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Health Information and Quality Authority
Social Services Inspectorate
Inspection report
Designated centres for older people
Centre name:
Riada House Community Nursing Unit
Centre ID: 529
Arden Road
Centre address:
Tullamore
Co. Offaly
Telephone number: 057 9359985
Fax number: 057 9359986
Email address:
audrey.wright@hse.ie
Type of centre: Private Voluntary Public
Registered provider:
Person in charge:
Health Service Executive
Acting Person in Charge: Audrey Wright
Date of inspection: 29 September 2009
Time inspection took place: Start: 09:15 hrs Completion: 19:00 hrs
Lead inspector:
Support inspector(s):
Type of inspection:
Eileen Kelly
Carol Grogan
Finbarr Colfer
Registration
Scheduled
Announced
Unannounced
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About 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 under the following topics:
1. Governance and leadership: how well the centre is organised.
2. The quality of the service.
3. How well the healthcare needs of residents are met.
4. Premises and equipment: appropriateness and adequacy.
5. Communication: information provided to residents, relatives and staff.
6. Staffing: the recruitment, supervision and competence of staff.
This report summarises the findings of the inspection under some or all of these
topics, highlighting areas of good practice as well as areas where improvements
were required as follows:
Evidence of good practice - this means that an acceptable standard was reached
and the provider demonstrated a culture of review and improvement and aimed to
drive forward best practice.
Some improvements required – this means that practice was generally
satisfactory but there were areas that need attention.
Significant improvements required – this means that unacceptable practice was
found.
The report also identifies minor issues, where applicable, to which the provider
should give consideration to enhance the quality of the service.
The report is available to residents, relatives, providers of services and members of
the public, and is published on our website www.hiqa.ie.
Acknowledgements
The inspectors wish to acknowledge the co-operation and assistance of the residents,
relatives, provider and staff during the inspection.
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About the centre
Description of services and premises
Riada House Community Nursing Unit is a purpose built single storey building
providing long term care for thirty six residents with six additional places for respite
care. The building has recently undergone major refurbishment and existing
residents had been settling into their new rooms during the past two months. Phase
two of the refurbishment project is in the planning stages and has yet to commence.
This will increase bed capacity by a further twenty places within the next year.
Presently, the accommodation consists of eighteen single rooms, three two-bedded
rooms, four three-bedded rooms and six multi occupancy rooms for between four
and nine residents. There are five single bedrooms with en suite, eight shared
bedrooms with en suite, six assisted shower rooms and two assisted bathrooms.
Other facilities include a spacious dining room, a treatment room, two kitchenettes
for making tea and coffee, an oratory, a large reception area in the front hall and a
comfortable day room. This kitchen also catered for a local meals-on-wheels service
as well as the day care service on site and a local mental health unit. Communal
rooms and hallways lead out to two garden areas, one with a fish pond and ivy clad
gazebo (used as a smoking area) and the other has a wide hazard free pathway to
allow less able residents to exercise.
Day-care facilities are also on site and some residents from the residential centre
attend on a regular basis.
Location
Riada Community Nursing Unit is located on the same site as the Health Service
Executive (HSE) Mid Leinster offices on Arden Road. It is situated close to the town
of Tullamore and is a five minute trip by car to the train station.
Date centre was first established: 1979
Number of residents on the date of 36 residents and 5 respite care
inspection
residents on the day. Total 41.
Dependency level of
current residents
Max High Medium Low
Number of residents 30 4 2 0
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Management structure
The provider is the Health Service Executive (HSE) and the designated contact
person is Gerry Raleigh, General Manager, Laois/Offaly. Audrey Wright is presently
acting as Person in Charge. The clinical nurse managers and nursing staff report to
the person in charge. The care attendants are supervised by the clinical nurse
managers. Household and catering staff report to the household and catering
manager who in turn reports to the person in charge.
Staff
designation
Number of
staff on duty
on day of
inspection
Person
in
Charge
Nurses
Care
staff
Catering
staff
Cleaning
and
laundry
staff
Admin
staff
1 6 6 6 3 1.5 0
Other
staff
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Summary of findings from this inspection
This was the first inspection of this centre, it was unannounced and was carried out
over one day. Inspectors spoke with residents and relatives, observed the daily life
and viewed records and documentation. There was a general meeting for staff and
union representatives on the day of the inspection, which went ahead without
disruption to the residents.
A focused and committed style of management was demonstrated by the acting
person in charge. There was evidence that the person in charge was beginning to
implement the requirements in 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.
Inspectors found that the person in chare created a learning culture and continuous
improvement on the quality of service for residents. High levels of satisfaction on the
quality of life were reported from both residents and relatives. Both staffing levels
and deputising arrangements were appropriate and the skill mix was satisfactory.
Peripatetic services were easily accessible. There were many opportunities for social
and fulfilling engagement for residents, both within and outside of the centre. On the
day of the inspection, there was strong evidence of the value placed on talking with
residents as opposed to a task-driven culture.
The bed capacity in this centre will increase by 20 places in the next year which will
be addressed by the registration process
There were some areas for significant improvement in risk management policies,
access to fluids, medication management and the statement of purpose. There were
some areas for improvement identified such as developing the complaints policy
further and implementing a staff appraisal system. These items are discussed in
further detail in the main report and actions to address these issues are outlined at
the end of the report.
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Residents’ and relatives’ comments
Inspectors spoke with twelve residents and three relatives. They joined residents for
lunch and sought the views of other residents throughout the day.
Residents reported a high level of satisfaction with their lives and said that staff were
“patient and gentle”, “very caring” and “very kind”. One resident said: “If you want
help you don’t have to wait”. Another resident told an inspector that staff “listen to
you and give some support”. Other comments included: “staff come immediately –
it’s never a problem” and “Everyone is so friendly, couldn’t be nicer – this is where I
want to be”. A resident availing of respite services told an inspector: “There’s never
a bad word said to anyone – no-one shouts at you, you are handled with care”. The
same resident added: “I get a cup of tea in bed at 8 am, get up around 9 am and
carers ask if you would like to lie in”. Another resident commented on flexibility in
the morning routine: “I get breakfast in bed, get up between 10.30 or 11 am, lunch
around 12.30 pm and tea at 5 pm.” This resident told the inspectors that tea with
biscuits or buns was available at three different times in the afternoon. He described
staff as very respectful and that staff “do things in a private way – everyone doesn’t
know your business”.
One relative described Riada House as “far superior” to other centres with which she
had come in contact with. She also said that rooms are made available for residents
to see visitors in private if they wished. She commented that staff were “always
cheerful, always pleasant, and always encouraging”. In reference to the care her
family member received she added: “They are great here – he gets loads of food,
anything he wants, gets up when he wants, sees the doctor anytime he wants and
has his feet seen to as well”.
Another visiting relative commented that staff kindly made arrangements for him to
have his dinner at Riada House every day as he has found it difficult to cater for
himself now that he is living alone. He also told an inspector that staff regularly
consult with him regarding his wife’s care needs. He said he particularly appreciates
how staff invite him to share his views about his wife’s health and well being.
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Overall findings
1. Governance: how well the centre is organised
Outcome: The centre is well organised and managed and complies with the
requirements of the Health Act 2007, the regulations and standards.
Good governance involves the effective and efficient deployment of
resources in accordance with the stated purpose and function of the
centre. Governance includes setting clear direction for the service, a
commitment to continual improvement and having a system in place to
effectively assess and manage risk.
Evidence of good practice
The person in charge demonstrated a calm and respectful style of management. As
she took inspectors on a brief tour she introduced them to staff and residents
explaining the purpose of the inspection visit. During this time, she paid particular
attention to any resident who required help or assistance. On one occasion, she
appropriately stopped talking with the inspectors while she tended to a distressed
resident calling out. She then arranged for a staff member to attend to this person
before re-engaging with inspectors. This practice was mirrored throughout the day
by other staff who met residents’ needs promptly and respectfully.
All staff interviewed demonstrated a clear understanding of their role and
responsibilities. They described the reporting mechanisms in place to ensure
appropriate delegation, supervision and competence in the delivery of care to
residents.
An administrator who takes responsibility for the management of residents’ finances.
This financial system is audited independently as part of an annual HSE audit of
accounts. Residents had ease of access to their personal income. This was
appropriately documented and there is a secure office safe which is offered to
residents to store any valuable personal items.
A strong commitment to a risk management culture was seen to be in place. The
person in charge informed the inspectors that regular audits of falls and pressure
sores and monthly weight monitoring of residents were carried out as well as random
auditing of care plans. Monthly nutritional meetings had recently been introduced
and were led by a dietician. Two of these meetings had taken place to date. The falls
and incident logs were viewed by the inspectors and were considered to be
satisfactory. As part of the refurbishment plans, new assistive aids, such as hoists
and wheelchairs were introduced as well as a new bleep system for nursing and care
assistants. The person in charge told inspectors that she did not intend to use these
aids until a risk management procedure was in place. This policy and procedure was
in the process of being developed with staff.
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The person in charge explained her role in maintaining the safety of residents and
staff members to the satisfaction of the inspectors. The residents’ register was
viewed by inspectors and considered satisfactory. The most recent fire training for
staff took place on 11 2009. Further scheduled fire training was due to take place in
November and December 2009. Fire safety procedures included a daily check by the
person in charge of all fire exits and a daily census of all residents and staff.
Inspectors found that a strong culture of learning and continuous improvement
existed. The person in charge had offered for the centre to be a pilot site for a HSE
tissue viability study during the summer of 2009. The person in charge viewed this
as an “opportunity to learn” and avail of up to date specialist training for staff. The
person in charge offered ongoing work experience for students on the Further
Education and Training Awards Council) FETAC social care study courses. Selected
staff were identified as change “link facilitators” to offer support and supervision to
students as well as give feedback on students’ performance to college tutors. The
person in charge also organised a weekly learning forum for staff to address topics of
learning interest. This forum takes place on a Tuesday and is called “Training
Tuesdays”. Presently the staff are involved in the process of reviewing all HSE
policies and procedures within this forum and making recommendations for their use.
Draft documentation of the outcomes of this work was made available for the
inspectors to read.
The person in charge and all staff demonstrated a good understanding of 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.
Some improvements required
The person in charge told inspectors that she was developing a new complaints
policy that would be centre-specific. The policy in existence was a generic HSE one
and did not contain a provision for an independent appeals process in accordance
with Regulations. However, the person in charge had a positive and proactive
attitude to the management of complaints and saw them as an opportunity for
learning.
Significant improvements required
There was no statement of purpose in place. The person in charge was aware of this
and stated her intention to address this matter.
Although staff demonstrated an understanding of the prevention and detection of
elder abuse, there had been no recent elder abuse training. The person in charge
informed inspectors that she intended to prioritise planning of this specific training.
There was ample evidence of risk management practices in place. There was a HSE
generic document entitled ‘Corporate and Regional Risk Management Policies,
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Procedures and Guidelines’ available. However, there was no coherent integrated risk
management policy in place for use by staff.
Although there was a weekly check of the fire alarm system and staff responses, the
fire safety records did not include a clearly documented day-to-day emergency
response plan of action for fire safety. There was no designated fire officer for each
staff shift.
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2. Quality of the service
Outcome: Residents receive a good standard of service, appropriate
treatment and are treated with courtesy and respect.
A quality service is one where residents are protected from harm or abuse,
where practice is person-centred, where rights are protected, where
residents are enabled to play an active part in the centre and where
management, staff and residents work together towards continuous
improvement.
Evidence of good practice
Inspectors observed that the privacy and dignity of residents was respected and
promoted by staff. Staff members knocked and waited before entering residents’
bedrooms and ensured doors were closed and curtains drawn while delivering
personal care. Inspectors noted that the manner in which residents were addressed
by staff was caring, friendly and respectful. Residents spoke highly of the staff. The
person in charge had recently introduced resident satisfaction surveys in relation to
meals.
Inspectors dined with the residents at lunchtime in a bright, clean and spacious
dining room. Tables were set with table mats, condiments and napkins. A menu was
displayed on a notice board. Residents were offered milk, water or orange squash
with their meal. Staff sat with residents who required assistance and used this
mealtime as an opportunity to talk and engage with more dependent residents. Staff
smiled at residents and calmly explained the choices available for lunch. There were
sufficient staff members available and assistance was offered discreetly and
sensitively. This was an unhurried and calm social occasion. Inspectors noticed a
buzz of talk and laughter and one resident began to sing after lunch for the
inspectors. Staff encouraged this resident’s spontaneity. Meal portions were good
and second helpings offered. Soft and pureed food was presented in an attractive
way.
The person in charge had implemented a practice of documenting the life histories of
each resident. The idea had been introduced by a speech and language therapist and
the process was completed with residents and relatives. During the inspection, two
residents made the comment “I have a life history” when talking to an inspector. The
person in charge intended to include this information in the implementation of the
newly proposed care plans.
Staff organised and supported a number of social events for residents. There is a
well established ‘Comfort Committee’ which actively fundraises for the centre. Staff
gave time to this on a voluntary basis. Several staff and 12 residents were planning
to attend a fundraising event entitled ‘Songs of Legends’ in one of the local hotels
where local and national singers were performing. The resident who sang after lunch
on the day of the inspection told the inspectors that she planned to do a solo song
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too. One resident went had been to Lourdes recently. On the week preceding this
inspection, the residents enjoyed glass of stout on Arthur Guinness day as the staff
arranged for a keg of beer to be delivered after lunch.
There was a full and varied programme of activities including art, hand massage,
discussion groups and social outings. Inspectors observed a member of staff playing
chess with a resident and another resident was knitting in the day room.
A group of residents were reminiscing with a staff member about when they were
growing up, two residents were doing a jigsaw and some residents were exercising
with a ball. Inspectors observed that the staff were attentive to residents. When a
resident asked for water it was arranged without delay. Another resident asked for
assistance to go to the smoking room and this was respectfully facilitated.
Some residents were prolific artists and their work was displayed. The art work was
presented alongside a photo of the artist at work and a brief summary of his or her
particular interest in the subject. An inspector read the following displayed on one
wall of a corridor about a resident who enjoyed art: “this resident was a farmer and
perhaps that explains his interest in drawing birds.”
This resident’s work was exhibited in community exhibitions annually.
Some improvements required
Staff wore disposable aprons during mealtimes and this created a social barrier
between residents and staff and appeared institutional.
There was only one vegetable served for lunch. This lack of choice failed to take
account of residents’ preferences and wishes.
Significant improvements required
Residents could not access water and other drinks easily in communal rooms.
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3. Healthcare needs
Outcome: Residents’ healthcare needs are met.
Healthcare is integral to meeting individual’s needs. It requires that
residents’ health, personal and social care needs are assessed and
reviewed on an on-going basis, within a care planning process, which is
person centred. Emphasis is firmly placed on health promotion,
independence and meaningful activity.
Evidence of good practice
Inspectors witnessed a good standard of healthcare. Residents had individual care
plans which addressed their assessed needs in relation to their physical and mental
care. Recognised clinical tools were used to measure risk factors, for example, in
relation to the prevention of falls. Care plans were linked to clear actions to be
carried out by staff in the delivery of care. Care plans were reviewed on a three
monthly basis or more regularly if required. The inspectors looked at a sample of the
care plans, observed nursing care practices and spoke with residents about their
health. For example, an inspector reviewed the care plan of a resident with diabetes
and found his health care needs were well monitored and reviewed. Another
resident with a urinary tract infection told an inspector that her pain was well
managed. A resident requiring acute hospital admission was seen promptly and the
person in charge liaised with the hospital during and after her admission. A new
care planning system is due to be implemented within the next three months which
aims to incorporate a more active involvement by residents and or relatives in this
process.
Both physical and mental health was promoted through the provision of exercise
programmes and social contacts. For example, a monthly nutritional meeting took
place, led by a dietician. These meetings were multidisciplinary in nature and were
recorded. There was regular access to GP (general practitioner) services and
residents are referred to specialist and allied healthcare services as and when
required. Assistive aids were widely available. It was noted by the inspectors that
residents requiring pressure mattresses also had pressure prevention cushions.
An inspector accompanied a nurse administering medication. The nurse gave due
attention to the residents’ well being prior to administering medication. The inspector
checked the drug supply and storage of medicines as well as reading the current
medication policy. There were no residents self-administering medication.
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Some improvements required
Care plans did not always reflect some of the good practices witnessed by inspectors.
For example, inspectors observed care given to a resident with dementia who was
agitated. The staff member was calming and reassuring and helped the resident by
applying hand cream for her – a practice known amongst staff to be soothing and
relaxing for the resident. However, this practice was not reflected in the resident’s
care plan.
Significant improvements required
The drug prescription sheet in use for each resident did not allow GPs to input the
specific time to administer drugs. This increased the risk of error in the
administration of medicines and did not adequately allow for a robust tracking
mechanism. For example, it was noted by an inspector that in one resident’s
medicine administration chart, the nursing administration record conflicted with the
prescription sheet completed by the doctor. The doctor had requested administration
at 18:00 hrs but the medication was administered at 16:00 hrs. The person in charge
had already recognised the potential for error in this practice prior to inspection and
was planning to implement a new prescription sheet for GPs which would support An
Bord Altranis best practice guidelines for nursing staff. She told inspectors of her
plans to introduce this new documentation and of an on-site training date in
November scheduled to coincide with this.
Although there was evidence of good care planning and a plan of action to review
the care planning process, there were some significant areas noted for improvement,
particularly that of documentation. For example, reviews of care plans were not
always signed. The inspectors noted on two residents’ files that manual handling
assessments had not been updated since October 2008. One resident had recently
returned from a holiday in Lourdes. His file did not contain the date on which he
returned, or weather has healthcare needs were assessed at that point. Some care
plans did not contain risk assessments for particular issues and did not inform
practice. There was no manual handling assessments in some care plans and an
inspector observed one resident being moved in a wheelchair without the use of
footplates.
In general, care plans had a medical focus. Care plans did not adequately reflect a
person-centred approach to care incorporating residents’ wishes in relation to
routines and expectations. There was no indication on residents’ files that they were
consulted in the care planning process.
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4. Premises and equipment: appropriateness and adequacy
Outcome: The residential care setting provides premises and equipment
that are safe, secure and suitable.
A good physical environment is one that enhances the quality of life for
residents and is a pleasant place to live. It meets residents’ individual and
collective needs in a comfortable and homely way, and is accessible, safe,
clean and well-maintained. Equipment is provided in response to the
assessed needs of each of the residents and maintained appropriately.
Evidence of good practice
A high standard of cleanliness was evident throughout the premises. Cleaning
schedules and cleaning checklists lists were reviewed by inspectors. Cleaning staff
were interviewed and clearly understood their role and paid due attention to infection
control issues as well as privacy and dignity of residents when carrying out their
responsibilities.
A number of residents’ bedrooms were visited by inspectors. Personal possessions
and photographs were in evidence and several residents spoken with on the day
reported their satisfaction with storage and space. Additional small tables were
provided for those residents who wished to display religious items. A cabinet was
provided for one resident who wished to display her pottery. This resident told
inspectors that she enjoyed dusting her collection and showing it to visitors. Some
rooms in the newly refurbished section had yet to be personalised.
The dining room and day room were both spacious, the front hall was large and had
ample seating and the oratory provided a quiet space for residents. The garden area
was awaiting landscaping and currently not freely available to residents, in the
interim, staff had identified one patio area which was safe and accessible should
residents wish to sit outside.
The kitchen was recently refurbished and had plenty of space. The inspectors found
the kitchen to be clean and well organised. Catering staff had all received hazard
analysis critical control point (HACCP) training and records reviewed by the
inspectors were up to date.
All types of assistive aids were available throughout the building such as hoists,
pressure mattresses, shower chairs and wheelchairs. Equipment was serviced
regularly. The new beds in the refurbished section were of an excellent quality. Call
bells were available in bedrooms and communal rooms. The inspector called a bell
and it was answered promptly by a care assistant.
All laundering of bed linen was contracted to an outside company. The laundry and
sluice facilities were adequate and there was due attention paid to infection control
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standards. For example, soiled clothing was laundered at appropriate temperatures
and separate areas were designated in the laundry room for clean and soiled
laundry. All residents’ personal laundry was carried out to the satisfaction of
residents spoken with on the day.
Inspectors observed that hand cleaning gels were widely distributed at critical points
and were seen to be utilised by staff and visitors. Waste disposal was satisfactorily
managed.
Significant improvements required
The corridor in the non-refurbished section, known as San Pio, was narrow and for
part of the morning was cluttered with laundry skips and a cleaning trolley. This
posed a potential hazard for residents, staff and visitors.
Minor issues to be addressed
Both gardens were in need of new garden furnishings.
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5. Communication: information provided to residents, relatives
and staff
Outcome: Information is relevant, clear and up to date for residents.
Information is accessible, accurate, and appropriate to residents’ and staff
needs. Feedback is actively sought from residents and relatives and this
informs future planning and service provision. Information is recorded and
maintained in accordance with legal requirements and best practice and is
communicated to staff on a need to know basis to ensure residents’
privacy is respected.
Evidence of good practice
Communication was of a high standard. Staff spoken with were able to tell inspectors
about residents’ life histories and interests. The person in charge operated a keyworker
system so that one staff member was the key-worker for two residents. One
resident introduced an inspector to three members of staff by name. She was aware
of issues about the running of the centre and knew that the person in charge was in
an acting capacity in the role.
Staff demonstrated an enthusiasm to engage with residents and the inspectors saw
staff frequently taking time to talk with residents. In particular, inspectors observed
staff communicating calmly and sensitively with residents whose behaviour was
challenging or who had dementia.
The centre’s ‘Philosophy of Care’ was displayed prominently in the front hall.
Suggestion boxes were in evidence but inspectors were informed that they were not
widely utilised. A notice was also displayed in some of the corridors notifying
residents of who to contact in the HSE should they wish to make a complaint.
A newly appointed advocate was due to commence work to liaise with residents and
ascertain views on communication and quality of life issues.
Some improvements required
Communication amongst staff in relation to residents’ needs was currently dependent
on the use of signs and notices. For example the inspectors observed a notice on the
bedroom door of a resident with MRSA (Methicillin-resistant Staphylococcus Aureus)
detailing her current status. Inspectors observed other notices about residents’
personal bathing routines in communal bathrooms. In the dining room, there were
notices were displayed about residents’ dietary needs and wishes. This practice of
using notices about residents’ personal needs and wishes infringed on each
individual’s right to privacy and dignity.
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The residents’ guide available was a HSE generic one and was not specifically
designed to inform new and existing residents of the facilities available which is
required by the Health Act 2007 (Care and Welfare of Residents in Designated
Centres for Older People) Regulations 2009.
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6. Staff: the recruitment, supervision and competence of staff
Outcome: Staff are competent and recruited in sufficient numbers to meet
residents’ needs
Staff numbers and skill-mix are determined by the size and complexity of
the service and there should be sufficient competent staff on duty, both
day and night, to meet the needs of residents. Robust recruitment and
selection procedures ensure the appointment of suitably qualified and
experienced staff. Staff are supported in their work by ongoing training
and supervision.
Evidence of good practice
A number of staff were interviewed by inspectors about their recruitment, induction,
understanding of their role and ongoing professional development. Staff reported
high levels of satisfaction with professional guidance, training and support. One care
assistant told an inspector that she was well supported during her FETAC training
programme and got adequate time for her college course and private study. A social
care student also reported good levels of support and supervision and conveyed a
clear understanding of her role and responsibilities.
The most recent staff training took place on 07 and 14 September 2009 on the
importance of hand hygiene. All staff members attended and a list of staff in
attendance was shown to inspectors.
A staff roster for the day of inspection was viewed by inspectors and it matched with
with staff present on site. Staffing levels were assessed as being appropriate for the
levels of dependency. A recent workforce plan increased staffing levels at night time
from one to two nurses to ensure timely, responsive care was provided. At night
time, nurses were supported by two care assistants. Care assistants told inspectors
about the nature of their role and described the multi-task role, working rotational
days in catering, laundry, cleaning and direct resident care. Staff carried out their
responsibilities in an unhurried manner and appeared to take pride and pleasure in
their roles. They displayed kindness and patience when attending to residents’ needs
and prioritised the dignity and respect of individuals.
A sample of staff files were made available to and viewed by inspectors. Verification
of all qualifications for nurses were in correctly in place. Signatory lists of nurses
were also viewed. References and some Garda Síochána vetting records were
available on the sample files.
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Some improvements required
Although a formal staff appraisal system was in place it was only for the first year of
employment.
Significant improvements required
Not all staff files had up-to-date Garda Síochána vetting records.
Report compiled by:
Eileen Kelly
Inspector of Social Services
Social Services Inspectorate
Health Information and Quality Authority
10 October 2009
Page 19 of 30

Health Information and Quality Authority
Social Services Inspectorate
Action Plan
Provider’s response to inspection report
Centre:
Riada House Community Nursing Unit
Centre ID: 0529
Date of inspection: 29 September 2009
Date of response: 24 November 2009
Requirements
These requirements set out what the registered provider must do to meet 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.
1. The provider is failing to comply with a regulatory requirement in the
following respect:
The complaints policy did not contain an up to date independent appeals process.
Action required:
Update the complaints procedures and implement a system that informs and reminds
residents and their relatives of the complaints process.
Reference:
Health Act, 2007
Regulation 39: Complaints Procedures
Standard 6: Complaints
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Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Contact details for Consumer Affairs Area Manager is available on
each ward through out Riada House. Updated complaints
procedures available on each ward.
Completed
2. The provider is failing to comply with a regulatory requirement in the
following respect:
The prescription sheet in use for medication administration is not appropriate or suitable
to ensure the safety of residents.
Action required:
Implement an updated medication policy and practice to ensure the safe administration
of medication in line with Board Altranais guidelines.
Reference:
Health Act, 2007
Regulation 33: Ordering, Prescribing, Storing and Administration of
Medicines.
Standard 14: Medication Management
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
ABA Medication Management training arranged for nursing staff on
the 03 r December 2009. Further training arranged for the 20
January 2010. Funding sought for ongoing training.
New Drug Card Index purchased – copy provided to inspector on
day of inspection.
Phased
Implementation
of New Drug Card
Kardexes to
commence
February 2010.
Roll out to GP’s & GP buy in sought regarding the use of Kardex’s
and a physical review of each resident at 3 monthly reviews of
medication. Phased in and to roll out in January 2010.
On the 16 December 2009, a Pharmacist Audit was carried out on
both wards regarding our medication management systems and
documentation pertaining to GP review of residents. We are
awaiting feedback of same.
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3. The provider has failed to comply with a regulatory requirement in the
following respect:
There is no Statement of Purpose and Function available within the centre.
Action required:
Develop a written statement of purpose to incorporate all matters listed in Schedule 1 of
the Health Act 2007 (care and welfare of Residents in Designated centres for Older
People) Regulations 2009
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 following the inspection with timescales:
Timescale:
Provider’s response:
Statement of purpose and function, contract of care currently in
draft form, target date for completion will be January 2010.
January 2010.
4. The provider has failed to comply with a regulatory requirement in the
following respect:
There was no written risk management policy specific to the centre, incorporating in
particular the assessments of residents’ dependencies and manual handling
assessments.
Action required:
Develop a comprehensive risk management policy appropriate for the centre and in line
with the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older
People) Regulations 2009 incorporating in particular the assessment of residents’
dependencies and manual handling assessments.
Reference:
Health Act, 2007
Regulation 31: Risk Management Procedures
Standard 26: Health and Safety
Page 22 of 30

Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Regional and corporate risk management policy available, we are
currently amending same to make it more centre specific.
Within 6 Months.
5. The provider is failing to comply with a regulatory requirement in the
following respect:
Not all personnel files had Garda Síochána vetting documentation.
Action required:
Ensure complete vetting of all staff in accordance with current regulations, guidelines
and legislation.
Reference:
Health Act, 2007
Regulation 18: Recruitment
Standard 22: Recruitment
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Garda Síochána clearance was only sought for those working with
clients with intellectual disabilities or mental health issues prior to
January 2008.
From the 01 January 2008 HR sought Garda Síochána clearance for
all permanent staff hired after the 01 January 2008.
Locations were requested to follow up on Garda Síochána clearance
for Temporary Staff hired after this date also.
HR department central office contacted regarding the need for all
staff regardless of when they commenced employment to have
Garda Síochána vetting.
The plan at local level in Riada House is to apply for Garda Síochána
vetting for all employees within 9 months.
9 months
Page 23 of 30

6. The provider is failing to comply with a regulatory requirement in the
following respect:
Individual care plans were not developed in partnership with each resident and were not
made available to residents.
Action required:
Revise the care planning process to reflect the individual needs and preferences of
residents. Include consultation with residents and a process to include any changes to
their care plan.
Reference:
Health Act, 2007
Regulation 8: Assessment and Care Plan
Standard 11: The Resident’s Care Plan
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Residents are now informed on admission that their individual care
plan will be available to them on request.
This information has now been included in our “Your Stay With Us”.
Complete
As part of our ongoing evaluation of our documentation in Riada
House, the key worker makes an appointment with the resident to
review their care plan.
A local guideline has been developed to support this practice.
Complete
The key worker now when reviewing and updating the residents
individual care plan does it in consultation with the resident. If the
resident wishes to see the care plan, this is made available to them.
7. The provider is failing to comply with a regulatory requirement in the
following respect:
In the San Pio unit of the centre, residents were exposed to potential trips and falls as a
narrow hallway was hazardous to navigate due to the presence of equipment e.g.
cleaning trolleys, laundry baskets.
Action required:
Take reasonable measures to prevent accidents to residents in this area of the centre.
Page 24 of 30

Reference:
Health Act, 2007
Regulation 31: Risk Management Procedures
Standard 25: Physical Environment
Standard 26:Health and Safety
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Above situation highlighted to all staff and health and safety
representatives to observe and practice.
Completed.
Commitment to take reasonable measures to prevent accidents to
residents in this area of the centre.
Staff reminded of their responsibilities under Health & Safety
Welfare at Work Act 2007 and their duty of care.
8. The provider is failing to comply with a regulatory requirement in the
following respect:
The provider has not made the necessary arrangements for recent training of staff in
relation to the risk and detection of all forms of elder abuse.
Action required:
Arrange for all staff to participate in suitable training aimed at preventing residents from
suffering abuse.
Reference:
Health Act, 2007
Regulation 6: General Welfare and Protection
Standard 8: Protection
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Page 25 of 30

Provider’s response:
Date of previous training: 09 August 2007.
Elder Abuse Training Pack & Policy provided to Riada House
management. Management committed to roll out of training to all
staff within an appropriate period and regular training thereafter.
Training planned
to commence
January 2010
with in-house
training schedule
planned for 2
month timeframe
thereafter.
9. The provider is failing to comply with a regulatory requirement in the
following respect:
There is no clearly written emergency response plan covering the issue of fire safety on
a day to day basis, specifying roles and responsibilities for each staff shift.
Action required:
Write a clear day to day fire emergency response plan detailing staff responsibilities.
Reference:
Health Act, 2007
Regulation 32: Fire Precautions and Records
Standard 26: Health and Safety
Please state the actions you have taken or are planning to
take with timescales:
Timescale:
Provider’s response:
Emergency response plan available on notice board in Front Hall
beside main fire panel.
Fire drills are carried out, and signed by, maintenance personnel
each week. Same filed in the Fire Management Folder. Fire drill not
carried out on the day of inspection as personnel called away.
Fire Drill & Staff
training for
evacuation took
place on
Thursday the 17 th
of December
2009.
Senior staff nurse identified on roster for each shift and assumed
role for fire safety response.
Ongoing.
Page 26 of 30

10. The provider has failed to comply with a regulatory requirement in the
following respect:
There is no ongoing staff appraisal system in place following the initial staff probationary
periods.
Action required:
Develop a suitable and ongoing staff appraisal system which identifies staff training and
performance issues in order to promote the best possible outcomes for residents.
Reference:
Health Act, 2007
Regulation 17: Training and Staff Development
Standard 24: Training and Supervision
Please state the actions you have taken or are planning to
take following the inspection with timescales:
Timescale:
Provider’s response:
HR Policy – evidence of same available in personnel files in director
of nursing’s office.
Appropriate practice observation and staff appraisals forms are
being drafted for ongoing feedback.
This is for
completion of
appraisals
within 12 months.
11. The provider has failed to comply with a regulatory requirement in the
following respect:
Residents did not have ease of access to fresh drinking water in communal rooms during
the daytime.
Action required:
Ensure suitable arrangements are put in place for residents to easily access fresh
drinking water at all times during the day.
Reference:
Health Act, 2007
Regulation 20: Food and Nutrition
Standard 19: Meals and Mealtimes
Please state the actions you have taken or are planning to
take following the inspection with timescales:
Timescale:
Page 27 of 30

Provider’s response:
Water cooler has been purchased for newly opened pantry (Room
45) same to be installed.
Staff reminded to offer drinks frequently to residents during the
day, as is our normal practice. Provisions are also available for
residents with swallowing difficulties/dysphasia.
Near completion
Completed.
Page 28 of 30

Recommendations
These recommendations are taken from the best practice described in the
National Quality Standards for Residential Care settings for Older People in
Ireland and the registered provider should consider them as a way of
improving the service.
Standard
Standard 4:
Privacy and
Dignity
Best practice recommendations
Review the practice of staff wearing disposable aprons during
mealtimes.
Provider’s response:
Corrected
Page 29 of 30

Any comments the provider may wish to make:
Provider’s response:
None received
Provider’s name: Riada House Community Nursing Unit.
Date: 19 November 2009
Page 30 of 30