Nursing Home Inspectorate Team HSE – West Finn Valley Centre Co. Telephone: 074-9189084/9189085/9189086 Facsimile: 074 9189067

26th April 2007

Ms. Maud Gray Proprietor Lake House Private Nursing Home Co. Donegal

Inspection Report

Re: Inspection of Lake House Private Nursing Home, Portnablagh, Dunfanaghy, Co. Donegal under the Health (Nursing Homes) Act, 1990 and the Nursing Home (Care and Welfare) Regulations 1993.

Dear Ms. Gray,

The Health Service Executive Nursing Home Inspection Team from a Medical, Nursing and Environmental Health perspective inspected Lake House Private Nursing Home, Portnablagh, Dunfanaghy, Co. Donegal on 6th March 2007.

The inspection commenced at 10am and was completed by 5pm. This inspection was unannounced.

There were 54 residents on this date. The Nursing Home is currently fully registered for 57 residents.

Issues identified in the previous Inspection Report dated 18/07/2006 have been satisfactorily addressed.

Current Inspection

The following issues require your attention and action.

Article: 19.1 In every nursing home the following particulars shall be kept in a safe place in respect of each dependent person:— (f) a record of drugs and medicines administered giving the date of the prescription, dosage, name of the drug or medicine, method of administration, signed and dated by a medical practitioner and the nurse administering the drugs and medicines;

Article: 29 The registered proprietor and the person in charge of the nursing home shall: (a) make adequate arrangements for the recording, safekeeping, administering and disposal of drugs and medicines; (b) ensure that treatment and medication prescribed by the medical practitioner of a dependent person is correctly administered and recorded. Non Compliance: The vast majority of the 52 kardexes examined did not have any errors. However, the following were noted: • To aid compliance with the medication, one kardex had the kardex code for an antibiotic entered for future drug rounds (although not signed). • Two kardexes had recording errors for drugs given on a weekly basis Required Action: The management of the Lake House Nursing Home should ensure that all nursing staff are aware of their responsibilities under Guidance to Nurses and Midwives on Medication management (2003), published by Bord Altranais. Time scale: Immediate

Article: 12 The registered proprietor and the person in charge of the nursing home shall: ( a ) take precautions against the risk of accidents to any dependent person in the nursing home and in the grounds of the nursing home; Non Compliance: The surface temperatures of the radiators in Rooms 1,2 and 5 and in the en- suite bathroom in Room 29 were 52 Degrees Celsius. Required Action: The surface temperatures should be reduced to 43 C. It may be necessary to fit an appropriate temperature limiter to prevent these radiators going above a surface temperature of 43 C. Timescale: Immediate.

Article: 14. The registered proprietor and the person in charge of the nursing home shall:— ( a ) ensure that the nursing home and its curtilage is maintained in a proper state of repair and in a clean and hygienic condition; ( b ) make adequate arrangements for the prevention of infection, infestation, toxic conditions, or spread of infection and infestation at the nursing home; Non Compliance: The covering to the shower hose in the shower room was broken. This was resulting in sharp edges and was also not in a condition that could be effectively cleaned. Required Action: Replace the broken shower hose cover. Timescale: One month.

Non Compliance: The current practice of bringing mop buckets into the sluice room to obtain hot water for cleaning the Rooskey Suite could be an infection risk as these buckets are being taken from the sluice room to all bedrooms and other areas. Required Action: Cease the practice of taking mop buckets into the sluice room for hot water. If necessary use an alternative hot water source or take hot water from the hot water heater boiler in the sluice room in a receptacle and fill the mop buckets in the corridor. Alternatively relocate this hot water heater to another area where its use does not present an infection risk. Timescale: Immediate.

Article: 15. The registered proprietor and the person in charge of the nursing home shall ensure that:— ( a ) there is a sufficient supply of piped hot and cold water and that wash-hand basins are provided in each bedroom; Non Compliance: There was no hot water available for hand washing in the bedrooms or in the toilet facilities on the ground floor Rooskey Wing at the time of inspection. Required Action: Provide an adequate hot water supply at all times. Timescale: One month.

Article: 8. The registered proprietor and person in charge of the nursing home shall ensure that:— ( a ) provision is made for the safe keeping of the personal belongings of a dependent person and a record kept of valuables signed by the person or a person acting on his or her behalf; ( b ) adequate space is provided for a reasonable number of personal possessions. 1.2 In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows:

Article: 1.2 In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows:— ( g ) bed and bedding appropriate to the dependency of each person and suitable and sufficient furniture and other necessary fittings and equipment; Non Compliance: There was only one small wardrobe provided in room no.6 which is a double room. Required Action: A second wardrobe should be provided in Room no. 6. Timescale: One month.

Article: 7.2 In the year following the commencement of the Act, the registered proprietor or person in charge shall execute a contract with a dependent person and/or a person acting on his or her behalf within two months of the admission of that dependent person to the nursing home.

Article: 7.3 Such contract shall deal with the care and welfare of that person in the nursing home and shall include details of the services to be provided for that person and the fees to be charged. Non Compliance: Contracts of care were not executed for residents in contracted beds. Required Action: Contracts of care to be executed for all residents in contracted beds within 2 months of admission to the Nursing Home. Timescale: 1 Month.

The Nursing Home Inspection Team is to notified in writing on or before the above dates indicating the steps taken by the Nursing Home to carry out the actions as required under the Regulations.

Yours sincerely,

______Senior Area Medical Officer Senior Environmental Assistant Director of Nursing Nursing Home Health Officer Nursing Home Inspection Team Nursing Home Inspection Team Inspection Team

Signed counterpart sent to Christine Wasson, Person-in-Charge