The Regulation and Quality Improvement Authority (RQIA), Northern Ireland’s health and social care regulator has issued two failure to comply notices to Ratheane Private Nursing Home in Coleraine relating to governance arrangements and the health and welfare of patients.
During an unannounced inspection on 27th November last year concerns were identified regarding the lack of effective managerial, monitoring and governance arrangements in the home. This included a lack of oversight and non-completion of the environmental audits.
A report issued to the home reveals that there were ineffective monitoring processes also in relation to wound management, care records and post falls management. It went on to say that there was also a lack of inclusion in the monthly monitoring reports regarding the actions that required to be taken to meet the areas of improvement identified in the quality improvement plan following the care inspection on 27th November 2018.
RQIA was also concerned that the monthly monitoring report did not identify the issues raised by RQIA to drive the necessary improvements.
The report said ‘At the previous care inspection on 27 November 2018 an area for improvement was identified in relation to pressure relieving mattresses.
At this inspection, we found that this area for improvement had not been met. Further concerns were identified in relation to the management of wounds and pressure ulcer prevention. Deficits were evidenced in the repositioning records of identified patients and inconsistencies were noted in the frequency of repositioning within care plans. We could not evidence that appropriate actions had been taken following unwitnessed falls.
Deficits were noted in record keeping which did not evidence the care delivered, regarding wounds and post falls management. We found deficits in the staffs’ knowledge in relation to the modification of fluids which had the potential to place patients at risk. We found ineffective communication between all grades of staff regarding newly admitted patients’ needs. There was evidence that deficits within the environment had not been identified or addressed within the home. This included damaged patient equipment and decor. Equipment was inappropriately stored in an identified lounge and was not conducive to a positive patient experience.’
By 5th July 2019 the following action is required by the care home to comply with regulations:
- The registered person must ensure all patients with wounds and/or pressure ulceration have up to date care plans in place to direct staff in the provision of wound care,
- The registered person must ensure that an accurate record is maintained in relation to the number, type and status of wounds in the home.
Individual patient records must reflect the wound care recommendations of the tissue viability nurse specialist when appropriate.
- The registered person must ensure that all pressure relieving equipment used is appropriately set to meet the needs of each individual patient.
- The registered person must ensure that patients are repositioned in accordance with their care plan.
- The registered person must ensure that staff can evidence that they are knowledgeable in relation to the management of wounds, prevention of pressure ulceration, the management of pressure relieving equipment and record keeping.
- The registered person must ensure that falls are managed in accordance with best practice guidelines and that relevant observations and/or treatment is provided/sought.
- The registered person must ensure that staff are provided with training relevant to their role and responsibilities in relation to modification of fluids.
- The registered person must ensure that systems are introduced to ensure that the environment is suited to patients’ needs. The registered person must ensure that staff are provided with sufficient information about newly admitted patients so as to be able to provide safe and effective, care.
- The registered person must ensure that the social interaction of patients is considered on a daily basis and that staff document clearly their interactions with individual patients within their care records.