Health Information and Quality Authority Social Services Inspectorate Inspection Report Designated centres for older people Centre name: Centre ID as provided by the Authority: Centre address: Boyne Valley Nursing Home 0119 Dowth Drogheda Co. Meath Telephone number: 041 983 6130 Fax number: 041 984 6899 Email address: niamhbynh@eircom.net Type of centre: Private Voluntary Public Registered providers: Person in charge: Nemeco T/A Boyne Valley Nursing Home Niamh Darcy Date of inspection: 08 January 2010 Time inspection took place: Start: 16:45 hrs Completion: 17:45 hrs Lead inspector: Support inspector: Florence Farrelly Sheila McKevitt Type of inspection: Follow up inspection Announced Unannounced 1
About the inspection The purpose of inspection is to gather evidence on which to make judgments about the fitness of the registered provider and to report on the quality of the service. This is to ensure that providers are complying with the requirements and conditions of their registration and meet the Standards, that they have systems in place to both safeguard the welfare of service users and to provide information and evidence of good and poor practice. In assessing the overall quality of the service provided, inspectors examine how well the provider has met the requirements of the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 and the National Quality Standards for Residential Care Settings for Older People in Ireland. Additional inspections take place under the following circumstances: to follow up on specific matters arising from a previous inspection to ensure that the action required of the provider has been taken following a change in circumstances; for example, following a notification to the Health Information and Quality Authority s Social Services Inspectorate that a provider has appointed a new person in charge arising from a number of events including information received in relation to a concern/complaint or notification to the SSI of a significant event affecting the safety or well-being of residents to randomly spot check the service. All inspections can be announced or unannounced, depending on the reason for the inspection and may take place at any time of day or night. All inspection reports produced by the Health Information and Quality Authority will be published. However, in cases where legal or enforcement activity may arise from the findings of an inspection, the publication of a report will be delayed until that activity is resolved. The reason for this is that the publication of a report may prejudice any proceedings by putting evidence into the public domain. 2
Background This inspection was initiated to follow up on matters arising from a previous inspection carried out on 16 September 2009 to ensure that the actions required and agreed with the provider on 07 December 2009 had been implemented. On the last inspection inspectors found that overall a good quality of care was provided to residents. Staff were knowledgeable about the individual needs of residents in their care. Residents told inspectors that they were pleased with the care provided by management and staff. They spoke positively about the centre and were complimentary about the food and quality of life. There was some evidence that there was formal consultation with residents regarding different aspects of life in the centre. However, the records and the views of each resident were not kept in a systematic manner and there was no residents committee. Residents had no input into the range or choice of activities provided. Inspectors found areas where improvements were required. A number of operational policies and procedures required by the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 were not in place for example: recruitment, selection and vetting of staff, communication, and complaints handling. Some staff involved in the care of elderly residents had not received training on the prevention of elder abuse. Evidence from inspection findings highlighted that the areas of waste management and infection control needed to be addressed. The Action Plan at the end of the report identifies improvements that are required in order for the centre to comply with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 and the National Quality Standards for Residential Care Settings for Older People in Ireland. 3
Summary of findings from the follow up inspection Since the last inspection the provider has implemented or is in the process of implementing the required actions as outlined in the providers response dated 7 December 2009. The time scale for some of the agreed actions had not yet elapsed and the provider is working on these outstanding issues. The provider has installed an electronic documentation system for residents records, care planning and assessment. The system is accessible to all members of staff and facilitates regular monitoring of all residents health and social care needs. A process has been developed to ensure nursing staff are acting in accordance with An Bord Altranais published guidance for nurses and midwives on medication management. Formal structures for consultation with residents have been put in place. Staff have received training on the prevention of elder abuse 4
Issues covered on inspection 1. Action required from previous inspection: All staff to receive induction and ongoing training in prevention, detection and response to abuse within the residential care setting All staff have now received induction training on elder abuse as laid out by the Health Service Executive (HSE) in their DVD Recognising and Responding to Elder Abuse in the Residential Care Setting. Two members of staff, a staff nurse and senior care assistant, hold the responsibility for the further and future training of all staff. Elder abuse awareness and prevention has also been added to the staff induction programme. The provider informed inspectors that she had delivered the Recognising and Responding to Elder Abuse in the Residential Care Setting training to all staff. Documentation to this effect was examined. Literature and a DVD relating to this subject were visible at the Nurses station. The provider identified the two key staff members responsible for delivering this training to new staff. 2. Action required from previous inspection: A. Review the draft statement of purpose to ensure compliance with requirements in Schedule 1 of the Health Act 2007 (Care and Welfare of Residents in Designated Centers for Older People) Regulations 2009 B. Written policies in place at the centre should be reviewed and updated to comply with Regulation 27 and schedule 5 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. All policies should have an implementation date and a review date. All staff must read the policies and document that they have read and understood the policies A. The statement of purpose is in draft form. On completion it will comply with Regulation 5 of the HIQA Standards and the requirements in Schedule 1 of the Health Act 2007. 5
B. All policy documents are currently being reviewed and updated if necessary. New policy documents are being compiled. An implementation date and review date will be included in each document. All staff will sign off on these new / updated policies. The provider showed the inspector the draft statement of purpose and all policies currently under review and confirmed her commitment to completing this review process within the agree time scales. 3. Action required from the previous inspection: Provision must be made for the proper and safe storage of chemicals, chemical safety and the arrangements made to provide a bed pan washer/macerator in the sluice room To comply with regulations locks have been attached to presses that are used for the storage of chemicals. A coded lock has been put on the sluice room door. Alternate arrangements have been made for the storage of recyclable goods. The sluice room is now wired and plumbed for a bed-pan washer. Delivery is expected in December or early January Inspectors examined the sluice room which now has lockable storage for chemicals and is plumbed and ready for a bed pan washer which is due for delivery before the end of January. 4. Action required from the previous inspection: Arrangements must be put in place to ensure residents are consulted with regarding the running of the centre. These arrangements should be detailed in the statement of purpose and function. A resident s meeting is now held on the first Monday of the month. Topics include menu planning and social activity and any other issues that they may 6
wish to discuss. The minutes of these meetings and attendants are documented When finalised the residents booklet will include this information. Inspectors were shown minutes of last meeting and the details outlined above were contained within these minutes. They also indicate that residents have expressed to the provider that they do not want to have a committee but are very happy with the monthly meetings. The provider also indicated that she is in the process of looking for an independent advocate and will inform residents as soon as this process is complete. 5. Action required from the previous inspection: Draft complaints policies and procedures to comply with Regulation 39 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 As explained in the factual accuracy a complaint s policy is in place in the nursing home and complaints procedures and forms are available at the visitors counter at the nurses station. Time scales: Implemented Inspectors examined the complaint s procedure and acknowledged compliance with current legislation. 6. Action required from the previous inspection: When a resident requires physiotherapy, chiropody, occupational therapy or any other services as may be required, access to such service must be facilitated by the registered provider or by arrangement with the Executive. Shortage of therapists in the HSE and refusal by the HSE to pay for physiotherapy and occupational therapy services for residents in nursing homes can lead to a delay in accessing these services. On such occasions families have undertaken to pay for a private therapist themselves, if their means allow. This matter is now been dealt with by the Ombudsman because, by right, people with medical cards are entitled to these services free of charge. 7
Chiropody is available ever month or more often if necessary, with the cost incurred by resident. The provider showed the inspectors correspondence between herself and a private occupational therapist and indicated residents / relatives inability to pay private fees for this service. She confirmed her commitment to continue to try source this service from the HSE. Specialised seating has been purchased for the resident identified in the previous report. Best Practice Recommendations Standard 19 Meals and Mealtimes The daily menu should be displayed in a suitable format and in an appropriate location so that residents and their representatives know what choices are available at mealtimes. A menu board is on display in the dining- room. Standard 17 Quality of Life The resident is given a choice to participate in individual and /or communal recreational activities. Up-to-date social assessments should be in place for all residents residing in the centre. All residents are given the opportunity to participate in individual and communal activities. Some residents do not wish to participate. Their refusal is now been documented. At the time of inspection some social assessments had been completed. It is hoped to complete the remainder by the end of December. Standard 14 Medication Management Nursing staff should be familiar with An Bord Altranais published guidance for nurses and midwives on medication management. To comply with regulations all MDA (Misuse of Drugs Act) drugs are checked and documented by staff at the beginning and end of each shift. Our Pharmacist has 8
agreed to carry out a medication audit every 3 months or more often if necessary. A monthly audit, by a staff nurse, of residents medication is now in place. The notice board for displaying daily menu had been purchased and available for the maintenance person to erect. Due to the inclement weather this member of staff was unable to get to the centre. However, the provider gave her assurances that this was a priority issue on his return to work. All care plans are now being generated electronically and a full review of all residents care needs including social assessments is being carried out. The provider showed the inspectors the procedure where two staff sign a book at the end of each shift to indicate that MDA drugs had been checked. She also outlined the process where the pharmacist will carry out a regular audit on residents medication. Report compiled by Florence Farrelly Inspector Manager of Social Services Social Services Inspectorate Health Information and Quality Authority Date 12 January 2010 9
Health Information and Quality Authority Social Services Inspectorate Action Plan Provider s response to additional inspection report Centre: Boyne Valley Centre ID as provided by 0119 the Authority: Date of inspection: 08 January 2010 Date of response: 07 February 2010 1. The provider is failing to comply with a regulatory requirement in the following respect: The statement of purpose does not meet the requirements of Regulation 5 and Schedule 1 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. Action required: Review the draft statement of purpose to ensure compliance with requirements in Schedule 1 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. Submit the document to the Authority within agreed time scales. Reference: Health Act, 2007 Regulation 5: Statement of Purpose Standard 28: Purpose and Function Please state the actions you have taken or are planning to take with timescales Timescale 10
Provider response: The Statement of Purpose is now complete and complies with requirements in Schedule 1 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. Resident s Guide/Information Booklet is also complete and a copy has been given to each resident. A copy of both documents and the staff nurses PIN numbers are in the post to you. Complete Complete Complete 2. The provider is failing to comply with a regulatory requirement in the following respect: The policies reviewed do not comply with Regulation 27 and Schedule 5 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. Action required: Continue with policy review and updated to comply with Regulation 27 and Schedule 5 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009. Ensure process is complete within agreed time scales. Reference: Health Act, 2007 Regulation 27: Operating Policies and Procedures Standard 29: Management Systems Please state the actions you have taken or are planning to take with timescales Timescale Provider response: Policies are being reviewed and up-dated on an on-going basis. New policies are in draft form. All relevant policies will be complete and implemented by the end of March 2010. March 2010 11
3. The provider is failing to comply with a regulatory requirement in the following respect: There are inadequate sluicing facilities. Action required: Provide a bed pan washer in the sluice room within agreed time scale. Reference: Health Act, 2007 Regulation 19: Premises Standard 25: Physical Environment Please state the actions you have taken or are planning to take with timescales Timescale Provider response: Bed- pan washer is now installed and in use. Complete 12