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Report of an inspection of a Designated Centre for Older People Name of designated centre:

Droimnin Nursing Home

Name of provider: Droimnin Nursing Home Limited Address of centre: Brockley Park, Stradbally,

Laois

Type of inspection: Unannounced Date of inspection: 21 May 2018 Centre ID: OSV-0000702 Fieldwork ID: MON-0024050

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About the designated centre

The following information has been submitted by the registered provider and describes the service they provide. Droimnin Nursing Home is a designated centre for older people. The centre has two buildings that are purpose built. The centre provides accommodation for a maximum of 101 male and female residents, over 18 years of age. Residents are admitted on a long-term residential, respite and convalescence basis. The centre is located at the end of a short avenue in from the road and within walking distance to Stradbally, Co Laois. A variety of communal rooms are provided for residents' use including sitting, dining and recreational facilities. The residents in building one have access to an enclosed courtyard. Each resident's dependency needs are assessed to ensure their care needs are met. The following information outlines some additional data on this centre.

Current registration end date:

21/12/2019

Number of residents on the date of inspection:

81

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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.

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This inspection was carried out during the following times: Date Times of

Inspection Inspector Role

21 May 2018 17:00hrs to 21:00hrs

Una Fitzgerald Lead

22 May 2018 09:00hrs to 14:30hrs

Una Fitzgerald Lead

21 May 2018 17:30hrs to 21:00hrs

Leanne Crowe Support

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Views of people who use the service

Inspectors spoke with residents individually and in small groups. The feedback and comments were complimentary of the staff and management within the centre. All residents confirmed that they felt safe and well cared for by staff who knew their individual likes and dislikes.

The residents were highly complimentary of the food served and the choices available.

Residents were kept informed of changes that occur within the centre as evidenced from the resident meetings. Residents spoken with said that they would not hesitate to make a compliant. Inspectors spent time sitting in the communal areas observing the interaction between staff and residents. Overall the atmosphere was calm and staff were available to support residents at all times.

Capacity and capability

The governance and management within this centre have good structures in place that ensure the care delivered is safe, appropriate, consistent and effectively monitored. This inspection was unannounced following receipt of unsolicited information. Overall, inspectors were satisfied that the centre is in good compliance with the regulations. The records and documents requested by the inspectors was made available in a timely manner and presented in an easily understood format. Since the last inspection in January 2018 the systems that were put into place have been bedded down. This was evidenced by:

• A comprehensive auditing schedule was in place. Each audit identified areas for improvement and appropriate actions were taken to ensure that changes required are followed up and communicated to staff.

• The management team had a detailed risk register in place that is kept under constant review and discussed at management meetings. Hazards identified were risk rated and additional control measures in place were documented.

• The was a training and development programme in place for all staff. The training in place met with regulatory requirements. In addition, the management team had carried out performance appraisals with staff.

Inspectors reviewed the complaints log within the centre. Overall complaints received since the last inspection were minimal. The documents in place evidenced that all complaints were followed up as per the centre policy which is in line with best practice guidelines and meets regulatory requirements. The level of satisfaction

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of the complainant was also documented.

Staff had access to a range of mandatory and supplementary training relevant to their role in the centre. There were appropriate staff numbers and skill-mix to meet the assessed needs of residents, and the safe delivery of services. As a result of resident care needs, an additional staff member had been allocated to the large communal area in one of the buildings. This extra resource was utilised to supervise residents, engage with them in a meaningful way and ensure that residents received assistance in a timely manner. Inspectors found this change had positively impacted on residents.

Inspectors spoke with multiple staff over the two days of inspection. Staff confirmed that the staffing compliment had stabilised. This impacted positively as staff knew residents care needs. Staff informed inspectors that they would not hesitate to bring any issue concerning a resident to the attention of the person in charge and had confidence in management to take action if required. The staff confirmed that the nursing management team have a presence in each building and were readily available for support.

Regulation 15: Staffing

There were adequate numbers of suitably skilled staff to meet the assessed needs of residents. There was at least one registered nurse available in the centre at all times. Judgment: Compliant

Regulation 16: Training and staff development

Staff had access to appropriate training and were well supervised. Judgment: Compliant

Regulation 19: Directory of residents

The directory of residents was up to date and contained all the information specified in paragraph (3) of schedule 3 Judgment: Compliant

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Regulation 21: Records

The inspector reviewed staff files and found full compliance with Schedule 2 regulation requirements. Judgment: Compliant

Regulation 23: Governance and management

There was a clearly defined management structure that identified the lines of authority and accountability. The systems in place ensured that the service was safe, appropriate, consistent and effectively monitored. The 2017 annual review of the quality and safety of the care delivered to residents was available for review. Judgment: Compliant

Regulation 31: Notification of incidents

The person in charge submitted notifications to HIQA in line with regulatory requirements. Judgment: Compliant

Regulation 34: Complaints procedure

The centre had effective procedures for responding to and recording complaints. The complaints procedure was on display in each building. The residents and the relatives spoken with confirmed that they felt comfortable in making a complaint and they knew who they could contact to do so. Judgment: Compliant

Regulation 4: Written policies and procedures

All of the policies and procedures required by the regulations were available within

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the centre, and had been reviewed in October 2017. These documents were accessible to staff. Judgment: Compliant

Quality and safety

Inspectors found that the centre was providing a good standard of care, support and quality of life for residents. The centre had effective arrangements in place to manage risk and protect residents.

Staff sought consent for care procedures and were observed to be kind and caring in their interactions with residents. There were measures in place to safeguard residents from abuse. A policy dated October 2017 was available and procedures were in place to inform management of any suspicions, allegations or incidents of abuse. Residents told the inspector that they felt safe in the centre.

Residents' assessed needs were addressed by person-centred care plans that reflected their individual preferences and care choices. The documentation in place was easily understood. The inspector found good evidence of consultation between the resident, clinical team and relatives. On admission, all residents had been assessed by a registered nurse to identify their individual needs and choices. The assessment process used validated tools to assess each resident’s dependency level, risk of malnutrition, falls risk and skin integrity. Clinical observations such as blood pressure, pulse and weight were assessed on admission and as required thereafter. Further review of the documentation and recording of wound management practices and procedures was required. There were good systems in place to ensure that appropriate referrals were made to allied healthcare professionals.

A positive approach was taken to support residents with responsive behaviours (how people with dementia or other conditions may communicate or express their physical discomfort, or discomfort with their social or physical environment). Files reviewed had detailed, person-centred behaviour support care plans in place that clearly identified their support needs and informed prevention management strategies.

The clinical management team informed the inspector that they were actively promoting a restraint-free environment. There was good evidence that the number of residents using bedrails had reduced. A review of the assessment tool that guides the clinical team on the need for bedrails is required. Although there was less restrictive alternatives available such as low low beds and crash mats, there was poor evidence of alternatives tried prior to using bedrails. The documentation in place regarding bedrails used did have signed consent and residents were monitored on a two hourly basis.

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Staff nurses administering medicines were patient and took time with individual residents. The pharmacist responsible for dispensing residents' medicines was facilitated to meet their obligations. Medicines management in the centre was audited by the nursing management and by an external provider. Residents' medicines were prescribed and regularly reviewed by their doctor. The inspector requested a review of practices on the disposal of unused medicines, as a large number of unused antibiotic medications was found in one clinical room.

Residents were supported to experience a good quality of life in this centre. The inspector observed that the privacy and dignity of each resident was respected. The choices they made in relation to their lives were facilitated on a daily basis. Residents spoke very highly of the food served and said there was plenty of choice. Inspectors observed the dining experience. The atmosphere was relaxed and there was good open communication and engagement with residents.

Compassionate, sensitive and supportive care from staff positively impacted on wellbeing and quality of life in the centre.

Regulation 18: Food and nutrition

Residents were provided with a varied, wholesome and nutritious diet that was reviewed by a nutritionist. Residents' special dietary requirements and their personal preferences were complied with. Fresh drinking water, snacks and other refreshments were available at all times. Judgment: Compliant

Regulation 25: Temporary absence or discharge of residents

A review of records and care plans conveyed that essential information was provided by staff when residents moved from one facility to another. Judgment: Compliant

Regulation 26: Risk management

The risk policy was last updated in October 2017 and contained all of the requirements set out under Regulation 26(1). The risk register was kept under

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review by the management team. Judgment: Compliant

Regulation 27: Infection control

The procedures in place for managing the prevention and control of infection were in line with National Standards.

Residents' conformed that their bedrooms were cleaned daily and deep cleaning was carried out regularly. There were hand hygiene alcohol dispensers strategically placed along all corridors. Staff were knowledgeable on the colour-coded system in place to minimise the risk of cross infection. Judgment: Compliant

Regulation 28: Fire precautions

While a number of staff required up-to-date training in fire safety, inspectors were informed that these staff were scheduled to attend training in the week following the inspection. All staff had received orientation to fire evacuation procedures during induction process. Judgment: Compliant

Regulation 29: Medicines and pharmaceutical services

Medication management policies were in place to guide practice. Medicine management practices were audited. Inspectors observed that medicine trolleys were not consistently locked. A review of the practices on disposal on unused medications was required. Judgment: Substantially compliant

Regulation 5: Individual assessment and care plan

Residents care records showed that pre-admission assessments were completed, care plans were put in place and reviews took place every four months. Inspectors

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reviewed care plans and documentation specific to the management of wound care. Improvement in the documentation and practice was required as there was significant gaps in some files. Judgment: Substantially compliant

Regulation 6: Health care

Residents’ healthcare needs were met through timely access to treatment and therapies. Residents have access to a general practitioner (GP) and allied healthcare professionals. There was good evidence within the files that advice from allied healthcare professionals was acted on in a timely manner. Judgment: Compliant

Regulation 7: Managing behaviour that is challenging

There were systems in place to assess if bedrail usage was appropriate. Documentation in place did not evidence if less restrictive alternatives had been trialled before bedrails were used. Judgment: Substantially compliant

Regulation 8: Protection

There were systems in place to support the identification, reporting and investigation of allegations or suspicions of abuse. All staff had received training in the prevention, detection and response to abuse. Judgment: Compliant

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Appendix 1 - Full list of regulations considered under each dimension 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 Compliant Regulation 23: Governance and management Compliant Regulation 31: Notification of incidents Compliant Regulation 34: Complaints procedure Compliant Regulation 4: Written policies and procedures Compliant Quality and safety Regulation 18: Food and nutrition Compliant Regulation 25: Temporary absence or discharge of residents Compliant Regulation 26: Risk management Compliant Regulation 27: Infection control Compliant Regulation 28: Fire precautions Compliant Regulation 29: Medicines and pharmaceutical services Substantially

compliant Regulation 5: Individual assessment and care plan Substantially

compliant Regulation 6: Health care Compliant Regulation 7: Managing behaviour that is challenging Substantially

compliant Regulation 8: Protection Compliant

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Compliance Plan for Droimnin Nursing Home OSV-0000702 Inspection ID: MON-0024050 Date of inspection: 21 & 22/05/2018 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 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 29: Medicines and pharmaceutical services

Substantially Compliant

Outline how you are going to come into compliance with Regulation 29: Medicines and pharmaceutical services: Meeting held with all Nurses to ensure that medicine trolleys are locked and stored securely at all times and keys are held with the nurse. The PIC will ensure that all medications belonging to Residents that are discharged/deceased will be returned to pharmacy in accordance with National legislation CNM’s have been briefed by the PIC to carry out Audits on same. Regulation 5: Individual assessment and care plan

Substantially Compliant

Outline how you are going to come into compliance with Regulation 5: Individual assessment and care plan: Meeting held with all nurses regarding their obligation to implement Person Centered Care plans re the management of wound care specific to each Resident’s needs. Wound care documentation has been improved since inspection to ensure that documentation does is completed correctly. Regulation 7: Managing behaviour that is challenging

Substantially Compliant

Outline how you are going to come into compliance with Regulation 7: Managing behaviour that is challenging: Since inspection all Nurses have received additional training to ensure staff have up to

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date knowledge and skills in relation to alternative/less restrictive options before bed rails are implemented. Nurses have received information and guidance on principles of good practice which comply with the Department of Health’s Policy set out in “Towards a restraint free environment in Nursing homes”.

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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 29(6) The person in charge shall ensure that a medicinal product which is out of date or has been dispensed to a resident but is no longer required by that resident shall be stored in a secure manner, segregated from other medicinal products and disposed of in accordance with national legislation or guidance in a manner that will not cause danger to public health or risk to the environment and will ensure that the product concerned can no longer be used as a medicinal product.

Substantially Compliant

Yellow 01/06/2016

Regulation 5(1) The registered provider shall, in

Substantially Compliant

Yellow 01/06/2018

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so far as is reasonably practical, arrange to meet the needs of each resident when these have been assessed in accordance with paragraph (2).

Regulation 7(3) The registered provider shall ensure that, where restraint is used in a designated centre, it is only used in accordance with national policy as published on the website of the Department of Health from time to time.

Substantially Compliant

Yellow 08/06/2018