Inspectors voiced concerns over Moate nursing home

Nursing home inspectors expressed concerns that a Westmeath nursing home did not meet national quality standards and regulations governing the operation of nursing homes. The concerns were expressed following an inspection on Moate Nursing Home, Dublin Road, Moate, late last year by inspectors from the Health Information and Quality Authority (HIQA) A report of the inspection, published recently by HIQA, included details of the case of one resident with a "grade four sacral pressure sore" in existence for over a year, which was MRSA positive. Inspectors said a grade four sore has been defined as "extensive destruction, tissue necrosis or damage to muscle, bone or supporting structure with or without full thickness skin loss" Inspectors said nursing records relating to the care of the wound and the needs of his resident were "incomplete and inaccurate" and did not meet the nursing home's own healthcare policy on wound management. Interventions outlined in one of two separate wound care plans for the resident were not implemented. The inspectors said they observed the resident being nursed on her back, despite a mobility care plan recommending that this should not take place. Charts recording a position change of the resident every two hours were found to be incorrect as inspectors observed that positions were unchanged when recorded as having been changed. A recommendation reported by a tissue viability nurse in two reports related to upgrading the pressure-relieving mattress had not taken place. The report, compiled following an inspection in October last, found that significant improvements were required in relation to pressure area care and the prevention, intervention and management of pressure ulcers. It pointed out that measures for improvement and prevention of deterioration, such as training and eduction, following four residents developing pressure sores, had not been undertaken. The report also found that incidents were not notified to HIQA as required by legislation. The provider said this was a "misunderstanding" relating to reporting existing conditions and that all notifications had been submitted in a timely manner since the inspection. The report found staff to be welcoming, friendly, well-presented and responsive to residents' requests. Management and staff were aware of the new legislation governing the regulation of centres and staff reported a good team ethos and positive working relationship with the person in charge. The report noted that security at the centre was given a high priority and that the front door could only be opened by staff. The report also praised the choice, quality and presentation of meals. There was evidence of good practice in the provision of social and recreational activities for residents. Residents also informed inspectors that they were consulted about their preferences regarding religious services, the clothes they wore and where they ate their meals as well as the choice of menu. The report also said that there needed to be more centre-specific policies, practices and records and that there were also significant improvements needed in medication management, notification of incidents, complaints procedures, fire precautions and staffing levels and recruitment. An action plan, outlining areas of non-compliance and improvements needed, was published and the nursing home provider, Mowlam Healthcare Limited, was asked to respond to 28 areas where HIQA sought action to be taken. Mowlam Healthcare said it had developed a programme of training surrounding pressure area care. At the time of response, six staff nurses and ten care assistants had attended training sessions. The operators said care planning surrounding tissue viability and pressure area care had been updated and there had been an emphasis on accurate documentation to reflect care given. In-house training sessions were also being developed and would be delivered on a continuous basis while a date was being arranged for the delivery of a more formal program. On March 15 last, Mowlam Healthcare Ltd told HIQA: "This inspection was a valuable learning experience and it is good to see the positive feedback as it recognises the efforts made by each member of staff to ensure the comfort and happiness of each of our residents. "We look forward to working with the Health Information and Quality Authority with a view to improving the quality of service consistently and in line with the Care and Welfare Regulations."