring that a good quality and safe service is being provided. It outlines how people who work in the centre are recruited and trained and whether there are appropriate systems and processes in place to underpin the safe delivery and oversight of the service. 2. Quality and safety of the service: This section describes the care and support people receive and if it was of a good quality and ensured people were safe. It includes information about the care and supports available for people and the environment in which they live. A full list of all regulations and the dimension they are reported under can be seen in Appendix 1. Page 3 of 14
This inspection was carried out during the following times: Date Times of Inspection Inspector Role 07 August 2018 09:00hrs to 19:00hrs Breeda Desmond Lead Page 4 of 14
Views of people who use the service The inspector met and spoke with residents throughout the inspection in various locations of the centre, including residents bedrooms, lounges and dining rooms. The inspector received feedback from several residents and 11 questionnaires were submitted from relatives and residents. Feedback was generally positive about the overall service as well as the standard of care provided. Residents relayed that staff were helpful, kind and considerate. They said that they could raise any issue with the person in charge and that things were dealt with. People reported that there was a good variety of activities, they were free to go by bus to Waterford, walk into Clonmel or walk about the gardens of the house. Most feedback in the questionnaires was very positive, nonetheless, some suggested that they would like more space in their bedrooms for storage of personal belongings. Capacity and capability This was an announced inspection following an application by the registered provider to register the centre and increase the number of registered beds from 44 beds to 51. The premises was extended to include seven single bedrooms with ensuite shower and toilet facilities, and a visitors room with kitchenette facilities. Overall, the inspector found that services provided were to a good standard. There was effective governance and management of the service to give assurances that the service provided was safe, appropriate, consistent and effectively monitored. Additional members recently appointed to the governance team included the quality and governance co-ordinator, clinical nurse manager (CNM) and deputy person in charge, which provided further support to the person in charge. Monthly governance meetings were convened in the centre and attendees included the provider representative, quality and governance co-ordinator, person in charge, deputy person in charge and CNMs. Standing items on the agenda included a) examples where staff exemplified company values, b) examples of staff suggestions for business improvements, c) achievements over the past month, followed by an indepth review of governance and operations, and ending with specific actions following from the meeting. Highlighted at the start of each minutes was the ethos espoused by the company of Teamwork, Empathy, Advocacy, Warmth, Energy, Empowerment and this was evident during the inspection. Present and future resources were discussed cognisant of the proposed bed increase. Proposed additional staff included a second nurse for night duty roster; an additional care staff for the day time roster; two additional hours per day for cleaning. Only personal laundry was done in the centre as bed linen and towels Page 5 of 14
were externally contracted so laundry resources were adequate. The activities coordinator worked 10:00hrs 17:00hrs and this will be kept under review in accordance with the assessed needs and dependency levels of residents. The quality and governance co-ordinator was in the process of reviewing and advancing their quality improvement strategy. They had recently introduced the Quality of Interaction schedule (QUIS) whereby the Quis tool was used to observe practice and to further enhance their practice. The deputy person in charge and CNM were enrolled in professional development courses pertinent to their management roles and following this training they will be involved in the audit process. While all the policies as listed in Schedule 5 were in place and in date, some were not referenced to show that they were based on researched best practice, while others referenced out-of-date regulations and standards. Nonetheless, observations showed that in general, best practice was adhered with regarding care, welfare, dignity, respect and protection. There were formal and informal complaints records. Informal complaints comprised everyday issues that were dealt with in compliance with the regulations. Formal issues comprised more serious issues which were also addressed in accordance with the regulations. Learning from matters raised comprised part of staff meetings and governance meetings to minimise the risk of recurrence and upset to residents and relatives. Registration Regulation 4: Application for registration or renewal of registration The provider successfully completed an application to register the service in accordance with the requirements of the registration regulations. Judgment: Regulation 14: Persons in charge The person in charge was a registered nurse with the appropriate qualifications and experience to the role and responsibilities of person in charge. He was engaged in the governance, operational management and administration of the service. He was knowledgeable regarding his responsibilities under the regulations and continuous quality improvement under the national standards. Page 6 of 14
Judgment: Regulation 19: Directory of residents The directory of residents was maintained in compliance with the regulations. Judgment: Regulation 22: Insurance There was a contract of insurance in accordance with the regulations that included both injury to the resident and other risks, including loss or damage to a resident s property. Judgment: Regulation 23: Governance and management There were effective governance and management systems in place to ensure the service was safe and effectively monitored. Nonetheless, there were areas for improvement to enhance the positive inspection findings. The clinical nurse manager was recently promoted from position of senior staff nurse; the deputy person in charge was new to the service and had just completed her induction. The inspector met both on inspection and highlighted that their knowledge of the regulations, national standards and notifications process was not in keeping with their roles and responsibilities. The quality and governance co-ordinator outlined that a review had commenced of the induction programme for new managers, and these would be included in the revised programme. The annual review was available and this was completed in accordance with the national standards. Resident surveys were completed on a regular basis and residents meeting occurred every three months, however, these were not reflected in the annual review to show that the report was compiled in consultation with residents and their families. Judgment: Not compliant Page 7 of 14
Regulation 24: Contract for the provision of services Each resident had an agreed written contract of care in compliance with the requirements set out in the regulations. While contracts were signed by all relevant parties including the resident, the date of signing the contract was not included in the form. This was remedied on inspection so that it could be determined when the contract was agreed. Judgment: Regulation 3: Statement of purpose The statement of purpose was updated to reflect the new person participating in management and the proposed increase in bed capacity from 44 to 51 residents. All other items as listed in the regulations formed part of the statement of purpose and this was kept under review as required by the regulations. This document was displayed at the front entrance to the centre for residents and visitors to review. Judgment: Regulation 31: Notification of incidents The person in charge was aware of his responsibilities regarding notifications to the HIQA. Notifications were timely submitted and they correlated with the incidents and accidents records reviewed. Judgment: Regulation 34: Complaints procedure Several residents spoken with, questionnaires submitted and observations on inspection demonstrated that residents and relatives could raise issues freely. They were given kind consideration and their issue addressed. The complaints procedure Page 8 of 14
was effective and in compliance with the regulations. Judgment: Regulation 4: Written policies and procedures All policies and procedures as listed in Schedule 5 were in place. While practice observed demonstrated that, in general, best practice was adhered with regarding care and welfare, policies did not reference research-based best practice or the most up to date regulations and national standards. Judgment: Substantially compliant Quality and safety Systems were in place to monitor the quality and safety of the service; areas for improvement were identified with associated actions and responsibilities assigned; follow-up actions and timelines formed part of the quality review. The service had completed a self assessment questionnaire from the fire-safety officer which identified issues to be addressed; an action plan was developed and control measures were implemented. Fire evacuation training, drills and fire safety measures were comprehensive. The maintenance person highlighted that he was about to start the training for the new wing so staff were familiar with the new layout. The inspector found that staff demonstrated good knowledge and understanding of the needs of residents and this information was reflected in individual care plans. Overall, residents received a good standard of care and access to medical resources and the services of allied healthcare professionals were in keeping with the assessed needs of residents. The physiotherapist attended the centre twice a week and residents gave good feedback regarding access to the physiotherapist. The activities co-ordinator discussed the activities programme and outlined that activities varied from day-to-day and they were developed in conjunction with residents life stories, preferences and interests. She relayed that some people prefer one-to-one sessions where she goes to a resident s bedroom and spends time with people doing something of their choice, for example, hand massage, reading poetry or the news paper. Residents were invited to group sessions and had access to an i-pad, tablet and laptop; the activities co-ordinator taught residents how to use these and access the internet. The proposed new extention will have a computer Page 9 of 14
hub as part of communal space identified. Residents relayed that they had access to the outdoors if they wished and had spent a lot of the summer outside. Garden furniture with tables, chairs and parasols were set up at the front entrance. There was a new extension that comprised seven single bedrooms with en-suite shower, toilet and wash-hand basin facilities; a visitors room with comfortable chairs and table, and tea and coffee making facilities. There was no lockable storage space in these bedrooms rooms; this was highlighted to the person in charge and the issue was remedied before the end of the inspection. The centre was repainted and other redecoration work was completed. New individual solid tables were available to residents in the lounges and residents gave positive feedback regarding these. Nonetheless, there was virtually no storage space for equipment such as laundry baskets, hoists and commodes. Infection prevention and control was identified as an area of concern on the last inspection and this remained an issue. While equipment was acquired for drainage and storage in sluice rooms, this was not used in compliance with best practice guidelines. Other issues were identified on this inspection which demonstrated that, overall, there was little oversight of infection prevention and control protocols. Regulation 11: Visits There was an open visiting policy and the inspector observed that visitors were well received and were known to staff. Questionnaires returned stated that visitors were welcomed and staff engaged with family members. Judgment: Regulation 13: End of life Care plans demonstrated that staff had spent time finding out peoples' wishes for their care and developing a comprehensive plan of care for end of life. Judgment: Regulation 17: Premises Page 10 of 14
The centre was recently painted and other refurbishment work was completed for this inspection. Overall, it was homely and bright with comfortable furnishings. Previously it was identified that the position of privacy curtains in multi-occupancy bedrooms limited the personal space afforded to residents; this was addressed in the rooms identified on the last inspection. There was totally inadequate storage space for equipment such as hoists, laundry baskets and commodes. These were stored in bedrooms, en-suite shower rooms and hallways, which was not in keeping with the homely ethos espoused in their statement of purpose. Judgment: Not compliant Regulation 18: Food and nutrition Residents gave positive feedback regarding meals and mealtimes, choice, quality and quantity of their food. The inspector sat with residents at lunch time and the meals presented looked appetising. Catering staff asked residents if they wanted additional sauce or gravy, and a choice of fluids was offered. In general, appropriate assistance was afforded to residents at mealtimes, but it was necessary to review practices in dining rooms where residents required little or no assistance at mealtimes, for example, staff standing around and waiting for residents to finish, which may put undue pressure on residents to hurry their meal. Judgment: Substantially compliant Regulation 26: Risk management Risk management policies and a safety statement were in place as required by the regulations. The risk register detailed risks, the level of risk and the control measures in place to mitigate or minimise risks identified. There was a weekly audit of the premises to identify issues, however, issues were not always identified, for example, some toilet seats were partially dislodged which would be a potential risk to residents especially those with balance or mobility concerns. Comprehensive reports were maintained for incidents, accidents, medication errors and near-misses including outcomes and lessons learned to mitigate the risk of recurrence. These were discussed at governance meetings as well as staff meetings. Page 11 of 14
Judgment: Not compliant Regulation 27: Infection control There was inadequate oversight of cleaning practices and infection prevention did not form part of the audit process. The annual review did not identify the shortcomings of their infection control practices, for example, while hand gel sanitisers were available throughout the centre, they were not part of the cleaning regime and the spout of these appeared as if they were never cleaned. Judgment: Not compliant Regulation 28: Fire precautions Adequate arrangements were demonstrated to ensure and enable safe and consistent fire safety, such as fire safety checks, maintenance of equipment, drills, evacuation and training. Judgment: Regulation 8: Protection Staff had completed appropriate training in protection. All relevant documentation in accordance with Schedule 2 relating to staff was in place to protect residents. Observations on inspection demonstrated that staff were respectful and kind and residents' feedback concurred with this. Judgment: Regulation 9: Residents' rights Residents had good access to facilities and recreation both within the centre and in the wider community. Residents reported that they were encouraged to try new things and their right to decline participation in activities was respected. Residents' meetings were convened every three months and their feedback was sought regarding all different aspects of life in the centre. People had access to Page 12 of 14
independent advocacy services; minutes of these meetings were evidenced; posters for advocacy services were displayed in lounges and at main reception. Judgment: Regulation 12: Personal possessions While residents had access and retained control over their clothes, personal storage space in some multi-occupancy bedrooms was inadequate to display photographs, hold mementos or facilitate storage of an ample amount of clothing. Questionnaires returned outlined that some residents would like additional space for personal storage and personal belongings. Judgment: Not compliant Page 13 of 14
Appendix 1 - Full list of regulations considered under each dimension Regulation Title Capacity and capability Registration Regulation 4: Application for registration or renewal of registration Regulation 14: Persons in charge Regulation 19: Directory of residents Regulation 22: Insurance Regulation 23: Governance and management Regulation 24: Contract for the provision of services Regulation 3: Statement of purpose Regulation 31: Notification of incidents Regulation 34: Complaints procedure Regulation 4: Written policies and procedures Quality and safety Regulation 11: Visits Regulation 13: End of life Regulation 17: Premises Regulation 18: Food and nutrition Regulation 26: Risk management Regulation 27: Infection control Regulation 28: Fire precautions Regulation 8: Protection Regulation 9: Residents' rights Regulation 12: Personal possessions Judgment Not compliant Substantially compliant Not compliant Substantially compliant Not compliant Not compliant Not compliant Page 14 of 14
Compliance Plan for Sonas Nursing Home Melview OSV-0000250 Inspection ID: MON-0022218 Date of inspection: 07/08/2018 Introduction and instruction This document sets out the regulations where it has been assessed that the provider or person in charge are not compliant with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2015 and the National Standards for Residential Care Settings for Older People in Ireland. This document is divided into two sections: Section 1 is the compliance plan. It outlines which regulations the provider or person in charge must take action on to comply. In this section the provider or person in charge must consider the overall regulation when responding and not just the individual non compliances as listed section 2. Section 2 is the list of all regulations where it has been assessed the provider or person in charge is not compliant. Each regulation is risk assessed as to the impact of the non-compliance on the safety, health and welfare of residents using the service. A finding of: Substantially compliant - A judgment of substantially compliant means that the provider or person in charge has generally met the requirements of the regulation but some action is required to be fully compliant. This finding will have a risk rating of yellow which is low risk. Not compliant - A judgment of not compliant means the provider or person in charge has not complied with a regulation and considerable action is required to come into compliance. Continued non-compliance or where the non-compliance poses a significant risk to the safety, health and welfare of residents using the service will be risk rated red (high risk) and the inspector have identified the date by which the provider must comply. Where the noncompliance does not pose a risk to the safety, health and welfare of residents using the service it is risk rated orange (moderate risk) and the provider must take action within a reasonable timeframe to come into compliance. Page 1 of 7
Section 1 The provider and or the person in charge is required to set out what action they have taken or intend to take to comply with the regulation in order to bring the centre back into compliance. The plan should be SMART in nature. Specific to that regulation, Measurable so that they can monitor progress, Achievable and Realistic, and Time bound. The response must consider the details and risk rating of each regulation set out in section 2 when making the response. It is the provider s responsibility to ensure they implement the actions within the timeframe. Compliance plan provider s response: Regulation Heading Regulation 23: Governance and management Judgment Not Outline how you are going to come into compliance with Regulation 23: Governance and management: Additional training given to CNM and APIC, CNM and APIC are now familiar with Regulations, national standards and notifications Families and resident s involvement were ensured previously though surveys which was not specifically mentioned in 23 d report this is now included in the report. 23 D report will be complied with involvement of residents and families Regulation 4: Written policies and procedures Substantially Outline how you are going to come into compliance with Regulation 4: Written policies and procedures: All policies reviewed and updated and referenced to updated regulation and standards Regulation 17: Premises Not Outline how you are going to come into compliance with Regulation 17: Premises: Page 2 of 7
Storage of laundry basket and commodes reviewed and rearranged, in new block additional storage place is created Regulation 18: Food and nutrition Substantially Outline how you are going to come into compliance with Regulation 18: Food and nutrition: Staff practices monitored by management team, arrangements made for RN and CNM to sit with residents whilst they have their meals hence creating a more relaxed atmosphere. Regulation 26: Risk management Not Outline how you are going to come into compliance with Regulation 26: Risk management: Regular maintenance check is in place. Toilet seat was fixed immediately Regulation 27: Infection control Not Outline how you are going to come into compliance with Regulation 27: Infection control: An audit schedule devised to address infection control, CNM and APIC will audit every 15 days and then monthly action plan will be devised after audit and implemented. Management team will supervise infection control practices in the home and produce monthly report. Additional training on practice of infection control will be given to all staff. All hand gel and soap dispensars are being cleaned and/or replaced. Regulation 12: Personal possessions Not Page 3 of 7
Outline how you are going to come into compliance with Regulation 12: Personal possessions: Locked facilities for all residents provided. Rooms reconfigured to create more private space, reviewed use and storage of commodes and equipment, additional storage place created in new block. Room was already given in new building for resident who looked for more space.all bedrooms complied with regulations Page 4 of 7
Section 2: Regulations to be complied with The provider or person in charge must consider the details and risk rating of the following regulations when completing the compliance plan in section 1. Where a regulation has been risk rated red (high risk) the inspector has set out the date by which the provider or person in charge must comply. Where a regulation has been risk rated yellow (low risk) or orange (moderate risk) the provider must include a date (DD Month YY) of when they will be compliant. The registered provider or person in charge has failed to comply with the following regulation(s). Regulation Regulation 12(c) Regulation 17(2) Regulation 18(1)(c)(i) Regulatory requirement The person in charge shall, in so far as is reasonably practical, ensure that a resident has access to and retains control over his or her personal property, possessions and finances and, in particular, that he or she has adequate space to store and maintain his or her clothes and other personal possessions. The registered provider shall, having regard to the needs of the residents of a particular designated centre, provide premises which conform to the matters set out in Schedule 6. The person in charge shall Judgment Risk Date to be rating complied with Not Yellow 31/8/18 Not Yellow 31/8/18 Substantially Yellow 15/8/18 Page 5 of 7
Regulation 23(b) Regulation 26(1)(a) Regulation 27 ensure that each resident is provided with adequate quantities of food and drink which are properly and safely prepared, cooked and served. The registered provider shall ensure that there is a clearly defined management structure that identifies the lines of authority and accountability, specifies roles, and details responsibilities for all areas of care provision. The registered provider shall ensure that the risk management policy set out in Schedule 5 includes hazard identification and assessment of risks throughout the designated centre. The registered provider shall ensure that procedures, consistent with the standards for the prevention and control of healthcare associated infections published by the Authority are Not Orange 20/8/18 Not Yellow 8/8/18 Not Orange 31/8/18 Page 6 of 7
Regulation 04(3) implemented by staff. The registered provider shall review the policies and procedures referred to in paragraph (1) as often as the Chief Inspector may require but in any event at intervals not exceeding 3 years and, where necessary, review and update them in accordance with best practice. Substantially Yellow 10/8/18 Page 7 of 7