Nursing home ‘non-compliant’ on some issues

A NURSING home in South-East Clare was found to be non-compliant with some regulations in an unannounced inspection at the facility recently.
In a report published on Tuesday, inspectors from the Health, Information and Quality Authority (HIQA) detailed “issues of significant concern” at the Athlunkard House Nursing Home in Westbury.
HIQA carried out the inspection on April 21 as a follow-up to an inspection that took place in January, when 19 issues were identified that needed to be addressed. Inspectors found that seven of these had been fully dealt with, seven others were partially addressed and the remaining five, relating to governance and management, restraint management and medication management were not satisfactorily dealt with.
While the inspectors noted that many of the issues relating to medication management identified during the January inspection had been addressed, there were “further issues of significant concern during this inspection with regard to the documentation of medicines administered in the centre”.
According to the report, inspectors were “concerned that there were still inadequate governance arrangements in place to maintain oversight of medication management, clinical assessment and nursing documentation”. These areas were identified as having “major non-compliance” with regulations.
It also found that the nursing home’s policy on use of restraint was not fully implemented or reflected in practice, stating that the restraint register did not include details of residents with chemical restraint measures.
“Risk assessments for the use of restraint were not fully completed, the alternatives tried or considered and for how long were not always included, rationale for use of restraint was not always clear and there was no evidence to indicate that there had been multidisciplinary input into the decision to use restraint measures, as per the centre’s policy on the use of restraint,” inspectors found.
According to the report, “There was no risk assessment carried out prior to using a particular restraint measure in the case of one resident”.
The inspectors expressed concerns that “a resident with bedrails in place had been assessed as being high risk, the assessment indicated ‘do not fit bedrails’ and there was no clear rationale documented or evidence of multidisciplinary input into the decision-making process to use the bedrail”.
On the day of inspection, the number of staff present and their mix of skills were found to be sufficient.
“The communal areas were appropriately furnished and the décor was pleasant” and residents were observed taking part in a variety of activities.
The report also stated that “the collective feedback from residents was one of satisfaction with the service and care provided” and they described staff as “very kind and helpful”.
An action plan was also published outlining what the nursing home must do to be compliant with legislation.
The nursing home provider, Killure Bridge Nursing Home Partnership, responded to this outlining what actions it would take and the timescale in which these would be carried out. The reply stated that a revised statement of purpose submitted to the authority by May 25 and in an effort to address “inadequate governance arrangements” added that a new assistant director of nursing, another clinical nurse manager and a part-time practice development co-ordinator will be hired by July 31 to ensure service is effectively monitored.
By the end of last month, all confidential records were to be relocated to a locked room and a complaints procedure was updated and is now in line with the policy.
In relation to the use of restraints, the response from the nursing home stated that a review had been carried out on all cases where restraint is in use “to ensure that documentation to include risk assessment, multidisciplinary input and so on is correct, guides practice and is now in line with policy. The restraint register has been updated accordingly.”
The risk register at the home was updated to include hazards identified by HIQA inspectors and controls put in place.
In the area of medical management, “major non-compliance” with regulations was identified after inspectors noted that where medications were missing from the monitored dosage system, “many were not accounted for in residents’ medication administration sheets” and “nursing staff spoken to were unable to account for when or to whom these medications were administered to”.
The HIQA report also found discrepancies between the prescription sheet and the medication administration sheet and a medicinal product that should have been stored in the fridge was stored on the medication trolley, on the day of the inspection.
The nursing home’s response said it had reviewed and enhanced the documentation and recording of PRN (as needed) psychotropic medication administered, adding that “all medications are now clearly accounted for” and nursing staff have been reminded about correct storage of medications.
It also conducted a review of prescription sheets and medication administration records to ensure there are no discrepancies. The response also stated that a review and update of care plans for its 97 residents was taking place and would be finished by the end of June.