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A message posted on the lawn of Cahercalla Community Hospital by the residents' families showing their appreciation to the staff there. Photograph by John Kelly

Steps taken to deal with Clare hospice’s reported shortcomings

DEPUTY Cathal Crowe has predicted a HIQA report identifying nine non-compliances with national regulations at Cahercalla Community Hospital and Hospice will improve the level of care provided at the facility.
HIQA has published a report outlining non-compliance with regulations on staffing; training and staff development; records, governance and management; complaints procedure; fire precautions; individual assessment and care plan; health care and residents’ rights.
Cahercalla was found to be fully compliant with standards on contract for provision of services, visits and infection control following a HIQA inspection of the facility on September 24 and 25.
There were 100 residents in the community facility at the time of the inspection, which can accommodate up to 112.
This inspection was completed months before Cahercalla recently entered into a new agreement with Mowlam Healthcare to provide clinical and management oversight at Cahercalla.
Cahercalla board chairman, Dr Michael Harty has stated this agreement will provide Cahercalla with strong governance, leadership and supervision of its residential care services and optimise their systems and practices.
Deputy Crowe said steps have already been taken to address some issues raised in the report and the remainder of those will be addressed by a new management team contracted by HSE.
“There will be no closure or winding down of this facility, which has offered a vital healthcare service for generations – that will continue as always.
“From a workers’ perspective there will be no job losses and there are changes in how the facility is being managed.
“I have every faith and belief that they will address any final aspects identified in inspection report that are yet to be acted on but I also have full confidence that every step has been and will be taken to implement the recommendations.
The September inspection was a follow-up on the actions of a compliance plan that was submitted following the last inspection of the centre on May 23, 2019.
The last inspection found a number of non-compliances in relation to the overall governance and management of the centre, individual assessment and care planning, the provision of activities, the management of complaints and residents’ rights.
A compliance plan update had been received in November 2019 with assurance that action had been taken to bring the centre into regulatory compliance.
According to the latest inspection, residents said that “staff were very kind” and “were good” to them. A resident said that she feels “very comfortable” in the centre.
Residents also spoke positively about the food that was served in the centre, including the choices that were available to them.
Many residents were happy with their bedrooms and confirmed that they were supported to bring belongings from home into the centre, such as furniture and a wide screen TV.
Residents recalled there used to be lots of activities, but they have been restricted since the Covid-19 pandemic began.
“The clinical oversight of care in the centre was poor. The management systems in place were inconsistent in quality and did not serve to identify issues that required quality improvement plans to be developed.
“A care plan audit developed to address the non-compliance’s of the last inspection failed to identify any quality improvement interventions in relation to the documentation of care plans.
“Inspectors found that staffing was inadequate to meet the needs of the residents and for the size and layout of the building.”
In its response to the inspection, Cahercalla said an assistant director of nursing was appointed in June while areas for improvement, which are identified through monthly quality and safety meetings will be allocated to ward managers for action and review on their management days.
This will include oversight of the assessment and care planning processes and staff performance.
Two new staff have been added to the activities team totalling 57 hours per week.
The increased activities staff and reduced catering responsibilities for care staff will ensure residents are better supervised and have more meaningful activities available to them.
All nursing and care staff will be assigned to a ward manager for performance management. The director of nursing will oversee all performance improvement actions identified through the appraisal system are taken and performance is monitored.
A daily nursing record is now being completed for each resident, which documents the resident’s health, condition and treatment given.
A full review of all care plans is being undertaken as they are being moved to the new electronic system.
The Board of Directors is working to put in place a stronger management structure, which will oversee and supervise the delivery of a safe, appropriate, consistent and effective service for residents meeting their individual needs and preferences based on their feedback and which uses the feedback from resident to continue to review and develop the service.
The fire compartment map identified has been rectified and now reflects the compartment layout.  Fire documentation is now up to date.
All residents will have a care plan, which is based on an ongoing comprehensive assessment of their needs and will be implemented, evaluated and reviewed, and will reflect the residents changing needs.

– Dan Danaher

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