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Report of an inspection of a Designated Centre for Older People Issued by the Chief Inspector Name of designated centre:
Beechwood Nursing Home
Name of provider: Maisonbeech Limited
Address of centre: Rathvindon, Leighlinbridge, Carlow
Type of inspection: Announced
Date of inspection:
05 November 2019
Centre ID: OSV-0000199
Fieldwork ID: MON-0022750
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About the designated centre
The following information has been submitted by the registered provider and describes the service they provide. Beechwood Nursing Home is a purpose-built, single-storey residential service for male and female persons over 18 years of age and is located within close proximity to the town of Leighlinbridge and across the road from a busy arboretum. The designated centre provides accommodation for 59 residents in 55 single and two twin bedrooms. Full ensuite facilities were provided in 30 single bedrooms. Sufficient toilet and shower facilities were conveniently located throughout the centre to meet residents' needs. Accommodation for residents is provided at ground floor level throughout. The centre has a number of communal facilities including two dining rooms and three sitting rooms, one of which could be subdivided to meet residents' activity needs. The centre provides long-term, respite and convalescence care for residents with chronic illness, dementia and palliative care needs. The provider employs a staff team in the centre to meet residents' needs consisting of registered nurses, care assistants, maintenance, housekeeping and catering staff. The following information outlines some additional data on this centre.
Number of residents on the
date of inspection:
55
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How we inspect
This inspection was carried out to assess compliance with the Health Act 2007 (as amended), the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (as amended), and the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2015 (as amended). To prepare for this inspection the inspector of social services (hereafter referred to as 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.
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This inspection was carried out during the following times:
Date Times of
Inspection
Inspector Role
Tuesday 5 November 2019
09:15hrs to 17:00hrs
Catherine Rose Connolly Gargan
Lead
Tuesday 5 November 2019
09:15hrs to 17:00hrs
Margo O'Neill Support
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What residents told us and what inspectors observed
Inspectors met with residents and some relatives who were in visiting them on the day of the inspection. Twenty two residents returned pre-inspection questionnaires distributed to them on behalf of the Office of the Chief Inspector prior to this inspection. The feedback from residents or family members who assisted them with completing these questionnaires was predominantly positive on all areas of the service. Residents comments included how they liked that there was plenty of natural light in the sitting room and that the gardens and small animals were very nice. Residents commented that they were 'extremely satisfied with all the facilities' 'very happy with their choice of nursing home' and that the centre was 'very homely' and 'an admirable place'. One resident commented that they wanted to go out to the garden more often. This comment was shared with the provider representative and person in charge who gave assurances that they would follow this up.
Residents confirmed they felt very safe. Residents and their relatives all said staff were 'exceptional', great people' and that they felt staff 'really cared about them'. The person in charge was mentioned by several residents regarding her 'kindness', 'respect', 'compassion' and that she treated residents 'like they were her own family'.
Residents told the inspectors they enjoyed the activities and had enough to do. Several residents spoke about the garden off the main sitting room and commented that it was 'beautiful', the 'shrubbery', 'fountain' and 'trees' in the garden were lovely'. One resident said they liked 'to look out at the garden' but did not want to go out into it.
Residents said there was a very easy and comfortable atmosphere in the centre and they could come and go as they wished. They said there was 'always plenty of laughs' and some residents talked about the friends they had made in the centre.
Residents and relatives who spoke to inspectors said they knew they could make a complaint to the person in charge or any other staff member if they were ever dissatisfied. Most said they had never any need to complain and those who did said that the issue they raised was addressed to their satisfaction without any delay.
Residents told the inspectors that they could have their bedrooms as they wished and that they had brought in items of furniture from their own home 'to make their bedroom their own'.
Satisfaction regarding care of residents clothing was expressed in the majority of the 22 pre inspection questionnaires for residents returned. One resident commented that their winter coat was missing and another resident mentioned that they would like their clothes returned to them following laundering faster. However, all other residents confirmed that their clothing was 'perfectly laundered' and 'better than I would do myself'. A small number of residents' families liked to launder
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residents clothing at home and confirmed that their choice was not a negative reflection on the service provided in the centre.
Capacity and capability
This was an announced inspection to monitor ongoing compliance with the Regulations and Standards. Inspectors followed up on notifications and unsolicited information received by the Office of the Chief Inspector since the last inspection in April 2019. Inspectors assessed completion of the compliance plan from the last inspection and found that six of the eight areas of non compliance with the regulations were now compliant. The two remaining areas of non compliance with the regulations were progressed but not completed to compliance on this inspection. These two areas of non compliance are restated in the compliance plan developed from this inspection.
Unsolicited information received regarding infection prevention and control procedures were partially substantiated on this inspection and inspectors' finding are discussed under regulation 27: Infection control in this report.
The centre's management structure was clearly defined and all staff were aware of their roles and responsibilities. Although improved since the last inspection, the management systems in place continued to require improvement to ensure that the systems in place to monitor the quality and safety of the service provided satisfactory assurances and informed continuous quality improvement.
Residents' quality of life in the centre was closely monitored and the provider and management team were committed to ensuring residents enjoyed meaningful and purposeful lives in the centre. The provider representative and person in charge each worked on a full time basis in the centre. This arrangement ensured that they were available to residents and any issues were addressed in a timely way. The person in charge had procedures in place to monitor effectiveness of clinical care delivered to residents and these key clinical indicators evidenced positive outcomes for residents in the service.
Sufficient resources were provided to ensure care was delivered in accordance with the centre's statement of purpose. The provider employed additional staff and adequate numbers of staff were available with appropriate skills to meet the needs of residents. Many staff who spoke with inspectors said they enjoyed caring for residents in the centre and confirmed that they were well supported in their role by senior staff. Staff were appropriately supervised and were facilitated to attend mandatory and professional development training. There was robust recruitment and induction procedures in place. The provider ensured that all staff had completed Garda Vetting before commencing working in the centre as per the National Vetting bureau (Children and Vulnerable Persons) Act 2012.
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Residents contracts regarding the terms and conditions of their residency required improvement to clearly detail an option for residents to opt-out of additional fees charged if they wished.
The majority of records that must be maintained in the centre were in place. The records maintained of restrictions to residents in the centre were incomplete.
Feedback on the service was welcomed and an effective complaints procedure was in place. The procedure was displayed and all expressions of dissatisfaction with the service were recorded and investigated. Complainants were informed of the outcome of investigations and their satisfaction was obtained. An appeals process was in place.
Regulation 15: Staffing
There were appropriate staff numbers and skill mix to meet the assessed needs of residents and as described in the centre's statement of purpose. Since the last inspection, staff roles and responsibilities were reviewed to enhance person-centred care and timely assistance for residents. Inspectors observations and feedback from residents confirmed there were no delays in staff attending to residents personal care and assistance needs.
An actual and planned staffing roster was maintained in the centre with any subsequent changes recorded as necessary. The staffing roster reflected the staff on-duty on the day of inspection and there were arrangements in place to provide cover for any planned or unplanned leave.
No volunteers were operating in the centre at the time of the inspection
Judgment: Compliant
Regulation 16: Training and staff development
Staff training needs were informed by residents' needs and annual staff appraisals completed by the person in charge. A staff training matrix record was maintained to assist the person in charge with monitoring and tracking completion of mandatory and other training done by staff. These staff training records confirmed all staff had completed mandatory training in safeguarding residents from abuse, safe moving and handling procedures and fire safety. Staff were also facilitated to attend professional development training to ensure they were skilled in meeting the needs of residents in the centre. A wide training programme was made available to staff and ensured staff in the centre attended training in dementia and supporting responsive behaviours, falls prevention, care planning, infection control,
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venepuncture procedures, medication management, end-of-life care, nutrition and health and safety.
All staff were supervised on an appropriate basis, and recruited, selected and vetted in accordance with best practice and legislative requirements. A staff recruitment policy was available and included details of the induction process for each staff grade. Induction of new staff was closely monitored by the person in charge and all staff were appropriately supervised in accordance with their roles.
Judgment: Compliant
Regulation 19: Directory of residents
The directory of residents was made available to the inspector. The centre maintains a directory of residents that is inclusive of all information required by the Regulations.
Judgment: Compliant
Regulation 21: Records
A sample of staff files were examined by inspectors and were found to meet the requirements of the Regulations. An Garda Siochana (police)vetting disclosures were available in the staff files examined. The provider representative gave assurances that all staff had completed satisfactory vetting in accordance with the National Vetting Bureau (Children and Vulnerable Persons) Act 2012 and their staff files contained the necessary disclosure documentation. All nursing staff had up-to-date professional registration with An Bord Altranais agus Cnáimhseachais na hÉireann.
A record of simulated emergency evacuation drills, tests of fire equipment. Documentary evidence was available regarding quarterly servicing of the fire alarm system and the centre's emergency lighting. A record of completed emergency evacuation drills was maintained.
Daily records of each resident's condition and treatments received was maintained by night and day nursing staff.
A register of any restrictive procedures used in the centre was maintained and made available to the inspectors. The register did not include a record of all physical and environmental restrictions in the centre. For example, some residents had lap belts fitted while in assistive chairs and the exit doors out of the centre were secured and accessible with a swipe card.
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Judgment: Substantially compliant
Regulation 22: Insurance
Confirmation of up to date insurance valid until 31 May 2020, as required by the Regulations was made available to the inspectors.
Judgment: Compliant
Regulation 23: Governance and management
The governance and management structure in the centre was clear. The roles and responsibilities of staff were defined and staff were aware of their individual roles and responsibilities in the service. Regular governance and management meetings were convened to review the quality and safety of the service. These meetings were attended by the provider representative and the minutes made available to inspectors, referenced review of key areas of the service including findings of audits done to progress improvements identified as necessary. However, the management systems in place did not provide sufficient assurances regarding residents' safe evacuation in an emergency.
Systems were in place to ensure the quality and safety of the service was monitored and these systems were strengthened since the last inspection with improved auditing of the service. Inspectors found that all audits done were appropriately analysed and confirmed that several improvements identified as necessary were completed. The person in charge monitored clinical effectiveness in the service. Information on key areas, such as resident falls, infections, antibiotic usage, skin integrity, hospital transfers and weight management among others was collated and analysed. Actions were detailed and inspectors confirmed that they were completed. However, as action plans were not consistently developed detailing the areas identified as needing improvement, persons responsible and completion dates, this process did not provide comprehensive assurances that actions were completed or comprehensively inform continuous quality improvement in the service.
A report detailing an annual review of the quality and safety of the service and quality of life for residents was done in consultation with residents and was available for 2018.
Judgment: Not compliant
Regulation 24: Contract for the provision of services
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Contracts for the provision of care were available for each resident. An explanatory reference document was prepared by the provider and person in charge to assist residents with the information in their contracts. Residents' contracts of care outlined the terms and conditions of their residency, services to be provided and the fees to be charged to residents in receipt of the 'Fair Deal Scheme' including additional fees. While the provider had arrangements in place to review additional fee charges to individual residents, an opt-out of additional charges was not explicitly stated in residents' contract information. Residents or their family members on their behalf signed the contracts.
Judgment: Substantially compliant
Regulation 3: Statement of purpose
The centre's statement of purpose was revised with some minor amendments and detailed all information as required by Schedule 1 of the Health Act (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013. The statement of purpose described the management and staffing structure, the facilities and the service provided and was reflected in practice in the centre..
Judgment: Compliant
Regulation 31: Notification of incidents
A record of all accidents and incidents involving residents in the centre was maintained. The person in charge submitted required statutory notifications of incidents involving residents to the Chief Inspector within the timescales as specified by the regulations.
Judgment: Compliant
Regulation 34: Complaints procedure
A policy was in place to inform the management of complaints in the centre. Residents' feedback was welcomed and used to improve the service as necessary. Information on the complaints procedure in the centre and accessing support was described in residents' admission packs and at residents' meetings in the centre.
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The complaints procedure was also displayed in the entrance area and provided instruction on making a complaint and the response process thereafter. The person in charge was the designated complaints officer for the centre. The complaint policy and procedure documentation was updated since the last inspection to reference the person in charge as the contact person for managing complaints in the centre.
A person in the centre was nominated to ensure that complaints were responded to appropriately and records were kept as required and this role was detailed in the complaints policy. Complaints received were appropriately recorded, investigated and the outcome was discussed with complainants. The satisfaction of complainants with the outcome of investigations was recorded and an appeals procedure was available.
An independent advocacy service was available to residents to assist them with raising a concern and contact information for this support was clearly displayed.
Complaints were reviewed at the centre's monthly governance and management meetings. Residents who spoke with the inspector confirmed that they were aware of the complaints procedure and said they would express their dissatisfaction or concerns to the person in charge, other staff members or their family.
Judgment: Compliant
Regulation 4: Written policies and procedures
The centre's operating policies and procedures were made available to th inspector. Policies and procedures were centre-specific and included policies as required by Schedule 5 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013. All policies were reviewed and updated at intervals not exceeding three years to ensure the information in them reflected best practice.
Judgment: Compliant
Quality and safety
Inspectors were assured that residents' needs were met and they enjoyed a good quality of life in the centre. Residents' nursing needs were met to a good standard and there were significant improvements made regarding the quality and content of residents' care plans since the last inspection. All residents' needs were addressed with care plans that clearly informed the care interventions that were of priority for them and reflected their individual preferences and wishes. Each resident's
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healthcare needs were met by a general practitioner of their choice. Staff who spoke with the inspectors knew residents' well and were knowledgeable regarding their individual needs. The person in charge and staff had developed good relationships with residents and were committed to ensuring their care was provided to a high standard. Good access to allied health professionals was put in place by the provider. A physiotherapist employed by the provider attended residents one day each week in the centre. This arrangement optimised residents' independence, good health and safe mobility.
Residents with behaviours and psychological symptoms of dementia (BPSD) were well supported by their GP, staff in the centre and community psychiatry of later life services. A minimal restraint environment was promoted and efforts were ongoing to reduce use of full-length bedrails. An information leaflet on use of bedrails was prepared by the centre for residents and their relatives to support staff efforts to reduce bedrail use in the centre. Residents told inspectors that they felt safe in the centre and spoke positively about the staff team and management in the centre. Staff were facilitated to attend training on safeguarding residents from abuse and clearly articulated their responsibilities regarding any suspicions, disclosures or incidents of abuse they may witness.
The provider promoted a proactive approach to managing risk in the centre and had appropriate measures and procedures in place to ensure residents health and safety needs were met. Some improvements were necessary to ensure hazard identification and assessment was comprehensive. Residents were protected from risk of fire in the centre. However, the information recorded in simulated emergency evacuation drills did not provide sufficient assurances that the emergency evacuation needs of residents would be met. Staff who spoke with the inspector were knowledgeable regarding the emergency evacuation procedures in the centre. Fire safety management procedures and equipment were in place and all staff were facilitated to attend fire safety training and evacuation procedures.
The layout and design of the centre premises met residents' individual and collective needs to a good standard. The centre was visibly clean and in a good state of repair. Residents' accommodation was comfortable and provided them with an accessible and homely living environment. Enclosed outdoor areas were freely available to residents . The provider valued residents' views and provided them with opportunities to participate in the running of the centre and any works done to the premises
Residents were provided with choices about how they spent their day, where they ate their meals, the activities they participated in, the time they retired to bed and the time they got up in the mornings. Improvements made since the last inspection ensured all residents had access to meaningful activities that met their individual and collective interests and capabilities.
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Regulation 11: Visits
There was an open visiting policy in place in the centre. Visitors were welcomed and residents were facilitated to meet their visitors private if they wished in several private areas outside of their bedroom available throughout the centre.
Staff controlled access to the centre and a record of all visitors to the centre was maintained to ensure residents were appropriately safeguarded.
Judgment: Compliant
Regulation 12: Personal possessions
Residents were provided with adequate storage space for their clothing and personal belongings and they were supported to access and maintain control over their property.
A laundry service was provided in the centre for residents and their clothing was laundered appropriately. The layout and design of the laundry generally reflected best practice standards. Residents' clothing was discretely labeled to ensure safe return to each resident. Residents' clothes were observed by the inspectors to be clean, ironed and well cared for.
Each resident was provided with a lockable space in their bedroom for secure storage of their valuable possessions if they wished. The provider kept small amounts of money in safekeeping on behalf of some residents for their day-to-day expenses and acted as pension agent for collection of four residents pensions. Inspectors examined the procedures in place and found that comprehensive records of transactions were maintained and balances were correct. The arrangements for collection of residents' social welfare pensions reflected legislative requirements.
Judgment: Compliant
Regulation 13: End of life
Staff provided end-of-life care to residents, with the support of the resident's GP and the community palliative care service. There were no residents in the service on the day of inspection receiving end-of-life care. Residents were given sufficient opportunities to express and have their end-of-life wishes met regarding their physical, psychological and spiritual needs. The person in charge ensured that residents were involved in decisions regarding their end-of-life care.
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While, most residents in the centre resided in single bedrooms, arrangements were in place to ensure residents in two twin bedrooms were accommodated in a single bedroom if end-of-life care was necessary. Residents’ relatives were facilitated to stay overnight with them when they became very ill. A kitchenette was provided that was available to residents' relatives during this time. Staff outlined how residents' religious and cultural practices and faiths were facilitated to inspectors and provided assurances that members of the local clergy from the various religious faiths were available to and provided pastoral and spiritual support for residents as they wished.
Judgment: Compliant
Regulation 17: Premises
The layout and design of the centre met the individual and collective needs of residents and provided them with a therapeutic, comfortable and homely living environment.
Residents’ bedrooms were bright and clean and residents’ were encouraged to personalise their bedrooms with their own pieces of furniture, paintings, pictures and soft furnishings. There was sufficient storage for residents’ clothes and possessions. Single bedrooms also had enough space for equipment such as hoists to be used, with sufficient space to access beds from either side. The two twin bedrooms in the centre were used to accommodate one resident only in each twin bedroom on the day of inspection. As one of these residents had a lot of assistive equipment, this arrangement met their needs. However, inspectors were not assured that the needs of two residents with assistive equipment needs would be met due to the layout and design of these two bedrooms. The provider had arrangements in place that only one resident with assistive equipment needs or two residents admitted on a respite basis would be accommodated in these two bedrooms. This arrangement was described in the centre's statement of purpose.
The sitting and dining areas were spacious and brightly decorated with furniture and fittings that were familiar to residents with dementia. For example, an old style kitchen dresser in the dining room had traditional china tea sets and crockery on display. The larger of the two sitting rooms could be divided into smaller areas and functioned as the main communal area for residents. The smaller sitting room was decorated in a comfortable library style. The bigger sitting room was brightly decorated with pictures and old style memorabilia, all of which encouraged residents to reminiscence. There were large wall hangings, ornaments, old photographs and posters displayed on the walls. Hand bags, scarves and items of costume jewellery were hanging on hooks for residents to pick up if they wished. Seating and tables for residents were arranged in clusters to encourage conversations between residents.
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Handrails were in place along all circulating corridors and grab rails were fitted in toilets and showers to maximise residents' functional ability and safety. Residents' access throughout the centre was optimised with bright floor covering , good use of natural light and appropriate signage throughout.
The arrangements for storing residents' assistive equipment was reviewed since the last inspection and inspectors found that sufficient storage was now provided for residents' equipment.
Judgment: Compliant
Regulation 18: Food and nutrition
Residents nutrition and hydration needs were assessed and were met. A validated assessment tool was used to screen residents' risk of malnutrition and dehydration on admission and regularly thereafter. Residents' weights were checked routinely on a monthly basis and more frequently if they experienced unintentional weight loss or gain. There were no residents with unintentional weight loss or gain of concern on the days of inspection and procedures were in place to support residents with poor fluid and food intake.
Residents meals were served in two dining rooms. Mealtimes were social occasions for residents in the centre. Efforts were made by staff to ensure residents were seated with friends they had made in the centre. Residents had timely and appropriate access to speech and language therapy and dietitian services as necessary. Special diets were communicated to the Chef. Meal preparations were provided as recommended for residents with swallowing difficulties, with unintentional weight loss or gain and for residents with medical conditions such as diabetes. Residents' dietary recommendations were described in their care plans to ensure they were communicated to all staff. Snacks and refreshments were provided for residents throughout the day and they had a choice of hot meals or alternatives to the menu for lunch and tea.
There were sufficient staff available to supervise residents in the dining room and meet their needs for assistance with meals as necessary.
Judgment: Compliant
Regulation 20: Information for residents
A residents' guide document was made available to residents and includes a summary of the services and facilities available in the centre. Each resident was provided with a copy of the residents' guide document for their information.
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Judgment: Compliant
Regulation 26: Risk management
The health and safety of residents, visitors and others was promoted and protected by proactive risk management procedures in the centre. An up-to-date safety statement and risk management policy was in place. However, the risk management policy did not reference the process for assessing the level of risks identified.
The centre's risk management policy included the measures and actions to control the risks specified in regulation 26(1)(c). While, the majority of hazards in the centre were identified, risk assessed and documented in the centre's risk register, this required some improvement to ensure all hazards were identified and that controls effectively mitigated levels of assessed risk. Arrangements were in place to identify, record, risk assess and investigate adverse events involving residents or others. Areas needing improvement were actioned and learning identified was implemented.
All residents' moving and handling procedures were completed in accordance with best practice procedures. Robust procedures were implemented since the last inspection to ensure staff competence in safe moving and handling of residents. The centre's physiotherapist was involved in staff training in safe moving and handling procedures and assessment of competence. Each resident's assessed moving and handling procedures and staff guidance documentation comprehensively informed residents' care procedures.
An emergency plan including the procedures to be followed for emergency evacuation of the centre was prepared and available to inform response to any major incidents that posed a threat to the lives of residents.
Judgment: Substantially compliant
Regulation 27: Infection control
A policy informing infection prevention and control procedures was available and included management of communicable infections and any infection outbreaks. Hand hygiene dispensers were located at convenient locations throughout the centre. Staff were facilitated to attend training in hand hygiene and procedures consistent with the national standards.
Inspectors observed that some staff practices did not reflect the national infection prevention and control standards regarding handling and disposal of used sanitary wear. While an audit was done of infection prevention and control in the centre, this
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audit did not review the areas as found by inspectors. These findings were discussed with the provider representative and person in charge at the inspection feedback meeting.
The majority of residents in the centre were accommodated in single bedrooms, approximately 50% of which had full en-suite facilities. The cleaning system in place reflected best practice cleaning procedures.
Judgment: Substantially compliant
Regulation 28: Fire precautions
Procedures and practices were in place to protect residents from risk of fire in the centre. Fire fighting equipment was in place throughout the building and emergency exits were clearly displayed and free of any obstruction. Arrangements were in place to carry out daily and weekly fire safety equipment checking procedures and no gaps were noted. The centre's fire alarm was sounded on a weekly basis to check that it is operational at all times. Arrangements were in place for quarterly and annual servicing of emergency fire equipment including emergency lighting by a suitably qualified external contractor. The centre's fire safety contractor also provided an on-call repair service. A sheltered smoking area for residents was equipped with appropriate fire prevention and extinguishing equipment.
Progressive horizontal evacuation arrangements were in place if necessary. A floor plan of the premises that identified compartmentation was displayed by the fire alarm to inform evacuation procedures. Each resident's emergency evacuation and supervision needs were assessed and this information was readily accessible in the event of an emergency. While, simulated timely evacuation drills were completed to test the efficacy of day and night time conditions including staffing arrangements, the information in the records regarding the evacuation procedures completed was not sufficient. For example, information was not included regarding the compartment evacuated, steps in the procedure followed and assurance that the evacuation needs of residents in the bedrooms evacuated was simulated. This finding did not provide sufficient assurances regarding residents' safe evacuation in the event of an emergency in the centre.
Staff who spoke with inspectors were aware of the emergency procedures including evacuation of residents to a place of safety. All staff were facilitated to attend fire safety training and to participate in a simulated evacuation drill.
Judgment: Not compliant
Regulation 5: Individual assessment and care plan
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Each resident’s needs were comprehensively assessed on admission and regularly thereafter. Staff used a variety of accredited assessment tools to assess each resident’s risk of falling, malnutrition, pressure related skin damage, activity and their mobility support needs. This information was used to detail the support and assistance interventions needed by each resident in their care plan.Residents' care plans were very person-centred and clearly described residents’ individual preferences and wishes regarding their care procedures. Minor improvement was necessary to ensure the recommended fluid intake over 24hours was stated for residents with assessed risk of dehydration. However, residents' fluid intake was closely monitored and timely action was taken if not satisfactory. The person in charge gave assurances that this information would be detailed in residents' care plans.
Inspectors observed that residents were closely monitored for any deterioration in their health and well being and where deterioration was identified, timely interventions and specialist support were sought and implemented. The frequency of blood glucose sampling, optimal blood glucose parameter levels and the actions that must be taken if blood glucose results are outside of these parameters were described in the care plans of residents with a diagnosis of diabetes.
Staff who spoke with inspectors were knowledgeable regarding residents' individual needs and their care preferences.
Residents' care plan were regularly reviewed and updated as necessary. Inspectors were told that where possible, residents, or their families on their behalf were involved in their care plan development and subsequent reviews but records were not consistently maintained of this consultation process.
Judgment: Compliant
Regulation 6: Health care
Residents were provided with timely access to medical and allied health professional services as necessary. Residents in the centre were cared for by general practitioners from a local practice as they wished. An out-of-hours on-call emergency medical service was also available to residents if necessary.
The provider employed a physiotherapist who attended the centre one day each week. The physiotherapist was involved in assessment of residents on admission, post a fall incident and in an exercise programme to optimise their health and independence. The centre's physiotherapist was also involved in assisting staff with reducing bedrail use, staff training on risk assessment and prevention strategies and in moving and handling assessments. This level of input by the physiotherapist in residents' care resulted in positive outcomes for their ongoing health and wellbeing. Community occupational therapy and speech and language therapy
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services attended residents in the centre regularly. In the absence of timely access to community dietician services, the provider had arrangements in place to ensure there were no delays to residents accessing a dietician which was free of charge to eligible residents. Chiropody, dental and optical services were available to residents as necessary. Community psychiatry of older age and palliative care services were available to residents on referral, as appropriate.
Residents were supported and facilitated to attend out-patient appointments and were given opportunity and supported to access national health screening programmes.
Judgment: Compliant
Regulation 7: Managing behaviour that is challenging
A small number of residents with dementia were periodically predisposed to episodes of responsive behaviours (how people with dementia or other conditions may communicate or express their physical discomfort, or discomfort with their social or physical environment). There were systems in place to support residents with managing any episodes of responsive behaviours that they experienced. Staff in the centre were facilitated to attend training in dementia care and managing responsive behaviours.
Residents at risk of responsive behaviours were well-supported by staff who knew them well and implemented person centred de-escalation strategies as necessary. Behavioural support care plans were developed for residents with responsive behaviours that detailed the triggers to behaviours and effective person-centred de-escalation strategies to guide consistency in care procedures. Inspectors recommended some minor improvements to the layout of this behaviour support information to improve accessibility. The details of any episodes of responsive behaviours experienced by residents were recorded to inform their treatment plans
A minimal restraint environment was promoted and the person in charge and staff team were working to reduce use of bedrails in the centre. Arrangements were in place to ensure the impact of any restrictive procedures and the period of time in place was minimised. Details of alternatives tried before a decision was made for use of full length bedrails were recorded. Risk assessments were completed to ensure each resident's safety when using a bedrail.
Judgment: Compliant
Regulation 8: Protection
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There were systems and procedures in place to ensure residents were safeguarded and protected from abuse. Staff were facilitated to attend training in recognising and responding to a suspicion, incident or disclosure of abuse. Staff who spoke with inspectors were knowledgeable regarding the different kinds of abuse and how evidence of abuse may present. All interactions observed by inspectors by staff with residents were respectful, courteous and kind and residents who spoke with the inspector confirmed that they felt safe in the centre.
Judgment: Compliant
Regulation 9: Residents' rights
Residents were encouraged to participate and influence the running of the centre. Their feedback was valued by the provider, person in charge and staff in the centre. Residents' meetings were held monthly and their feedback was seen to be used to inform the service. Residents were very positive in their feedback to the inspectors and in feedback in pre inspection questionnaires regarding the service and their quality of life in the centre.
Since the last inspection, the provider employed an additional activity coordinator to facilitate residents' activities over six days each week. A varied and meaningful activity programme was provided for residents, including activities that were suitable for residents with dementia or other residents unable or unwilling to participate in the scheduled group activities. Residents activities were facilitated in hub arrangements in the main sitting room and this arrangement provided residents with choice regarding the activities they wished to attend. The centre's activity coordinators also prepared an information leaflet to inform individual residents about the activities facilitated in the centre. One part of the main sitting room had a large white screen and this area could be closed off to create a home cinema which several residents enjoyed. Some residents were provided with personal battery operated headphone units so they could listen to their favourite music as they moved around the centre. The person in charge told inspectors that this had positive outcomes for residents predisposed to responsive behaviours. Residents' interests were assessed and used to inform the centre's activity programme. Records of activities that residents participated in and their level of interest in these activities were recorded. This provided assurances that the activities programme was meaningful for individual residents and it met their interests and capabilities. The activity staff ensured that residents who remained in their bedrooms were provided with access to activities that were meaningful to them. Some residents were supported to continue integrate in the local community with bus trips. One resident attended a local day service and another choose to go into the local town on a daily basis. This gave residents opportunities to stay in touch with friends and to keep up-to-date with their local community.
Residents were afforded opportunity to access the outdoors as they wished with provision of two enclosed garden/courtyard areas accessible from communal rooms.
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Outdoor seating was in place at various points along the pathways so residents could rest and relax as they wished.
There was a significant focus on optimising their residents' comfort and familiarity in their living environment. All communal rooms had an abundance of traditional memobilia to make the environment familiar for residents and to encourage their reminiscence.
Residents' privacy and dignity needs were respected. Each resident was accommodated on a single occupancy basis in their bedrooms including residents in the two twin bedrooms in the centre. Some residents liked to leave their bedroom door open and could do so as they wished, as all doors were fitted with self closure devices that ensured bedroom doors closed in the event of an emergency. Staff were observed to knock on residents' bedroom doors before entering and ensured bedroom and toilet/shower doors were closed during residents' personal care procedures. Since the last inspection, the provider ensured that all bedroom, toilet and shower doors were fitted with privacy locks.
Residents were facilitated and supported to meet their wishes regarding practicing their religious faiths. All residents were provided with access to a telephone if they wished. Local and national newspapers and magazines were available to residents.
Judgment: Compliant
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Appendix 1 - Full list of regulations considered under each dimension This inspection was carried out to assess compliance with the Health Act 2007 (as amended), the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (as amended), and the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2015 (as amended) and the regulations considered on this inspection were:
Regulation Title Judgment
Capacity and capability
Regulation 15: Staffing Compliant
Regulation 16: Training and staff development Compliant
Regulation 19: Directory of residents Compliant
Regulation 21: Records Substantially compliant
Regulation 22: Insurance Compliant
Regulation 23: Governance and management Not compliant
Regulation 24: Contract for the provision of services Substantially compliant
Regulation 3: Statement of purpose Compliant
Regulation 31: Notification of incidents Compliant
Regulation 34: Complaints procedure Compliant
Regulation 4: Written policies and procedures Compliant
Quality and safety
Regulation 11: Visits Compliant
Regulation 12: Personal possessions Compliant
Regulation 13: End of life Compliant
Regulation 17: Premises Compliant
Regulation 18: Food and nutrition Compliant
Regulation 20: Information for residents Compliant
Regulation 26: Risk management Substantially compliant
Regulation 27: Infection control Substantially compliant
Regulation 28: Fire precautions Not compliant
Regulation 5: Individual assessment and care plan Compliant
Regulation 6: Health care Compliant
Regulation 7: Managing behaviour that is challenging Compliant
Regulation 8: Protection Compliant
Regulation 9: Residents' rights Compliant
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Compliance Plan for Beechwood Nursing Home OSV-0000199 Inspection ID: MON-0022750
Date of inspection: 05/11/2019 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 non-compliance 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.
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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 Judgment
Regulation 21: Records
Substantially Compliant
Outline how you are going to come into compliance with Regulation 21: Records: A New Restrictive Practice Register has now been compiled and it includes all restrictive practice within the Home. This includes the OT prescribed lap belts and Exit Door.
Regulation 23: Governance and management
Not Compliant
Outline how you are going to come into compliance with Regulation 23: Governance and management: Management Systems have now been addressed. (1) Beechwood has retained the services of an External Evacuation Officer, specialising in Emergency Evacuation Training for all staff. A training schedule has been compiled and the first session was completed post Inspection. (2.) Regarding future Auditing of all our facilities and services: Beechwood is now in the process of installing a computerized Auditing System which will ensure that all actions will be completed. All areas requiring improvement identified, the persons responsible and the completion dates, thus ensuring quality improvement.
Regulation 24: Contract for the provision of services
Substantially Compliant
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Outline how you are going to come into compliance with Regulation 24: Contract for the provision of services: It is now detailed in the Contract of Care and the Resident Information Booklet and Guide that a Resident may choose not to avail of any services being provided by the centre, which are not covered by the Nursing Homes Support Scheme.
Regulation 26: Risk management
Substantially Compliant
Outline how you are going to come into compliance with Regulation 26: Risk management: With regard to future Risk Management of all our facilities and services, Beechwood is now in the process of installing a computerized Risk Management System which will ensure that all processes of assessment will be referenced and controls put in place in order to identify the level of risks involved, thus ensuring quality improvement.
Regulation 27: Infection control
Substantially Compliant
Outline how you are going to come into compliance with Regulation 27: Infection control: Regarding Infection control within the home – a process has been put in place to ensure best practice by staff with regard to handling and disposal of sanitary wear and auditing of same.
Regulation 28: Fire precautions
Not Compliant
Outline how you are going to come into compliance with Regulation 28: Fire precautions: Beechwood has now retained the services of an External Evacuation Officer, specialising in Emergency Evacuation Training for all staff. A training schedule has been compiled and the first session was completed post Inspection. Documentary evidence reflects this.
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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 Regulatory requirement
Judgment Risk rating
Date to be complied with
Regulation 21(1) The registered provider shall ensure that the records set out in Schedules 2, 3 and 4 are kept in a designated centre and are available for inspection by the Chief Inspector.
Substantially Compliant
Yellow
04/12/2019
Regulation 23(c) The registered provider shall ensure that management systems are in place to ensure that the service provided is safe, appropriate, consistent and effectively monitored.
Not Compliant Orange
31/01/2020
Regulation 24(2)(d)
The agreement referred to in paragraph (1) shall relate to the care and welfare of the resident in the designated centre concerned and include details of
Substantially Compliant
Yellow
18/12/2019
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any other service of which the resident may choose to avail but which is not included in the Nursing Homes Support Scheme or to which the resident is not entitled under any other health entitlement.
Regulation 26(1)(a)
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.
Substantially Compliant
Yellow
31/01/2020
Regulation 27 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 implemented by staff.
Substantially Compliant
Yellow
04/12/2019
Regulation 28(1)(d)
The registered provider shall make arrangements for staff of the designated centre to receive suitable training in fire prevention and
Not Compliant Yellow
04/12/2019
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emergency procedures, including evacuation procedures, building layout and escape routes, location of fire alarm call points, first aid, fire fighting equipment, fire control techniques and the procedures to be followed should the clothes of a resident catch fire.
